Eager to Learn

[chaz90]

I don't think that it's a requirement, but IMO it can help and does shorten the learning curve. I worked as a basic on a 911 truck for three years, and I feel it absolutely helped me in becoming a medic. Feeling comfortable with interviewing patients, running calls, and managing scenes is something I was grateful I didn't have to learn at the same time as the paramedic portion. This is by far the more valuable experience than the 120 hour class. YMMV. As you stated, I know many outstanding paramedics that weren't a basic first, but I've also seen some that I think may have benefited from the EMT experience before diving into the deep end. It all depends on the individual, and perhaps more importantly, what kind of experience the EMT is getting.

 

[Ace 227]

Was replying to a reply to Christopher. My bad. Forgot to click "quote".

My fault. Carry on.

 

[STXmedic]

Maybe that's an "in my area"-thing. It's something that's preached on around here. "You can't be a good medic without being a good basic first" Idea being that BLS should always come before ALS. Every patient doesn't need drugs and electricity. Sometimes simply opening an airway does wonders -I'm sure you're aware. I didn't say basic skills are difficult. I did say I was in a great EMT and currently finishing a great paramedic program. I am a good EMT and take offense to your statement that I should find a new line of work because I believe in field experience. You can assess as many patients in basic class scenarios as you want, but nothing compares to assessing an actual patient. And that can only happen with experience. Sure, you get experience in medic class, but you should have experience before going in, too.

Please show me in my post where I singled you out as needing to find a new line of work. Also, that statement was not targeting your belief for needing experience first.

The "skills" a basic performs is not something that takes years (or a year) to master. If they do, you may want to find a new line of work.

Please, allow me to paraphrase: If it takes you years to become proficient in taking vitals and holding c-spine, prehospital medicine may not be for you. I stand by my original statement. Again, this is not directed at you, so there is no need to take offense.

I've heard that mentality preached down here as well. I now run circles around the medics that preached that BS to me.

If you can find somewhere to get good, quality experience (not dialysis derby and discharges all day) then by all means, especially if you feel uncomfortable with the idea of being in charge or making decisions. However, for most I don't see it necessary.

 

[VFlutter]

I am a good EMT and take offense to your statement that I should find a new line of work because I believe in field experience.

If it takes a person a year of experience to become a competent EMT then something is seriously wrong. The EMT skill set is simple and requires very little education. What do you think is so difficult that a person should work years to master before going to paramedic school?

Sure experience helps but I think you are overestimating by how much. If a paramedic class had half its students who worked previously as EMTs and half who did not I am willing to bet that they would all be at the same level upon graduation. Sure the previous EMTs may have an advantage in the beginning but that advantage will quickly fade as the class progresses.

I never worked as a Nurse Assistant does that mean that I can not be a good Nurse? Arrogance aside, I am an exceptional RN and run circles around my fellow new grads most of whom were techs for years before going back to school. But N=1

I've heard that mentality preached down here as well. I now run circles around the medics that preached that BS to me.

I was already typing my reply before you responded. Don't want to steal your line h34r:

 

[Lola99]

Please show me in my post where I singled you out as needing to find a new line of work. Also, that statement was targeting your belief for needing experience first.


Please, allow me to paraphrase: If it takes you years to become proficient in taking vitals and holding c-spine, prehospital medicine may not be for you. I stand by my original statement. Again, this is not directed at you, so there is no need to take offense.

I've heard that mentality preached down here as well. I now run circles around the medics that preached that BS to me.

If you can find somewhere to get good, quality experience (not dialysis derby and discharges all day) then by all means, especially if you feel uncomfortable with the idea of being in charge or making decisions. However, for most I don't see it necessary.

I'm glad you run circles around those medics. I know plenty of fantastic medics that believe that and can't believe anyone would argue it, honestly. Basics work all the 911 around here. For at least the 75mile radius I'm very familiar with. I am absolutely comfortable with being in charge and making decisions or I wouldn't be an EMT in the field, but that doesn't mean experience wasn't invaluable to me as a soon-to-be medic. That doesn't mean I am or was a bad EMT. I'm not. This discussions is going nowhere though, so I'll bid you a good night here.

 

[Lola99]

If it takes a person a year of experience to become a competent EMT then something is seriously wrong. The EMT skill set is simple and requires very little education. What do you think is so difficult that a person should work years to master before going to paramedic school?

