Does Anyone Else Hate "Too Smart to be a Paramedic"?

[NYMedic828]

Glad to know it's all in good jest

I just get defensive because I've always wanted to be a paramedic and threads like these that present personal realities that suggest that it's not fulfilling or actualizing of one's potential kinda make me sad :sad:

Really not helping your situation... You need to throw out the delusion of what EMS is to you and realize what it actually is...

 

[VFlutter]

But they are trained BY doctors to be as proficient AS doctors at a few things. And I can tell you, they definitely are.

So what skills are they definitely as proficient as doctors at? Also being able to perform physical skills just makes you a technician as stated earlier.

 

[NomadicMedic]

So what skills are they definitely as proficient as doctors at? Also being able to perform physical skills just makes you a technician as stated earlier.

Just because I give breaking treatments and use a vent, that doesn't make me as proficient as an RT.

I can intubate and decompress a chest. That certainly doesn't make me as proficient as an ER Trauma Doc.

I may know some skills and be deemed competent to perform them. That doesn't mean I have the same education or skill set as a physician or any other specialist. I equate my skill set to that of a plumber or an electrician. I may fix the pipes or wire a doorbell, I'm not trained to draw the plans to build the house. An architect is.

I, like the KCM1 medics, am only a paramedic. Trained to perform very specific skills in very specific situations in order to stabilize and manage patients while they are transported to an Emergency Department, or infrequently, treat and release patients that meet specific criteria.

Paramedics that think they're "as good as doctors" are dangerous and do nothing to develop respect for paramedicine as a profession, rather than just a skilled trade.

 

[medicsb]

The do a great job of resuscitating witnessed VF arrests and then writing press releases about it. .

I'm really only half kidding. Their service is really no more progressive than many others, their culture is one of elitism and exclusion and they provide some of the absolute worst customer service I've ever witnessed. Oh yeah, they turf a lot of stuff to BLS. I don't know if its because they're lazy, overworked or just know they can get away with it...

(And yes, I worked in King County as a BLS provider both before and after medic school. I worked with those medics every day. My opinions of KCM1 are based on what I witnessed.)

Other than that, they have nice trucks, the education they are provided is nice and the pay is outstanding.

I've always been curious about how they triage to BLS. I've always found it interesting that they have never published any data about the patients that do not go by ALS who were triaged to BLS (either by medics or EMTs). I think that is something that could help guide other systems - who can be safely transported without ALS.

Anyhow, in my opinion, there is plenty that people would make ALS that doesn't actually need to be ALS. When I worked in NJ, ALS was dispatched on about half of all EMS calls (a lot of overtriage as dispatchers didn't have to follow the guide cards) and we generally got recalled anywhere from 40-70% of the time. In my general experience, about 1/3 to half of what we regularly "rode in" didn't need us. I would have gladly turfed those patients to BLS if I didn't have to worry about the medical director raising a stink for turfing a dyspneic patient with normal VS in no distress because she got sent to a tele floor with anemia. I would have gladly turfed plenty of pneumonias, hyperglycemias, pleuritic CP, etc. but couldn't because of the chance that they would get admitted to non general medical floor, which would prompt the medical director send out a nasty-gram.

Anyhow, there is a lot that KCM1 does well for which they deserve credit. (For one, I can't think of one EMS system that does even half the research they do.) Also that PR they generate likely keeps them funded. More EMS systems should do similar. Also, most (say, 98%) of EMS systems probably have too many medics, so KCM1 will always get credit for not diluting their system with unneeded medics. That and research are the two things that all EMS systems should try to emulate.

 

[Aidey]

When he says turf to BLS he isn't just talking about downgrading patients. KCM1 has a very nasty habit of treating things on scene, pulling the interventions and then sending the pt in with a BLS crew. Brilliant idea for allergic reactions and asthma attacks. I have a friend who used to work BLS in King County and she pretty much spits every time someone says their name.

 

[NomadicMedic]

When he says turf to BLS he isn't just talking about downgrading patients. KCM1 has a very nasty habit of treating things on scene, pulling the interventions and then sending the pt in with a BLS crew. Brilliant idea for allergic reactions and asthma attacks. I have a friend who used to work BLS in King County and she pretty much spits every time someone says their name.

Don't forget opiate ODs, altered mental status, assaults with head injuries and chest pain.

One of my last days working in King County, a medic tried to turf a fulminant CHF patient to me. Seriously.

And yeah, I refused to take the patient. That's an ALS call, pal.

 

[Veneficus]

it is 'jack the thread week

I've always been curious about how they triage to BLS. I've always found it interesting that they have never published any data about the patients that do not go by ALS who were triaged to BLS (either by medics or EMTs). I think that is something that could help guide other systems - who can be safely transported without ALS.

