It kills me that we are the only area of allied health that thinks healthcare is simple enough to divide into "BLS" and "ALS". It's all medicine, and I guarantee any Paramedic has had more exposure to "BLS skills" through clinical rotations than an EMT who had run dyalisis patients to and fro for a year. Go to paramedic school, work part-time if you are able but concentrate on learning medicine and not the assinine notion of advanced and basic "skills".
EMT/MEDIC Mill?
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You are onto it mate. The notion of fracturing ambulance skillsets into various levels is *** backwards and not only inconsistent with other medical professions but also with other public safety agencies such as Police and Fire.
That article is right, there is nothing basic about being a Technician; however it is a shame that in your system the education requirements do not seem to recognise that. Infact patient assessment is probably the most complex task performed.
I have to agree EMTs should read this. It is the most ignorant, yahoo EMT-B! thing ever posted.
I want somebody (anybody) to explain to me how without anatomy, physiology, pathophysiology, and other medical science knowledge a person can possibly do a good physical exam and history and come up with some kind of reasonable dx and treatment.
Most EMTs (including medics) can't figure out that there is only one exam you perform on all patients.
"The patient couldn't breath so I placed him on oxygen" I am afraid doesn't attest to some level of compentency.
Take for example a massive PE, they complain they can't breath. I have even seen one wrestle with 4 large firemen trying to put on an NRB before she coded. Even if they got the NRB on, do you really think it would have made a difference?
Paramedics should be called EMT2s? Here is a news flash: "EMT" is being removed from the title of "paramedic" in the new curriculum. Because the 2 are not comparable anymore.(if they ever were) You can look at the skills a paramedic performs all day, but if you don't know why, thinking you measure up is hubris. (fantasy at best)
Just quantitatively. The EMT Basic text Emregency Care devotes 113 pages to patient assessment. The Brady Paramedic Care has 309 pages, My Bates guide to history and physical 870 pages. Have a look at this:
http://www.nremt.org/nremt/downloads/patientassessmentmanagementmedical.pdf
compare the level of detail to:
http://www.nremt.org/nremt/downloads/Patient Assesment.pdf
EMT Basic training requires no knowledge of anatomy and physiology. Please do not point the the 50 pages of 1 picture per page as evidence of A&P.(granted the minimum paramedic requirement isn't enough either) If you don't know what is normal, how do you know what is pathological? DCAPBTLS tells you? Perhaps an EMT Basic could point to the part of the text that describes the implications of Caput Medusa? (a finding you can see just by looking)
The finding doesn't have to be part of an abdominal complaint, but can lead to the suspicion of some life threatening emergencies and a host of complications for other complaints. What would a similar finding in the face and head tell you that would be different from the abdomen?
So much for importance of the EMT Basic assessment...They might not even know they are looking at an emergency.
I just looked through a Basic EMT text and could not find how to determine likely pt history by looking at the medications they are taking. That is part of assessment is it not? Perhaps you are just supposed to ask what they are and tell somebody who can?
I was entertained by the 3 things you need to know when giving a medication: indications, contraindications, and side effects. (I guess mechanism of action among others really doesn't matter) I don't have much confidence in "healthcare providers" who dole out medications but can't tell me how they work. I appreciate even less being told things like "blood thinners," "water pills," "blood pressure medicine", etc. I expect more from providers than patients.
I know a few physicians who became EMT basics prior to medical school. I am sure JP can attest to how much that helps. I can tell you being a paramedic helps in Medical school, but not at all in the classroom. In fact sometimes the oversimplified knowledge actually hinders learning.
This article comparing a basic EMT skills to the skills of a good nurse or a good doctor, it isn't hubris, it is ignorance. I am sure most will attest, it is the knowledge (that book learnin' stuff) that is the basis for good medical care, not a few "basic skills." Come to think of it, there is more internship time in paramedic school to learn assessment than in the whole of EMT class by more than 5 times in several different healthcare environments.
You cannot get such exposure working on a 911 ambulance, even with a paramedic. You'd be better off on an IFT truck, but then when you have an "interesting" patient the only skill the EMT-B will be practicing is driving.
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mikie
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10 Weeks? 12? Is it just skill-oriented? B)
I have 2 years for my program (well, 4 since it's a B.S. too)!
I have 2 years for my program (well, 4 since it's a B.S. too)!
Shishkabob
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How so? Nurses can't do half the crap the doctors can. Heck, many new RN's can't do many things that new Paramedics can. PA's can't do everything that an MD can. An LVN can't do everything that an RN can.
