EMTs and Paramedics: What would you change?

Aprz

EMT Student
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DrParasite

The fire extinguisher is not just for show
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If you need more hands, do you request an additional unit from your service?
At my former service, that was exactly how we operated. and the one before that, yes, absolutely (big city department, FD never went to EMS calls).

If I need lifting assistance, send the FD. if I just need hands to help me with something, send me the nearest BRT, and I will tell them what to do. If I need someone to pump on a guys chest, send two. If I need technical rescue assistance, send me someone who knows about ropes and how to use a stokes basket.

but If I have a sick patient, where I need clinicians who can do clinical stuff, send me another ambulance with a crew who can assist. maybe an EMS supervisor. even if the FF has an EMT or medic cert, unless I know they are up to my agency's clinical standards (which usually means they used to work full time on the ambulance or still work regularly on a non-FD ambulance), they are muscle unless demonstrated otherwise. Or they are driving my truck while my partner and I work on the patient.

for full disclosure, I'm a level 2 fire instructor, and I stand by my statement. There are definitely exceptions, but not the norm.
 

NomadicMedic

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There are 3 types of EMS providers: Dumb providers, Smart Providers and Brilliant Providers. Dumb providers never learn from their mistakes. Smart providers learn from their mistakes but brilliant providers learn from other peoples mistakes. I worked as an EMT for 4 years before going to Paramedic school and one of the biggest benefits was to watch Paramedics do the job both correctly and incorrectly.
I agree with this. I stratify the staff into three levels when I decide how I’m going to divvy up my time. There are A,B and C level providers. The C level providers will never get better and will suck up your valuable time with little ROI. Do what you can to get them competent and don’t waste time trying to fix them. The A players are usually good and don’t need much handholding. They’re competent and need to be reeled in, if anything. As an educator, I believe it’s important to spend the majority of my time on the B level providers. That’s where you can make the most difference.
That’s not a totally popular opinion, but when there’s one guy and 100 staff members, you have to triage.
 
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Carlos Danger

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Require EMTS to have at LEAST two years of full time experience before getting into paramedic school.
Lots of people say that and it sounds great on the surface, but it seems pretty arbitrary to me. Why two years? Why not one year? Why not 5 years? Also, two years of what TYPE of experience? Busy urban EMS running 10 calls a day on a BLS-only rig? Lazy rural EMS, doing 10 calls a week and really only ever driving the paramedics around?

What is the purpose of this prerequisite experience, anyway? To get a decent orientation to EMS and ambulance ops and basic patient care skills so that in paramedic school you don't have to worry about learning those things and can instead really focus on that paramedic stuff? I think that makes good sense. But does that really take a minimum of two years of full-time work?

I've known some really good paramedics who had very little EMS experience before going to paramedic school, and it didn't seem to hold them back a bit. I've also known a few EMT's who were doing it for a long time before going to paramedic school, only to end up being the kind of paramedics that you just pray aren't on duty if someone you love really needs EMS.
 

VentMonkey

Family Guy
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yes. I have one wife, and she’s not at work. Nor would I insult my wife by implying someone else could take her place when shes not around.
Spoken like a real man.

Topic-wise, a healthy respect for one another regardless of one’s “patch”.
 

Fezman92

NJ and PA EMT
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Strong unions and abolishing for profit EMS.
 

ffemt8978

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Strong unions and abolishing for profit EMS.
Each of those has their own set of problems, but that discussion belongs in its own thread.
 

DrParasite

The fire extinguisher is not just for show
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Lots of people say that and it sounds great on the surface, but it seems pretty arbitrary to me. Why two years? Why not one year? Why not 5 years? Also, two years of what TYPE of experience? Busy urban EMS running 10 calls a day on a BLS-only rig? Lazy rural EMS, doing 10 calls a week and really only ever driving the paramedics around?
It is arbitrary, but I think it's sound logic (just like PA schools require so many hours of patient contact experience. How about "you need to have renewed your EMT cert at least once?" would that be better? This way you have gone through an entire certification cycle, and (in theory) you are performing patient care... somewhere. I also agree there is a huge difference between a high volume system where you are assessing and treating people vs where you are simply an ambulance driver.
What is the purpose of this prerequisite experience, anyway? To get a decent orientation to EMS and ambulance ops and basic patient care skills so that in paramedic school you don't have to worry about learning those things and can instead really focus on that paramedic stuff? I think that makes good sense. But does that really take a minimum of two years of full-time work?
Maybe it's just me, but I learned very little about how to perform a patient assessment in paramedic school. The biggest difference is now I had a cardiac monitor, a BGL monitor, and an auto cuff. My treatment options and interventions exploded, but my assessment was pretty much the same. Had I need spent a few years on an ambulance, my assessment wouldn't have been nearly as smooth. asking the right questions, forming differential diagnoses, being able to not hide behind the clipboard.... TALKING TO PEOPLE and TOUCHING PEOPLE during an assessment. the number of providers who have trouble doing this is mind boggling. This is what having the prerequisites should help avoid.
I've known some really good paramedics who had very little EMS experience before going to paramedic school, and it didn't seem to hold them back a bit. I've also known a few EMT's who were doing it for a long time before going to paramedic school, only to end up being the kind of paramedics that you just pray aren't on duty if someone you love really needs EMS.
Very few piss poor EMTs become amazing paramedics. similarly, for every zero to hero paramedic you find who is amazing, I will show you 2 who are horrible. And just because you have been an EMT for a long time doesn't mean you will be a great paramedic.
 