Anyhow, in my opinion, there is plenty that people would make ALS that doesn't actually need to be ALS. When I worked in NJ, ALS was dispatched on about half of all EMS calls (a lot of overtriage as dispatchers didn't have to follow the guide cards) and we generally got recalled anywhere from 40-70% of the time. In my general experience, about 1/3 to half of what we regularly "rode in" didn't need us. I would have gladly turfed those patients to BLS if I didn't have to worry about the medical director raising a stink for turfing a dyspneic patient with normal VS in no distress because she got sent to a tele floor with anemia. I would have gladly turfed plenty of pneumonias, hyperglycemias, pleuritic CP, etc. but couldn't because of the chance that they would get admitted to non general medical floor, which would prompt the medical director send out a nasty-gram.

I read a study years and years ago done by an anesthesiologist in Virginia who was a prior medic about EMS ability to determine which patients were likely to be admitted to the hospital.

That doesn't come a a surprise to me because at no point in my EMS education was I told who would be addmited or why.

I have seen a handful of studies over the years showing that while many patients transported to the ED by ambulance did not need acute care, they did need primary care and may have been admitted for such.

I think it was a misunderstanding on the part of your medical director to give you grief on that.

I also think we need to perhaps redefine what the role of EMS is.

If it is a service only dedicated to acute emergencies, then we will need something to handle everything else to preserve and best utilize this resource.

If it is going to be "an extension of the ED" which fulfils the role of not only acute care, but entrance into the health system for many, then education and procedures for that will need to be included.

 

[Veneficus]

Of course, they're not doctors, and their certifications reflect that fact. But they are trained BY doctors to be as proficient AS doctors at a few things. And I can tell you, they definitely are..

I can tell you they are definately not.

There is a lot more to being a doctor than a handful of skills and field resuscitation.

Many years ago I believed this same thing of the EMS system I worked in. I simply didn't know what I didn't know.

In terms of enviable EMS systems, Wake county is about the only one in the US I would list. AU/NZ definately make the number 1 spot for EMS in the world in terms of non-physician based EMS, with some European countries rounding out the top 5.

Keep in mind, in the AU/NZ/EU systems, 3000 hours of training would not even be enough for you to legally provide care on an als truck in those places.

King county has identified and as close as possible perfected a very small part of what EMS of today is. They also have made great strides in demonstrating effective EMS in the US in terms of bystander involvement, a small number of ALS providers, and as mentioned research. There is much that they could teach other US EMS, but it is simply not the best or the future of EMS.

I think doctors are required to know a little about a lot (med school) and then a lot about a little (residency).

Not exactly. This is a popular misconception because it is often used comparing an MD/DO to a PhD.

What a doctor is educated in is the principles of basic and clinical science and how to apply that to all patients. (medical school)

Specialty training gives additional knowledge and skills in order to improve upon the base understanding of medical school. While many doctors chopose not to function outside of their given specialty, an unlimited license to practice medicine is just that. Unlimited.

Where I am at is is the dominant philosophy/practice that all doctors must be capable GPs. Only then can they move on to specialty training. They are still expected to maintain competency as a GP.

I just get defensive because I've always wanted to be a paramedic and threads like these that present personal realities that suggest that it's not fulfilling or actualizing of one's potential kinda make me sad :sad:

Reality sucks doesn't it?

As food for thought, how do you know you want to be a paramedic when you don't seem to know what the realities of it are?

That is not meant to be discouraging, on paper I am still a paramedic, but when I started I had the same perception of it you describe. My perception has changed. But still I stay involved.

 

[NYMedic828]

I just get defensive because I've always wanted to be a paramedic and threads like these that present personal realities that suggest that it's not fulfilling or actualizing of one's potential kinda make me sad :sad:

Not a day goes by I don't wish I cared more in high school/college. Could have been a year or two into med school by now had I only known what I really wanted. Instead I'm staring at a dashboard for the next 6 hours.

Psyanotic, I presume you are young, as am I. EMS is not a waste of your time but its obvious you have ambition. More than likely, too much to be satisfied by EMS till you grow old and grey. I urge you to make the right decisions now and reach higher than you planned. If your interest in medicine is genuine and your heart is in it then climb the ladder, don't stop half way.

I hope to return to school in the near future for some higher medical title but who knows maybe my name will eventually end in MD. EMS has allowed me to see and experience things that most doctors/people will never. It isn't a loss but don't take it as a definitive career goal. You are too young and enthusiastic.

 

[VFlutter]

Glad to know it's all in good jest

I just get defensive because I've always wanted to be a paramedic and threads like these that present personal realities that suggest that it's not fulfilling or actualizing of one's potential kinda make me sad :sad:

You should be happy you are finding this out now and not after spending time and money on paramedic school if it is not something you truly want. I thought I always wanted to be a paramedic until I actually got into the field. Personally I could not get over the fact of not having a degree, among other issues.