The only difference is we call it 'basic life support' instead of medical procedures... which you would think many here would be happy about considering most of you don't consider EMT-B's medical practitioners in the slightest, but just first aiders.
Will people please, please pleaseplease for the hope of my continued sanity stop making this absolutely worthless arguement?
You out of all people ought to know better. How long will your internship last? How long will your residency last? How many clinical hours will you do during med school?
Now contrast that to the paramedic student who may do 200 hours of internship time and less than that of clinicals. See the difference?
If and when paramedic education is truly reformed and somewhere around a year is spent on the internship plus much more clinical time, then you will have a valid point. Until then, you do not.
Calling it "skills" instead of "procedures" is part of my beef, a skill implies a self contained action, a procedure (to me anyway) is something you do when you understand the reasons behind it.
The problem with comparing EMS the LVN/RN/NP/PA/MD model is that in 99% of other healthcare settings the highest level practitioner is readily available. RN thinks the patient needs a chest tube? Call the physician. LVN's patient needs blood? Call the RN. In addition, experince counts. New RNs aren't doing triage or getting IABP patients by themselves, brand new CRTs aren't usually taking care of vented ARDS patients and brand new xray techs don't go straight into CT. Contrast that with EMS, where a patch and a pulse often are all that's required to run 911 calls as a lead crewmember :blink:. Nowhere but in EMS are we throwing new, inexperinced practitioners out and having them make descions on patient care that involve knowledge way over their head with no support whatsoever in many cases.
I came from a patch and a pulse volunteer system, and it's honestly scarey the level of responsibility I had at the "brand new EMT" stage of the game.
JPINFV
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In the best comparable way, a year of internship under a limited practice license (first year of residency) and 2 years of what could best be described as clinicals (clerkship rotations). However, there are plenty of programs at my school that put students in clinics performing exams and reporting to residents in our first year. Does it really take 200 hours to teach someone how to backboard or apply an oxygen mask? You're (generic "you") a paramedic for goodness sakes, even if you have zero experience, you should be able to master that after your first, maybe second call.
Saying this, I don't think its fair to deflect the conversation because paramedic programs refuse to offer adequate education during the lecture portion and clinical portions of the course. As I've said before, I personally hypothesize that one of the reasons that paramedics "forget" to do something and rush to "ALS" interventions is, in part, because of splitting interventions into "ALS" and "BLS" interventions instead of viewing everything as a continuum of medical care. Yes, "BLS" interventions are important. Yes, "ALS" interventions are important, but if someone in acute pulmonary edema secondary to heart failure called 911, I'd really prefer that paramedics not sit onscene for 5 minutes waiting if the "BLS" intervention of supplemental oxygen administration works before going to an "ALS" intervention.
JP, great post! I cannot stand the whole "BLS before ALS" BS argument paraded around. How about the intervention that best treats the patient's condition? Also, 200 hour internship and less than that for clinical??? My field internship was 576 hours minimum and much more than that in hospitals, not just ED but OR, PICU, ICU, Burn and Peds ED. Also, we were not allowed to perform ALS skills until the program was satisfied with our assessments and BLS skills, for the first few months it was all BLS, making sure everyone was on a level playing field.
LucidResq
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I agree with your post, with one caveat. People skills are "basic skills" that do not come from good ol' book learnin', but they are vital.
I work with med students and residents regularly, and you and I both know there's a handful every year (especially the med students) who are extremely book smart, rock their USMLEs, but have absolutely no people skills. It's impossible to be an effective provider when you creep your patients out, can't relate to them at all, or otherwise make them uncomfortable.
However, this is something that almost always comes before EMT school, medic school, medical school, whatever. The socially inept likely will not learn how to deal with others by working as an EMT for a while.
There's no deflecting anything, and if all you learned by working as an EMT was how to put a NRB on someone, then no, don't bother working as one, go to paramedic school. But...you worked as an EMT for how long? How much did you pick up that, while not strictly medically related, was still needed to adequately practice medicine? At the same time, do you really only think you'll be learning about how to treat/dx during your time in med school and after? I've said it before, and I'll keep saying it: it's not learning the minimal medical procedures an EMT can do that'll help while in paramedic school, it's learning everything else that comes with working in the field. Of course I'm also obligated to say that the EMT experience isn't always necessary and could be a drawback for some people, depending on the situation.