Sure experience helps but I think you are overestimating by how much. If a paramedic class had half its students who worked previously as EMTs and half who did not I am willing to bet that they would all be at the same level upon graduation. Sure the previous EMTs may have an advantage in the beginning but that advantage will quickly fade as the class progresses.

I never worked as a Nurse Assistant does that mean that I can not be a good Nurse? Arrogance aside, I am an exceptional RN and run circles around my fellow new grads most of whom were techs for years before going back to school. But N=1



I was already typing my reply before you responded. Don't want to steal your line h34r:

The least I've seen required (or recommended, I believe was how some worded it) to apply for a medic program is 1 year. The majority 2. Like I said, maybe it's my area. But I've never heard anyone preaching jumping from EMT straight to medic is better than getting field experience first. Once again, I never said anything basic is difficult. I never said someone needs field experience to master EMT skills. They're easy. We all know that. But you should get field experience because it's that -experience. Experience working calls, assessing actual patients, learning to lead efficiently, seeing all the crazy things we see. Can it be done in a year? Absolutely. But in my opinion (and to be honest, I've never been in a situation where this wasn't the majority opinion) I think you should spend some more time as a basic before jumping into medic. Agree or not, that's your opinion. This is mine.

 

[JPINFV]

There is no benefit from EMT experience that can't, and shouldn't, be fixed with an appropriately long clinical and field internship period.

As a medical student, I learned to do medicine assessments on my internal and family medicine rotations. I learned to do surgical assessments on my surgery rotation. I learned to do psychatric assessments on my psych rotation. I learned to do gyncological and obstetrical assessments on my OB/Gyn rotation. I learned how to do pediatric assessments on my pediatric rotation.

How? By being pointed in the direction of a door with a patient in it (real patients) and told to go in there. If I ended up going back and forth 2 or 3 times between the attending physician and the patient's room, than so be it. However, by the end of those 4 week (full time... I spent 90 hours in the hospital my first week on surgery) I had no issue interviewing surgical patients, gyn patients, medicine patients, etc.

Supervised experience working at the level you're training for >>>>>> experience at a lower level. It's also the same reason we don't have fluff courses like medical terminology. Don't know what that word that's being used 20 times in a lecture is? That's what Google is for. However, by constantly using appropriate terminology in an actual conversational setting, you learn it better. I know my Spanish has definitely improved over the past 10 months, despite it being almost a decade since my last Spanish course.

 

[Lola99]

There is no benefit from EMT experience that can't, and shouldn't, be fixed with an appropriately long clinical and field internship period.

As a medical student, I learned to do medicine assessments on my internal and family medicine rotations. I learned to do surgical assessments on my surgery rotation. I learned to do psychatric assessments on my psych rotation. I learned to do gyncological and obstetrical assessments on my OB/Gyn rotation. I learned how to do pediatric assessments on my pediatric rotation.

How? By being pointed in the direction of a door with a patient in it (real patients) and told to go in there. If I ended up going back and forth 2 or 3 times between the attending physician and the patient's room, than so be it. However, by the end of those 4 week (full time... I spent 90 hours in the hospital my first week on surgery) I had no issue interviewing surgical patients, gyn patients, medicine patients, etc.

Supervised experience working at the level you're training for >>>>>> experience at a lower level. It's also the same reason we don't have fluff courses like medical terminology. Don't know what that word that's being used 20 times in a lecture is? That's what Google is for. However, by constantly using appropriate terminology in an actual conversational setting, you learn it better. I know my Spanish has definitely improved over the past 10 months, despite it being almost a decade since my last Spanish course.

Right. I've done my paramedic clinical hours in those parts of the hospital, too. And they're great. Yes, you get experience during medic class. Yes, yes, yes. Again.
I still believe it is beneficial to the student to be proficient (including field experience) in those assessments before their paramedic program and add their new paramedic knowledge to their assessment during class.
You will never convince me that most people wouldn't benefit from field experience prior to their paramedic program. Why would having more experience NOT be a good thing?
I still stand by my statement that you have to be a good basic before you can be a good medic. I never said you must have 1+ years' experience working as a good basic to be a good medic. I just said that you have to be a good basic. If you're a good basic the minute you pass cert tests, good for you. You should be a good basic.
But being a good basic and having experience working as one are two different (though related) things.

