EMT-B to EMT-P... A Bad Idea?

[Jon]

We'll give this another shot. I'm going to open the thread again.
If we have to close it again - there will be infractions issued.

Well... I see both sides of this - If the program is designed well... you don't need experience. If the program is designed to accommodate the student who's been working as an EMT for a while, likely with some contact with ALS providers... the student with no experience seems to have a tougher time. It can be a lot, all at once.

 

[JPINFV]

If the program isn't designed to accommodate the student who's been working as an EMT for a while, likely with some contact with ALS providers... the student with no experience seems to have a tougher time. It can be a lot, all at once.

Welcome to college, graduate, and professional school. Medical school has a lot of material quickly (try taking histology and biochemistry at the same time), but few schools require undergrad biochem and fewer require cell biology. It's been a long time since I've been in an EMS classroom, but for my own sanity, I hope that EMS students don't need to be spoon fed every little detail.

 

[Akulahawk]

We'll give this another shot. I'm going to open the thread again.
If we have to close it again - there will be infractions issued.

Well... I see both sides of this - If the program is designed well... you don't need experience. If the program isn't designed to accommodate the student who's been working as an EMT for a while, likely with some contact with ALS providers... the student with no experience seems to have a tougher time. It can be a lot, all at once.

Believe it or not, I actually have a similar view on this.

If a Paramedic Program is designed to incorporate all the skills at the EMT level and provide sufficient experience performing those skills that then becomes a SOLID foundation to build ALS upon, I have zero problems with that type of school.

Some Paramedic programs require that their students arrive with some prior experience. The idea behind those schools is that someone else trained their student to do BLS, so all they have to do is verify the knowledge and skills of the EMT and get into the teaching of Paramedicine.

Preceptors that primarily work with the 2nd type of school do NOT want to have to teach their students how to be an EMT. Preceptors who primarily work with the 1st type of school are able to work with their students and teach them how to do all the skills and integrate all the knowledge along the way.

Both types of schools can turn out quality Paramedics... but the person who is most responsible for the quality is the student.

 

[Akulahawk]

Welcome to college, graduate, and professional school. Medical school has a lot of material quickly (try taking histology and biochemistry at the same time), but few schools require undergrad biochem and fewer require cell biology. It's been a long time since I've been in an EMS classroom, but for my own sanity, I hope that EMS students don't need to be spoon fed every little detail.

Medical School also exposes the Medical Student gradually to patients. The student isn't expected to be able to diagnose and treat extremely complex patients on the first day they're sent out to begin their clinical time, as might be expected of an attending... Yes, the amount info presented to you is great, and much like trying to sip from a 2.5" line...

I suspect that as you reach your PGY-2/3 years, you're likely going to feel like all those Med Students under your tutilage need to be spoon-fed...

 

[Achromatic]

And then you have the 'odd one out' situations that no-one's blanket statements will be able to cover.

Take me, for example. I'm an EMT-B student, who has, as I've stated, no misunderstandings about the fact that when I finish my training, I will be qualified to give Basic. Life. Support.. What's more, I even work as a volly (quelle horreur!).

So, some might say "you don't have enough knowledge to know whether what you're doing is the best thing for the patient under the circumstances" (the 'raise the bar' refrain, which I actually happen to agree with). What do you do then when I tell you that I went through medic(al) school? Actually, that's not quite accurate, I did biomedical science in Australia.

For those not in the know, medicine in Australia used to be exclusively an undergraduate degree (albeit a six, then five year one). Around 15 years ago, the biomedical science course was introduced, similar, but not identical, to a more U.S. system of "pre-med", with post-grad medicine as an option.

So I have no experience in the field at the moment, and I got no practical medicine experience (no rounds, etc) at school.

