EMT-Basic: Is 120 hours enough?

[VickiEMTfire]

I feel although 120 hours does not seem like near enough time to learn all you need to know to do patient care in the field it is like anything else you take on. The more you put into it, both in class and outside of class, the more you will get out of it. I suggest if you want to have the best advantage to go out and be able to perform the skills you learn in class you need to take it upon yourself to attend other outside classes usually offered by local fire departments or hospitals. I definitely suggest you attend an ALS assist class! There are also many books out there that can help such as an A&P book.The more you take upon yourself to learn, the more prepared you will be.
You also need to remember you are never prepared for some things you will see and do until you are in the situation.Just take a deep breath and do what needs done.You will be fine.
I am currently about half way through my paramedic course and believe me I feel totally lost and unprepared right now.I know that it will all come together and make sense and when I am in the field for the first time as a medic I will be nervous but I will take that breath and do what needs done.There is always later, sitting in the station, to panic or cry.
Good luck to all newcomers,you will make a difference in someone's life!

 

[TKO]

I feel that the less education you have, the less the employer will have to pay you. And I believe that's a big reason for the low standards of EMS.
"If you don't go to college and have certification and a restricted medical license, why should they pay you more than a few bucks over minimum wage?" appears most often to be the motive of the system. I really believe that the allmighty dollar is behind the majority of our professions short-comings.

There is no justifiable reason that any person in the industry should have to work extra hard to make themselves a better rescuer and more knowledgable at their own expense. Especially for the sole benefit of their pt's care, it should be already be available.

It is time that the public learned the truth of the system and this stopped. EMTs deserve a better education and consequently better pay, and the public deserves a better emergency care system.

 

[BossyCow]

I'm not sure urban/suburban BLS is quite as horrible as Bossy portrays it.

Hey, only some of them, by no means did I intend to imply that all are that way. But there are those systems out there, we've all seen them and worked with them.

 

[MSDeltaFlt]

My thoughts on the course is this:

I believe the didactic portion might be long enough. HOWEVER, I believe that the clinical portion should be seriously increased. EMS should be an apprenticeship; on ALL levels. the book can never teach you everything you need to know. You can't teach experience. You must experience it. You must be an apprentice.

My honest, yet humble, opinion.

 

[JPINFV]

I do find it interesting, though, that after suffering ad hominem attacks over the issue in a different thread [since cleaned by admins], no one seems to fully disagree that EMT-B is not long enough.


I do agree that EMT-B should be extended both in the diadatic part and the clinical part. Even if you don't remember every single minute detail from an anatomy and physiology courses, students should still leave the courses with an understanding and respect of the major themes. You can't consider different differential diagnosises [yes, we don't "diagnose," but we come as damn close to that line as possible, even as an EMT-B] if you don't know that they can even exist. Similarly, you can't really consider assessment tools if you don't understand what they're really measuring [this goes back to the mantra "treat the patient, not the monitor"]. It is this problem [lack of diadatic education] that will prevent our scope, and therefore our ability to provide care, from being increased.


Another reason is that, as long as the entry requirements are so low, anyone with two brain cells can pass. Sure, the providers that value their medical care will continue their education, be it in theory [A/P, pharm, etc. I'm talking about formal education] or practical [focused Con-Ed, higher cert level (moving from basic to paramedic)], but think about it for a minute. The person requesting a call for service doesn't get to pick and choose who their responder is going to be? Do you really want to roll the dice that the provider answering your 911 call is going to be someone who wants to learn?

Similarly, if you're 2 hours away from advanced life support and an hour away from the hospital, shouldn't that mean that you [generic "you", not directed at anyone] should be more educated since you don't have a paramedic safety net to fall back on?


The clinical part of the education should be increased as well. It's all fine and dandy to talk and teach about how to deal with the ideal situations, but as the cliché goes, patients don't read the manual/protocols. The clinical part is where the theory gets integrated into the practice of medicine. This is especially true since regional variances [my favorite example is DNR procedures] will always trump what the text book and teachers tell their students. My EMT-B course required 8 hours of ambulance ride alongs. That was a total of 2 calls [I even pulled a second ride along, at a different station and only got 2 calls on the second 8 hours as well. This was in the middle of Orange County, CA, not exactly your backwoods, low call volume area].