The issue isn't people being poorly taught and rushing through one thing to get to another (though that certainly is a problem; part of the way to fix that would also be to extend the time in an internship) it's people not having enough time to really learn how to apply what they are learning in the classroom to the real world, especially if they are learning how to function in that environment for the first time. Already having that ability will make things easier for them. I'm really not going to repeat myself again, promise, but much more is needed to practice medicine than just an understanding of "medicine." In a nutshell, comparing EMS to other medical professions when this argument comes up isn't valid until an appropriate amount of clinical and internship hours are required. And education, but that's another topic.
jgmedic- actually I think I made a mistake and the number of clinical hours probably well exceeds 200 hours. But...nationally, 200 for an internship is all that is required. That's maybe a month of full time work. Many places do more, but...576 hours...maybe 3 months fulltime work. With EVERYTHING that we are expected to know, and EVERYTHING that is required to be a competent medic, you really think that is enough?
JPINFV
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Did my experience (about 2.5 years of actual work out of 5 years of certification) help with the standardized patients? However, it wasn't a huge advantage and has, by this point (8 standardized patient encounters in, of which 1 was a group exam, 1 set was group communication drills, 3 'annual checkup' exams, and 3 focused exams), been negated. Do I feel that it was necessary to have prior clinical experience in that vein (as in doing exams and the like)? Absolutely not. I've said it before, and I'll say it again. A properly designed program should be able to teach how to do a physical exam and ensure that students are capable and comfortable prior to leaving school without prior experience. If that means that the minimum number of hours (medical school has a minimum number of hours [4,000 in California], but I can't think of a single school that advertises the amount of hours in that students actually go through) needs to be increased, then it needs to be increased since too many paramedic schools are obsessed with the minimum and not competency.
So, essentially, EMS is special because the education sucks and the schools are refusing to fix themselves. I am curious as to why this phenomenon (since I imagine a large part is due to the number of people looking to go into EMS vs the number of spots) isn't seen in medical school since there's twice the number of med school applicants than spots, yet schools manage to hold themselves to a high standard and constantly work to improve themselves.
Don't be obtuse. The things I'm talking about learning wouldn't apply to a standardized pt, not all of them anyway; they'd apply to the environment in which you were expected to perform your job, and, even the things that are learned about interacting with pt's would be hard to recreate in the classroom environment. Hell, look at lucidresq's post; that's part of what I'm talking about. Like I said, it's not learning "medicine" as an EMT that will help, it's what goes with that.
I agree; but there are very few, if any paramedic schools that are set up that way. Some are getting better about upping the amount that is taught during the didactic portion, but as with all medical professions, and really all professions period, time needs to be spent learning how to apply that knowledge; time needs to be spent learning how to function in your new capacity, ie an internship. That is still an area where medic schools fail students.
It's not that EMS is special...or maybe it is if you mean "special" as short for "special needs." If things were really reformed and the educational structure was fixed, then hell no I wouldn't tell people to consider working as an EMT, if things were really fixed I see no reason why a prospective paramedic should even be certified as an EMT EVER; go straight through and become a medic. Unfortunately, we aren't at that stage yet. And because of that failing, FOR SOME PEOPLE, not everyone, and DEPENDING ON MULTIPLE FACTORS, it may be beneficial to work as an EMT.
The systems broken. Fix it, and then compare the paramedic educational structure to a MD's, PA's, RN's or whatever.
JPINFV
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I don't think you have a firm understanding of a standardized patient program as run by medical schools. These aren't your classmates acting as patients. These are community members who are trained to act out certain conditions and give specific responses supplemented by their own health history. I'd argue that there's very little difference between doing a H&P for an annual checkup on a standardized patient vs a real patient. If a student is having problems doing a H&P on a SP, then they're going to have problems with real patients.
If you aren't talking about the intangible interpersonal interactions between provider and patient, including scene management, then I have no clue what you're talking about.
You're the one arguing that EMS education is special because it's unfair to compare EMS education to just about every other health professional out there.
If it works for some people, not everyone, and depending on multiple factors, then why require everyone to go through the process for the benefit of a few?
Also, how can you fix something if you don't know which direction to go to. Comparing EMS education standards and process to other health professionals gives a framework to work off of. You have to know the flaws before you can fix it.
Replies in red.
Like I said, if the system was fixed, then no I wouldn't bother telling anyone to consider working as an EMT. It's not fixed though, and because of that, it is something that needs to be given some thought.