But while many are assured and confident in the belief that an EMT-B couldn't possibly know (as a great generalization) "just how much they don't know", a brief list of my studies: biomedical chem, cells tissues and organisms, medical biophysics, human neurobiology, molecular biology, A&P, biochemistry in human function, body systems, genetics, microbes in health and disease, bioinformatics, molecular medicine and biotech, biomedical basis of disease, nutrition, embryology, immunology, and pharmacology. Assumption, as they say ...

`Tis sad to see something that we can all agree on, I believe (after all, who would argue that less education is a good thing), be such a source of tumult.

 

[JPINFV]

Just checking. You do know what an outlier is and how it affects statistics, right? Sure, I'm still an EMT-B (at least according to the State of Massachusetts and the NREMT), but I don't consider the body of knowledge that I work off of to be the standard body of knowledge that other basics are working from. In terms of EMT-Bs, we're high end outliers and you don't make policy off of the high end outliers.

 

[Achromatic]

Just checking. You do know what an outlier is and how it affects statistics, right?

Touche. Hence the "as a great generalization" qualifier, but yes, to be clear - I am by no means living under the misapprehension that your average EMT-B student has the education that you or I do

That being said, I've been surprised within my EMT-B class by the number of questions asked of our instructors that far exceed the "body of knowledge" specified or required.

"All generalizations are evil. Including this one."

You aren't required to become a PA to become an MD, nor an LPN to become an RN, so many wonder why "EMT-B to become EMT-P", but that analogy conveniently ignores that you don't walk into med school off the street (although as I pointed out in my original post, medicine is still an undergrad degree in Australia, but with structured pre-reqs). Those that require a year of experience as an EMT-B, I believe, have a lot to do with the concern over the "lack" of education you receive in EMT-B school. You want someone who meets a pre-req body of knowledge. 120 hours and a 70% on the NREMT has a lot of scope for inadequacy, so the presumption (and the validity thereof is another argument altogether) is that this, combined with you being able to provide care for a body of patients (and from all I've seen with this pre-req, the number of patient contacts is required, sometimes with a breakdown, just to be sure your 'one year of experience' isn't 'I vollyed 8 hours a month in a far rural region that had 100 BLS calls per annum') for a period of time without being fired, dismissed for negligence, etc, etc, is more of an assurance of a baseline knowledge that can then be applied to your training as an EMT-P without having to spend the first week of medic class doing vitals, etc. All of this is of course subject to statistics, deviations, and, yes, outliers.

 

[Akulahawk]

Just checking. You do know what an outlier is and how it affects statistics, right? Sure, I'm still an EMT-B (at least according to the State of Massachusetts and the NREMT), but I don't consider the body of knowledge that I work off of to be the standard body of knowledge that other basics are working from. In terms of EMT-Bs, we're high end outliers and you don't make policy off of the high end outliers.

I think that there are a number of us "outliers" on this forum... which partly accounts for some of the tenor of recent discussions. My own knowledge base is, while not to the level of having gone through Medical School, is quite extensive in it's own right and is far beyond what any garden variety US Paramedic gets. I would put it like this: the more you know, the more you realize what you don't know...

I know a lot... therefore I seek more knowledge.

 

[Achromatic]

I would put it like this: the more you know, the more you realize what you don't know...

I know a lot... therefore I seek more knowledge.

Precisely. I have a thirst for medical knowledge (well, knowledge in general) - trick is knowing what you know and what you don't, and knowing what you can apply, and what you can't (both within a generalized perspective, as well as statutes and protocols).

Most of my biomedical science course ran parallel to the first three years of med school, so we had the same lectures, and like the professor who stood up on the first day said, "Remember this, and remember it well. You're going to get friends, and family, ask you to diagnose them as party tricks, as novelties. You - you ain't a doctor til you have a bit of paper that says you are, and /then/ you'll realize just how much you've got to learn."