 

[STXmedic]

Ever thought of just being a good provider? A good provider doesn't have to break it down into basic and advanced. Know what the patient needs, and do it. Basic, intermediate, advanced, it doesn't matter. Never do I think "what basic skills do I need to apply to this patient. Okay, now what advanced skills." No. Understand what's going on, and fix it. A paramedic should (emphasis on should) be able to do this more effectively than an EMT. There is no need for basic and advanced.

 

[JPINFV]

Right. I've done my paramedic clinical hours in those parts of the hospital, too. And they're great. Yes, you get experience during medic class. Yes, yes, yes. Again.

Were you doing appropriate assessments and presenting your findings and treatment plan to a physician or just watching other people work while doing tech chores like hooking up monitors and starting IVs? We had paramedic students on L&D. They weren't the ones doing the physical exams and presenting to the residents (since the hospital I rotated through had an OB/Gyn residency).

I still believe it is beneficial to the student to be proficient (including field experience) in those assessments before their paramedic program and add their new paramedic knowledge to their assessment during class.
You will never convince me that most people wouldn't benefit from field experience prior to their paramedic program.

Do you have to be a CNA to become an RN? No.

Do you have to be a PA to become a physician? No.

Do you have to be a... I guess CNA... to become an RT? No.

What's defective about paramedic education that you need experience as an EMT first? What makes EMS different?

Why would having more experience NOT be a good thing?

More time to learn bad habits.

Being forced to unlearn thought patterns as expectations change and your fund of knowledge and scope of practice increases.

Lost potential income.

 

[Lola99]

Ever thought of just being a good provider? A good provider doesn't have to break it down into basic and advanced. Know what the patient needs, and do it. Basic, intermediate, advanced, it doesn't matter. Never do I think "what basic skills do I need to apply to this patient. Okay, now what advanced skills." No. Understand what's going on, and fix it. A paramedic should (emphasis on should) be able to do this more effectively than an EMT. There is no need for basic and advanced.

You're right. That is how it should be. No one said anything about thinking what basic interventions a patient may need vs. advanced ones. I know what you were trying to say. I think maybe you misunderstood what we were discussing.
On scene, a medic should absolutely just see what needs done and do it. I still believe "BLS before ALS" is a fair thought process, too. But when talking about things you can do to prepare yourself before jumping into a paramedic program, I think experience is the most important. Experience should (SHOULD) shape a person into a good basic if they make the most of it. And before you can be great at ALS skills/knowledge, you need to 100% understand the basics. That's all.

Note: When I say "BLS before ALS", understand that I don't mean you should go on a call worrying about whether you're performing advanced interventions or basic. That's irrelevant at that point, so long as you're properly providing the care your patient needs. I mean you should go on a call and if BLS is sufficient in caring for your patient, that's what they get. There's no need to ALS them if BLS will appropriately meet their needs.

 

[VFlutter]

And before you can be great at ALS skills/knowledge, you need to 100% understand the basics. That's all.

Except EMT class does not teach you the basics of ALS knowledge. It is so over simplified that is almost detrimental for future education. If you ever take an advanced college course you will realize that half the battle is trying to forget all the crap you thought you knew or were taught wrong.

 

[Lola99]

Were you doing appropriate assessments and presenting your findings and treatment plan to a physician or just watching other people work while doing tech chores like hooking up monitors and starting IVs? We had paramedic students on L&D. They weren't the ones doing the physical exams and presenting to the residents (since the hospital I rotated through had an OB/Gyn residency).

Absolutely assessing my patients both in the hospital and on the ambulance during clinicals and performing the necessary interventions. In the ER, we did IV's, blood draws, 12-leads, meds, yes. We also had nurses to supervise. We would carry out everything they needed for a patient (within paramedic scope). They supervised assessment and would add things when necessary, we monitored the patient and reported our findings, We would discuss what we thought was going on and what our treatment would be and they would provide feedback and direction. We had the opportunity to speak with at least 2 ER Dr's on any shift about any patient any time we wanted to. (You'd be crazy not to take advantage of that, and we did.) Occasionally, a code would come in and docs would allow students to intubate, lead, work thel monitor, etc.
In the OR, we performed supervised intubations, like any program.
In L&D, we sat in on c-sections, assessed and monitored newborns, and yes, delivered them, too.
In ICU, and peds, similar situation. We did everything within medic scope that needed done under direct supervision.

What's defective about paramedic education that you need experience as an EMT first? What makes EMS different?