Nothing is ever as fulfilling as it seems. I was excited to be a nurse and actually take care of patients (instead of just transporting them and dropping them in the ED) until I realized that 80% of nursing is trying to turf gomers to SNFs and hope they don't bounce back anytime soon or watching your oncology patient slowly suffer until they eventually die (never soon enough).

Some people may criticize my attitude but I am glad that I realized this now before I graduate. The ones with the save the world attitude are always the first to burn out. It's good to have a realistic view of how the world actually works.

 

[psyanotic]

sure, they've given us a couple sick patients before, but that changes from.crew to crew. the majority of them end up transporting patients without any clear ALS indicators (at least to me) simply because they're already there.

also note I'm only talking about the south county medics. Seattle, shoreline, etc. m1 are AMR's cup of tea.

 

[abckidsmom]

sure, they've given us a couple sick patients before, but that changes from.crew to crew. the majority of them end up transporting patients without any clear ALS indicators (at least to me) simply because they're already there.

also note I'm only talking about the south county medics. Seattle, shoreline, etc. m1 are AMR's cup of tea.

Let's shift our focus back to the topic at hand, what happens to the brightest medics. Further discussion of behaviors of specific agencies in this thread is not acceptable.

 

[MexDefender]

From what I've gathered it's something the elders have stumbled upon and people who join as first career get verbally assaulted by the older crew for even wanting to do for your entire life. You're too green - a over said burnout response reserved for burn outs and the unchangeable. The reason one would say this is because of the education needed for you to become one back in the day, it has become better in time but many still believe it to be a undereducated course (paramedic) only when you learn to think like the cynic/burnout/experienced narrow minded paramedic will you become a respectable ems provider in their eyes. Being green until you see THE LIGHT they see but we "greenhorns" will only be able to in time and experience. These people are what hurt the service and keep it in the unchanged broken system it is.

Too smart, too green, too this or that, it's all annoying and sad to see. I smile and agree so I don't have to deal with the egos that rule this field.

 

[Veneficus]

From what I've gathered it's something the elders have stumbled upon and people who join as first career get verbally assaulted by the older crew for even wanting to do for your entire life. You're too green - a over said burnout response reserved for burn outs and the unchangeable. The reason one would say this is because of the education needed for you to become one back in the day, it has become better in time but many still believe it to be a undereducated course (paramedic) only when you learn to think like the cynic/burnout/experienced narrow minded paramedic will you become a respectable ems provider in their eyes. Being green until you see THE LIGHT they see but we "greenhorns" will only be able to in time and experience. These people are what hurt the service and keep it in the unchanged broken system it is.

Too smart, too green, too this or that, it's all annoying and sad to see. I smile and agree so I don't have to deal with the egos that rule this field.

I am not so sure this is always the case. I have had coworkers, even mentors tell me I needed to get out of EMS because I could make a bigger difference somewhere else.

These were not burnout old coots, these guys were the best of the best of some extremely respectable agencies.

One of the things that never changes in EMS is that when the older guys (gals, whatever) try to push people to move on, because they have not so much seen the light, but have seen the forest from the trees, there is always a pushback from the idealistic new persons.

These new people work very hard with tremendous dedication to fight the good fight before becomming one of those guys trying to get young guys not to make the same mistakes they did or have to settle for being less than what they are.

I will agree there are many burnt out people in EMS who are just disgruntled in all respects.

However, this topic is not news. EMS has been losing its best and brightest for all of my career.

The reason hasn't changed either.

There are organizations and advocates who benefit from EMS not progressing into a profession. Thier money, power, and very job depend on it.

So I will echo the advice I was given...

Get your experience and get out. Move on to where you can really make a difference.

The younger you are, the easier it is. But it is never too late.

to steal a quote that wasn't on Youtube.

"We are both pawns in the same great game. But I escaped! So can you..."

 

[VFlutter]

I remember we had a short answer question on the pediatric exam asking "What is the clinical signfiicance of grunting in infants." My response "The infant is breathing against a partially closed glottis to produce PEEP and promote gas exchange." It was origonally marked wrong until my instructor asked me to explain my answer to him and at the end told me to keep it simple and just put difficulty breathing next time.....

 

[shfd739]

One of the things that never changes in EMS is that when the older guys (gals, whatever) try to push people to move on, because they have not so much seen the light, but have seen the forest from the trees, there is always a pushback from the idealistic new persons.

These new people work very hard with tremendous dedication to fight the good fight before becomming one of those guys trying to get young guys not to make the same mistakes they did or have to settle for being less than what they are.

We have a few young people that want to make a difference and have the dedication to hang around long enough to see it happen. Hopefully they make it as I see them being able to do it. These folks love EMS enough and dont want to be anything else. They also want to see their coworkers step it up. I hope the system doesnt burn them before they can make a difference.