I think you've made a good point. A lot of the people here, -B's, -P's, etc, are here because we have a PASSION for this, and an understandable pride. By definition, we are the outliers, and I think that in turn has a lot to do with how personally many people take slights, perceived or otherwise, about education, about superiority or inferiority, when really, most people's belief is that "more education is a good thing", and the debate is "/how/ much more". Because even if you extend things from, say, a 120 hour training course to EMT-B and say "well, no, a 1 or 2 year AAS medic course should be the baseline" (for example - no side fires on whether 1 year is sufficient, or whatever), there's always another step - "Well, what should that AAS cover?", witness the oft-heard complaint about many medic schools lack of A&P, etc.

If someone believes that they will be better rounded by spending some time as a practicing EMT-B before heading to medic school, I think that's great, and any arguments to the contrary should consist of more than vague "more bad habits to un-teach you"-like remarks.

 

[Cory]

Well, my main thing is that private companies don't run emergencies in Cincinnati, but all ff's have to be EMT's. So only paramedics are JUST EMS, and I'm not interested in being a firefighter.

 

[Shishkabob]

It may be my morning induced stupor, but what does that have to do with the conversation at hand?

 

[medic417]

So, I have been reading a lot about getting hired as an EMT, and I know that areas around me have either stopped hring or are making their requirements impossibly high for the majority of people.

Now, yes, I am still far away from even an EMT-B course, but I was just wondering (because as far as I know, I do have the intention to get EMT-P certified some day) Is it a bad idea to go straight from EMT-B class into a medic class? Is it discouraged to go into a medic class without time on a job? For some reason, I get the notion that most people get EMT-B, work as an EMT for a year or two, THEN go to Paramedic class. But in times where EMT jobs are far and few between (I know of a department where I have been told numerous times that I could be hired at when I'm 18 or older, but things could change in 3 or 4 years time) it seems like getting a medic cert. would be better before trying to get hired at an over-staffed department.

Anyway, my basic question: Is it a bad idea to go straight from EMT-B into EMT-P without job experience, if it could potentially make you more likely to get hired?

Just questions, not really trying to relate them to me yet, just trying to get an idea here.


-Cory-

It is actually smart to go straight to Paramedic. Many colleges now include basic as the first part of their Paramedic degree programs.

Your patients benefit more because you will be higher educated. The only ones that benefit from basics is company's saving money hiring basics instead of Paramedics.

 

[Sasha]

We'll give this another shot. I'm going to open the thread again.
If we have to close it again - there will be infractions issued.

Well... I see both sides of this - If the program is designed well... you don't need experience. If the program isn't designed to accommodate the student who's been working as an EMT for a while, likely with some contact with ALS providers... the student with no experience seems to have a tougher time. It can be a lot, all at once.

I disagree entirely, and my experience was just the opposite. The students who had experience had a tougher time adapting to how it was REALLY done, because they had already developed the bad habit "don't need no book learnin'" mentality that is pawned off by so many.

Also you assume they will get experience with ALS providers yet many areas still run basic trucks. I'm sorry but there is nothing you learn as a basic on a basic truck that A) is useful or B ) cannot be learned during your medic school clinicals.

If it really takes you an additional year to let all the first aid sink in and become comfortable with it, then how do you expect to learn more "advanced" medicine??

 

[VentMedic]

The other thing is some do not take the opportunities presented to them to learn. They get into the "BS" or "you call, we haul" mentality and just say, "I'm just doing my time until I can be a Paramedic". They go through the motions and believe getting a Paramedic patch will change everything including their attitude towards patient care.

In California I have had the opportunity of seeing CCTs with 2 EMT-Bs and one RN doing seriously sick patients. I do have a problem with this especially since the participation from some (not all) of the EMT-Bs is to hang out in nurses' break room while their nurse gets report. When it is time to move the patient, they show up. When I've asked why they don't listen to report their response is sometimes along the lines of "It's just another IFT only with a few more gadgets attached", "I'm an Emergency Medical Technician and this isn't emergency stuff" or "I don't have to worry about do any of that stuff until I'm a Paramedic".