Fair point, but I don't think it should be considered a negative thing to have experience first, by any means.

More time to learn bad habits.

So a medic with 1-year of experience is superior to a 20-year vet because they've had more time to develop bad habits?

Being forced to unlearn thought patterns as expectations change and your fund of knowledge and scope of practice increases.

In every medic program in my area, being a basic is a prerequisite to taking the paramedic program. I believe this is true everywhere. Correct me if I'm wrong. Do you think, then, that it would be better to jump directly into paramedic rather than going through basic first? To avoid having to "unlearn thought patterns"?

Lost potential income Amen..

 

[Lola99]

Except EMT class does not teach you the basics of ALS knowledge. It is so over simplified that is almost detrimental for future education. If you ever take an advanced college course you will realize that half the battle is trying to forget all the crap you thought you knew or were taught wrong.

I agree that EMT class is oversimplified, but it is still the foundation. Basics effectively serve a purpose using the information and skills presented to them in EMT class. I don't agree that EMT class doesn't teach the basics of ALS knowledge, however. Maybe you'd like to elaborate on that point and we can discuss it? Maybe we mean two different things?
I have taken plenty of advanced college courses. I've never been in a situation where I had an issue learning new information because of poor prior instruction -and absolutely not in my EMS classroom experience. I had a fantastic basic instructor and equally fantastic paramedic instructors. Of course there were some things I had to adjust to, but I can't say that prior knowledge ever held me back.

 

[JPINFV]

In the OR, we performed supervised intubations, like any program.

So no pre-op anesthesiology assessments? Discussing airway options, indications of a difficult airway, etc?

In L&D, we sat in on c-sections, assessed and monitored newborns, and yes, delivered them, too.

So no obstetrical assessments when the expecting mothers first showed up on L&D?

So a medic with 1-year of experience is superior to a 20-year vet because they've had more time to develop bad habits?

Apples and oranges. A medic with 1 year experience as a medic is superior to a medic with zero years experience as a medic and 1 year experience as an EMT.

A medic with 20 years experience as a medic is going to be superior, to the medic with 19 years experience as a medic and 1 year experience as an EMT.

Why is this argument never made with equal number of years experience? Why is it always the fresh out the gate medic being compared to the one with 20 years of EMS experience... with that experience never being broken down?

In every medic program in my area, being a basic is a prerequisite to taking the paramedic program. I believe this is true everywhere. Correct me if I'm wrong. Do you think, then, that it would be better to jump directly into paramedic rather than going through basic first? To avoid having to "unlearn thought patterns"?

Provided paramedicine pulls their heads out of their rear ends and looks at something besides "how can I get through school the fastest", then yes. It's better to jump into paramedic directly. You don't need to think of "ALS" or "BLS" because it's all paramedicine. There's no "as an EMT we did ____" while failing to take into account the greater fund of knowledge, assessment scope, and treatment scope of paramedics when compared to EMTs. Things are different when all of a sudden that lights and sirens altered mental status patient becomes a patient who AMAed on scene after having his glucose repleted.

 

[Lola99]

[/B]
So no pre-op anesthesiology assessments? Discussing airway options, indications of a difficult airway, etc?
So no obstetrical assessments when the expecting mothers first showed up on L&D?

Yes, we assessed those patients, too. Yes, we discussed airways and had plenty of access to anesthesiologists before, during, and after the actual intubation should any questions arise outside of their instruction. We spent PLENTY of time with expecting mothers assessing, monitoring, and caring for them prior to delivery (and post-delivery, as well.) Of course we assessed our patients. OF COURSE we did.

Apples and oranges. A medic with 1 year experience as a medic is superior to a medic with zero years experience as a medic and 1 year experience as an EMT.

A medic with 20 years experience as a medic is going to be superior, to the medic with 19 years experience as a medic and 1 year experience as an EMT.

Why is this argument never made with equal number of years experience? Why is it always the fresh out the gate medic being compared to the one with 20 years of EMS experience... with that experience never being broken down?

I suppose I could have clarified. I meant a provider with one year of experience as a paramedic (post-EMT), then 20 years as a paramedic post-EMT. I was only applying your logic.
Although on a side note you seem to be of the opinion that someone with more total experience in EMS will be superior to someone of the same certification level or licensure, but less total experience. Yes? Or did I just read too much into that? Out of curiosity.