Now Im pushing myself and some others to move on while we're still young enough to.

Its been 11 years of playing this game and I dont care to hang around long enough for it to change. I want more for myself.

 

[sir.shocksalot]

We have a few young people that want to make a difference and have the dedication to hang around long enough to see it happen. Hopefully they make it as I see them being able to do it. These folks love EMS enough and dont want to be anything else. They also want to see their coworkers step it up. I hope the system doesnt burn them before they can make a difference.

Now Im pushing myself and some others to move on while we're still young enough to.

Its been 11 years of playing this game and I dont care to hang around long enough for it to change. I want more for myself.

I can't count how many times I have seen this happen, heck it described me perfectly a year or two ago. A rookie EMS provider gets through a tough paramedic program and has this idealistic view that all EMS providers have the same desire for excellence and continuing clinical education that they do only to find that they are very alone. They push others to step up and better themselves for the sake of their patients and their profession, only to get pushed back and told nonsense like: "We aren't doctors", "I just did this to get a fire job", "You don't need to know THAT much A+P to be a good paramedic", and the excuses go on and on. Eventually said provider gets burned out trying to change things, or not being rewarded for their hard work as a clinician and moves on to a profession that will value their attitude and drive.

The fire department, private EMS, and volunteer agencies have lots of money invested in keeping EMS easy and simple. The efforts one individual are unlikely to change a system where money and time is put in to keep it as a non-profession. If you are smart enough to go back to school and get a degree that will get you somewhere, I doubt you will find much fulfillment out of an EMS career. It's not that you can't challenge yourself and become a phenomenal paramedic, it's just that you will never receive any professional recognition for excellence in clinical care. I have never heard of one person getting promoted because they were a "good paramedic", they get promoted for political reasons or "time in grade" reasons. We have created a career where we burn out and push out the best among us, and I don't see this changing.

 

[shfd739]

I can't count how many times I have seen this happen, heck it described me perfectly a year or two ago. A rookie EMS provider gets through a tough paramedic program and has this idealistic view that all EMS providers have the same desire for excellence and continuing clinical education that they do only to find that they are very alone. They push others to step up and better themselves for the sake of their patients and their profession, only to get pushed back and told nonsense like: "We aren't doctors", "I just did this to get a fire job", "You don't need to know THAT much A+P to be a good paramedic", and the excuses go on and on. Eventually said provider gets burned out trying to change things, or not being rewarded for their hard work as a clinician and moves on to a profession that will value their attitude and drive.

The fire department, private EMS, and volunteer agencies have lots of money invested in keeping EMS easy and simple. The efforts one individual are unlikely to change a system where money and time is put in to keep it as a non-profession. If you are smart enough to go back to school and get a degree that will get you somewhere, I doubt you will find much fulfillment out of an EMS career. It's not that you can't challenge yourself and become a phenomenal paramedic, it's just that you will never receive any professional recognition for excellence in clinical care. I have never heard of one person getting promoted because they were a "good paramedic", they get promoted for political reasons or "time in grade" reasons. We have created a career where we burn out and push out the best among us, and I don't see this changing.

You nailed it my friend. So many of my coworkers are using this as a stepping stone to fire or because it's easy compared to doing an RN program. The ones that will stay see no reason to improve themselves and follow protocols like a bible.

As we try to push things forward it gets nowhere. Our newly promoted FTO has barely 2 years experience as a medic, no critical care transport experience, is still learning as a clinician and asking the more experienced ones what to do. Im supposed to have this person looking over my care? Not. So much for someone to push care forward when they arent even sure what to do.

It's like we took 2 steps back. The experienced/older ones of us that do care have been burned trying to make a difference so we are done. Time for the next group to try. I wish them luck. Sadly some are seeing how difficult it will be and are second guessing if it's possible.

 

[JPINFV]

I wonder if the only real solution is to create little fiefdoms of meritocracy, high standards, and high pay. Then make it a "want to play with the big boys? Step it up."

Unfortunately, the only way I see system wide change is for a private organization to do it where they can start absorbing and taking on contracts. The problem with places like Wake County is that they're bound by political boundaries, thus limiting their impact on the industry as a whole.

 

[shfd739]

I wonder if the only real solution is to create little fiefdoms of meritocracy, high standards, and high pay. Then make it a "want to play with the big boys? Step it up.".

For the most part I like this.

Makes me think of Australia where if you want to play you have to have the schooling. And are rewarded for it pay wise and system wise.

Whereas in the US you can go to school, get the knowledge, have the EMS degree but it wont pay you any better or get you any further ahead.

There is no reward/incentive for making yourself a better medic and if you wanna spend the time on school might as well make it count for something- which means switching to another field.