Finally, there is the issue of pay. This is, in the end, a chicken and the egg situation. Reimbursements won't go up as long as every 2 weeks to 3 months another batch of wide eyed providers graduate. First, as long as the procedures that can be done are low, the amount that can be requested and lobbied for reimbursement [BLS vs ALS 1 vs ALS 2, Medicare payments, for example], the pay will remain low. Second, as long as there are vastly more EMT-B providers then there are jobs, then pay will remain low. there's a reason that a certain 911 provider in my old area payed $3 less per hour than the local IFT companies [$2/hr less than one of the local waterparks]. The answer is simple supply and demand. This is the same reason that the mean hourly wage for garbage men is about 50 cents higher than EMTs [B, P, or otherwise] [http://www.bls.gov/oes/current/oes_nat.htm#b00-0000 Emergency Medical Technicians and Paramedics vs Refuse and Recyclable Material Collectors]. Simply put, even though there is vastly less at risk with your garbage man, less people want to do it, so the wage is higher.

On the other hand, providers will complain about the pay vs education problem until a higher wage is offered for more education [example: paramedic students deciding against an associate degree, or even a BS [not wanting to go into education or management at that time] because everyone, in the end, will be payed the same in a lot of systems]. The problem is that it is easier to raise education standards and THEN request a higher wage, then ask for a higher wage to get a higher education.

Therefore, before anything changes at the BLS level, and by connection, the rest of the profession, education must first be increased. Most, if not all, of the problems facing EMS would be solved by requiring more education.

 

[Topher38]

I have to agree with JPINFV, I enjoyed the clinical time ALOT! I learned alot during the clinical time because I actually saw how it was done and how it is diffrent in the field.

I think it would improve the EMT student much much more if the clinical time was atleast double it is now. 10 hours is not much, 1 shift maybe 2 depending where you go. And alot of people do clinical time at thier own VFDs.

 

[BossyCow]

I think a lot of systems figure that your first 90 days of probation on the job are your real clinicals. Most systems pair you with an overseer/babysitter until they are sure you aren't a bone head.

I've heard over and over that the 'real' education comes in the field. The problem with that type of thinking is the supposition that your precepter in the field is going to be worth a crap or even want to be holding your hand or powdering your behind.

I would love to see more background in A&P/Medical Terminology and call me a heretic, how about some basic communications skills, like report writing, spelling and grammar. Being able to communicate what we saw in the field to those of higher education than us, is important. Lets not make it tougher on them by having to play a guessing game with our reports.

But I'm not going to hold my breath. I'm seeing less rather than more when it comes to education in this field. The prevalence of on-line CME and the reduction of an instructor's role in the actual education of the student has me very, very afraid. There's the attitude that after a while in the field, everyone already knows everything and CME just needs to be a tacit nod in the direction of risk management record keeping.

(BossyCow steps off her soapbox and awaits the :censored:storm to follow)

 

[Ridryder911]

My state requires 48 hours clinical time for basic level, even then that is so little and ridiculous. Majority Basic Level clinicals are observation only. Truthfully, what are they going to do? Vital signs, assessment (non in-depth) application of splints and oxygen. Discussion of physiological responses, pathological etiologies has to be kept a minimum. Treatment modalities has to be kept simplistic.

Scrap the Basic level altogether. Require an associate level for entry point as Paramedic with at least 1000 hours clinical time within in the program . Then require one year residency (licensed as probation/intern) time for the first year. Continuous review at intervals for evaluation. After successful completion, then one can acclaim Paramedic level and full license and then be able to work in the field as an individual.

Basic level should be considered as a first responder level for agencies such as fire, police and volunteer responders. Those that responsibility is to stabilize until relieved by another EMS responder. Initial care to maintain life, until ALS can arrive.

R/r 911

 

[emtwacker710]

I believe that the 120 hours is enough for the Basic EMT, If you are a member of a squad or FD, then they usually have drill nights or have some sort of training program where you keep refreshed and also learn some new stuff, like I know our local hospital has lectures at least once a week if not twice on wide variaties of medical and trauma emergencies, I believe the most recent one we had was syncope and the one before that was hypothermia...so no matter how much you learn in class, you still continue to learn more once your out.

 

[Arkymedic]

I believe that the 120 hours is enough for the Basic EMT, If you are a member of a squad or FD, then they usually have drill nights or have some sort of training program where you keep refreshed and also learn some new stuff, like I know our local hospital has lectures at least once a week if not twice on wide variaties of medical and trauma emergencies, I believe the most recent one we had was syncope and the one before that was hypothermia...so no matter how much you learn in class, you still continue to learn more once your out.

This is an exception and is most definately not the rule.

 

[skyemt]

I believe that the 120 hours is enough for the Basic EMT, If you are a member of a squad or FD, then they usually have drill nights or have some sort of training program where you keep refreshed and also learn some new stuff, like I know our local hospital has lectures at least once a week if not twice on wide variaties of medical and trauma emergencies, I believe the most recent one we had was syncope and the one before that was hypothermia...so no matter how much you learn in class, you still continue to learn more once your out.