Provided paramedicine pulls their heads out of their rear ends and looks at something besides "how can I get through school the fastest", then yes. It's better to jump into paramedic directly. You don't need to think of "ALS" or "BLS" because it's all paramedicine. There's no "as an EMT we did ____" while failing to take into account the greater fund of knowledge, assessment scope, and treatment scope of paramedics when compared to EMTs. Things are different when all of a sudden that lights and sirens altered mental status patient becomes a patient who AMAed on scene after having his glucose repleted.

The "how can I get through medic school the fastest" mindset frustrates me to no end. That we can agree on.
Say we allowed jumping straight into paramedic - that would not eliminate basics (advanced, intermediate, whathaveyou). Or do you have other thoughts on the different levels in EMS, as well? And I ask that because there would still be a need to think BLS/ALS. Not in terms of "how do I treat this person? If I start an IV, I have to ALS them", but in terms of "can a basic handle this or do I need to care for this patient?"
Again, I'll say that I don't agree that having EMT knowledge prior to paramedic hinders learning as a paramedic in any way, but for the sake of my curiosity and this discussion...

 

[Christopher]

So a medic with 1-year of experience is superior to a 20-year vet because they've had more time to develop bad habits?

Since Kelly Grayson isn't here to steal his own thunder, I'll paraphrase his paraphrasing of a paragraph from somebody...

I'd much rather have the medic with 1 year of good experience than a veteran who repeated 1 year of experience 20 times.

The issue is not that you did well by spending extra time as an EMT. I'm a huge advocate for "basic" level procedures and the importance of knowledgable BLS providers (you'll find no bigger advocate for EMT's).

The issue is the assumption that this actually helps you be a good Paramedic.

I stand behind my statement that the only reason field experience as an EMT or EMT-I would help in a Paramedic program is if the program has a really poor didactic or clinical process.

If what you're actually saying is 1200 hours is not enough to be a "good" Paramedic, you'll find we're all on your side. Just don't focus so much on the field experience, your preceptors can round out whatever rough edges you still have left after school.

Hairless monkeys are taught to start IVs every day. Focus on education, not on On-the-Job-Training.

 

[Lola99]

Since Kelly Grayson isn't here to steal his own thunder, I'll paraphrase his paraphrasing of a paragraph from somebody...

I'd much rather have the medic with 1 year of good experience than a veteran who repeated 1 year of experience 20 times.

The issue is not that you did well by spending extra time as an EMT. I'm a huge advocate for "basic" level procedures and the importance of knowledgable BLS providers (you'll find no bigger advocate for EMT's).

The issue is the assumption that this actually helps you be a good Paramedic.

I stand behind my statement that the only reason field experience as an EMT or EMT-I would help in a Paramedic program is if the program has a really poor didactic or clinical process.

If what you're actually saying is 1200 hours is not enough to be a "good" Paramedic, you'll find we're all on your side. Just don't focus so much on the field experience, your preceptors can round out whatever rough edges you still have left after school.

Hairless monkeys are taught to start IVs every day. Focus on education, not on On-the-Job-Training.

I've come to the conclusion through this thread that you're right. One year is probably good enough experience at a minimum, but I still don't believe you should jump straight into paramedic with no field experience as a basic first. \
One year is okay, I still think more than one would be beneficial, but not necessary.
I suppose we'll have to agree to disagree.

 

[Sublime]

I've come to the conclusion through this thread that you're right. One year is probably good enough experience at a minimum, but I still don't believe you should jump straight into paramedic with no field experience as a basic first. \
One year is okay, I still think more than one would be beneficial, but not necessary.
I suppose we'll have to agree to disagree.

Going to add myself to people on here that disagree with the "must have EMT-B experience prior to working as a medic". I am one of those who now works as a medic in a 911 system and had no 911 experience as a basic prior to working here. Granted I did work in a hospital, particularly a busy level 1 trauma center before coming here as a medic, but I know those who didn't have that experience either and do fine now.

What do you think clinicals are for? Why does every 911 service have an FTO period? Why do 911 services (all the ones I know of) have a "secondary" medic position?

Waiting for basic experience prior to going to medic school is a waste of time.

 

[Ace 227]

As a follow up, I just received my copy of Walraven's Basic Arrhythmias($6 well spent!) and I'm wondering if anyone has any advice for going through the text since they claim it to be a "self-teach" program. Thanks!