Thus, EMT-B seriously does not foster the need to learn medicine. In fact, the EMT-B should be titled Ambulance Attendant and revised with more concentration on medical issues. Then maybe there wouldn't be the expectation that everything will be an emergency or a cool trauma. At least CNAs get a truer viewer of their profession and what to expect when they become a nurse. They have no illusions of grandeur when they get their CNA patch but they definitely know the importance of their job as do others because they accept it for what it is. Some EMT-Bs fail to see their job as being part of patient care in the vast world of medicine and only look for the emergency excitement while believing everything else is BS. To continue with this belief for 1 - 3 years without furthering one's education they fail to see where their lack of medical knowledge can be the harming patients they are supposed to be helping.

 

[bunkie]

In my area, we're required a year active B and sponsorship from your agency to get into the medic programs here. I want to be a paramedic, not a basic for life, so it kind of annoys me that I have to do a step process and wait. I wont be where I want to be for a few years, pending I get hired immediately after I finish school. With a family, its kind of difficult to follow this "process" they have. But I'll make it work.

 

[Jon]

Vent - I would have killed for the opportunity to get onto a CCT truck as you talk about - in PA, CCT's are EMT + RN, EMT + RN + RN, or EMT + EMT-P + RN

I would have LOVED the learning opportunities inherent in such an environment.

 

[VentMedic]

In my area, we're required a year active B and sponsorship from your agency to get into the medic programs here. I want to be a paramedic, not a medic, so it kind of annoys me that I have to do a step process and wait. I wont be where I want to be for a few years, pending I get hired immediately after I finish school. With a family, its kind of difficult to follow this "process" they have. But I'll make it work.

They can not restrict you from taking prerequisites like A&P, Pathophysiology, Psychology and English or some writing classes before you enter the Paramedic program. ALL of the other healthcare professions require prerequisites before they are allowed to enter the core portion of their degree. Hence with the wording or the lack of prerequisite requirements for some Paramedic programs, some believe one can not get ANY education for that year. Taking college classes in the sciences or general education should be considered part of a Paramedic program. One should not look at the Paramedic class itself as the end all to all education. It is time those in EMS start thinking about being a medical professional and not just a "medic".

 

[bunkie]

They can not restrict you from taking prerequisites like A&P, Pathophysiology, Psychology and English or some writing classes before you enter the Paramedic program. ALL of the other healthcare professions require prerequisites before they are allowed to enter the core portion of their degree. Hence with the wording or the lack of prerequisite requirements for some Paramedic programs, some believe one can not get ANY education for that year. Taking college classes in the sciences or general education should be considered part of a Paramedic program. One should not look at the Paramedic class itself as the end all to all education. It is time those in EMS start thinking about being a medical professional and not just a "medic".

I'm aware of that. After I finish my EMTB, I'm starting those courses as I intend on getting a degree in paramedicine. Not just certification.

 

[VentMedic]

Vent - I would have killed for the opportunity to get onto a CCT truck as you talk about - in PA, CCT's are EMT + RN, EMT + RN + RN, or EMT + EMT-P + RN

I would have LOVED the learning opportunities inherent in such an environment.

It is truly what you make it to be.

In the past we have hired EMTs and Paramedics as our drivers for Specialty but have since gone to using qualified drivers from the Security/Transport department.

The EMT(P)s were told up front that they could assist with equipment but would be very limited when it came to hands on skills. They could still get knowledge and some experience in an area of medicine that they normally would not see. This frustrated many, especially the Paramedics, and then there was the lights and sirens thing as they wanted to drive with L&S and really fast every time we got a sick baby which was always. The concept of a real mobile intensive care team was difficult to comprehend.

However, those that did understand the depth of the learning process for these very complex situations and babies/kids who needed expertise at a very high level got a great experience. They were also inspired to set their goals higher be it in EMS or in some other profession.

 

[Jon]

Vent - My one company provides drivers and trucks for the Children's hospital and one of the other large hospitals (with a big cardiac and burn program). I've subbed at both places at one time or another, and some of the staff just want us to be drivers and stay out of their way. Its a shame.