That is called CME, and is how most emt's recertify these days, at least in our area...

has absolutely nothing to do with the fact that 120 hours is not nearly enough.

you are combining two separate issues... initial education, and continuing education.

 

[VentMedic]

That is called CME, and is how most emt's recertify these days, at least in our area...

has absolutely nothing to do with the fact that 120 hours is not nearly enough.

you are combining two separate issues... initial education, and continuing education.

As I mentioned in an earlier post, in some states the recertification requirement is a "refresher" or a review of what you should know and utilize on the job. Rarely do they present anything that is a continuation of what you have learned. It is essentially like taking a mini EMT-B class again.

I find it fascinating that many volunteer squads do take their skills maintenance and continuing education seriously. It is difficult to get paid people to attend any class that is not mandatory. For the recert class, they prefer to do it in a weekend or two. Some may even have their trainers who work for their company sign them off without taking the class so they can stay on the job at the benefit of the company for a warm body on the truck and not an educational opportunity for the employee.

Hospitals and community colleges usually have great CME or CEU classes that are relatively inexpensive. Many educators from the hospitals and these colleges are usually willing to offer onsite classes also. However, there is rarely a good turnout even if the classes are free for the EMTs or Paramedics. They also may not want to take classes from anyone but another EMT or Paramedic. Thus, they may get a limited amount of classes and a limited view of the world of medicine.

 

[Megz7464]

yea the emt-basic course im taking right now is 131 hours....but i see it as that if you can pass your modules and your test, you have learned and know what your suppose to be doing....what else do you think they need to factor into that would require it to be longer?:mellow:

 

[JPINFV]

what else do you think they need to factor into that would require it to be longer?:mellow:

Enough anatomy and physiology so that you [generic "you", not directed at the poster] know what you're doing. Did the course cover Sterling's Effect? Hopefully they did if they're still teaching Trendelenburg position.

How about oxygen dissociation curve?

Glycolysis-Krebs-Electron Transport Chain [at least talked about it, not neccessarily step by step]? This integrates the importance of both glucose AND oxygen pretty nicely.

How the body maintains blood pressure, and by connection, the importance of the patient's mean arterial pressure?

 

[Rob123]

Not long enough

Hello,
I've been a long time lurker but this thread finally motivated me to make my first post.

I am almost complete with my EMT-B course in NYS. I honestly don't think that the limited class time is enough. I am pulling tours as a dispatcher with my vollie and taking the course at night since I go to work during the day. Even with my hectic schedule, I would appreciate if we can go more indepth on many of the topics.

The sad part is, I have often joked that I learned most of class topics during Boy Scouts first-aid training... except perhaps emergency childbirth and WMD. I'll have to add the "nail technician training hours" to my comedic repertoire.

All jokes aside, I would really consider that EMT-B course should really be more of a first responder (CFR) course. However, as devil's advocate I would say that since there is a receiving hospital within 10 minutes of any location within City limits, "load and go" would probably still provide adequate care in many cases.

Robert
(Still in training and quite naive)

 

[JPINFV]

The sad part is, I have often joked that I learned most of class topics during Boy Scouts first-aid training...

I'll definately agree with that. Splinting, "hurry cases," and identification/initial treatment of plenty of other situations.

 

[JPINFV]

Did the course cover Sterling's Effect

Note: That should be Starling's Effect.

 

[Outbac1]

Just because you are not responsible to "do" advanced interventions doesn't mean you shouldn't know about them or be able to assist in them. Eg: If you are working your garden variety cardiac arrest with a paramedic and they ask for some "BURP" can you help them? Have the next drug ready to go before its needed? Can you pick out the possible medical history of the pt from looking at their medications? They may not always be able to tell you their history.

120 hours isn't enough. You need that just in A & P and pathophysiology as a place to start. Using a glucometer or getting a 3 or 12 lead ecg are not advanced skills. To raise EMS to the level of respect it deserves we have to get away from being "ambulance drivers". I believe it starts with a proper medical education.

 

[JPINFV]

Burp? I don't think I've heard that acronym before. I doubt that it can be as stupid of an acronym as HAM [Hx Allergies Meds] though.

 

[Summit]

My 180 hour course... after I then took IV, EKG, Bio I & II, A&P I & II, Microbio, Pathophysiology, PHTLS, and about 200 other hours of CEs, I finally felt like I had education I should have received before being allowed to practice as an EMT in the first place.

EMT-B should be a comprehensive AAS degree, not a 9 credit hour cert.

I thought for a while I had a differnet outlook because I actually had to figure out what was wrong with patients on a long transport or that I couldn't expect ALS backup all the time. Short or long transports shouldn't matter...

And it kills me that Colorado requires a mere 36 hours of CEs to renew.