Carlos Danger

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It is arbitrary, but I think it's sound logic (just like PA schools require so many hours of patient contact experience. How about "you need to have renewed your EMT cert at least once?" would that be better? This way you have gone through an entire certification cycle, and (in theory) you are performing patient care... somewhere. I also agree there is a huge difference between a high volume system where you are assessing and treating people vs where you are simply an ambulance driver.

Maybe it's just me, but I learned very little about how to perform a patient assessment in paramedic school. The biggest difference is now I had a cardiac monitor, a BGL monitor, and an auto cuff. My treatment options and interventions exploded, but my assessment was pretty much the same. Had I need spent a few years on an ambulance, my assessment wouldn't have been nearly as smooth. asking the right questions, forming differential diagnoses, being able to not hide behind the clipboard.... TALKING TO PEOPLE and TOUCHING PEOPLE during an assessment. the number of providers who have trouble doing this is mind boggling. This is what having the prerequisites should help avoid.

Very few piss poor EMTs become amazing paramedics. similarly, for every zero to hero paramedic you find who is amazing, I will show you 2 who are horrible. And just because you have been an EMT for a long time doesn't mean you will be a great paramedic.
Like I said, I've seen too little correlation between how good of a paramedic one is and how long they did EMS prior to paramedic school to ever agree that any arbitrary measure of time or recertification cycles is necessary. I don't necessarily think having some experience requirement is a bad thing, but if you want to have a prerequisite that actually matters, there are probably much more effective and efficient metrics than "two years full time".

PA school experience requirements serve a totally different purpose. Graduate programs in healthcare have many data points to look at when evaluating an applicant. The patient contact hours are simply intended to ensure that the applicant has enough exposure and familiarity with the healthcare environment to ensure that they are truly motivated to finish the program and minimize the chance of them dropping out due to lack of interest or motivation, which negatively affects the school. No one thinks that the type of patient contact experience that most PA or MD applicants have is a necessary prerequisite to learning clinical medicine.
 

NomadicMedic

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Again, EMS education is so situational. I learned how to perform a VERY detailed assessment in Paramedic school. I think learning how to move patients safely, communication with others (including nurses and docs) and the basics of customer service should really be the focus of most EMS programs. Less livesavin’, more hand holdin‘.

The only value I got out of EMS experience before paramedic school was learning how to perform mechanics of the EMT job so I didn’t have to think about it when I was a paramedic. Again. That was me and YMMV.

There is a caveat to this, and that’s rural areas where an EMT is all that’s coming No paramedic for 75 miles in any direction. Those providers should have additional training to teach them how to manage patients when they’re CTD. In reality, they should be trained to the AEMT level and we should make it a mission to eliminate the EMT for everything except basic BLS IFT, making AEMT the minimum staffing for a 911 response unit
 

WannebeParamedic

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At my former service, that was exactly how we operated. and the one before that, yes, absolutely (big city department, FD never went to EMS calls).

If I need lifting assistance, send the FD. if I just need hands to help me with something, send me the nearest BRT, and I will tell them what to do. If I need someone to pump on a guys chest, send two. If I need technical rescue assistance, send me someone who knows about ropes and how to use a stokes basket.

but If I have a sick patient, where I need clinicians who can do clinical stuff, send me another ambulance with a crew who can assist. maybe an EMS supervisor. even if the FF has an EMT or medic cert, unless I know they are up to my agency's clinical standards (which usually means they used to work full time on the ambulance or still work regularly on a non-FD ambulance), they are muscle unless demonstrated otherwise. Or they are driving my truck while my partner and I work on the patient.

for full disclosure, I'm a level 2 fire instructor, and I stand by my statement. There are definitely exceptions, but not the norm.

I am not an EMT/Paramedic/Firefighter so I might be a bit ignorant. But are you saying that paramedics who work for fire departments are poorly trained?

I thought the EMT qualifications were uniform across the board and Fire Service EMTs drive ambulances - it just so happens that the fire service provides paramedic/EMT services in a particular city??
 

johnrsemt

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I don't know that College will help: I have seen paramedics with degrees that can't write a run report that will stand up to QA/QI, much less in court, and I know a lot of medics with 2 year degrees that shouldn't be allowed to touch a patient.
I have a 2 year degree, but not in a medical field, I can write a run report (if you don't count hand writing against me), never been to court (except for the fact no one could read the writing on one) and never had patient care questioned, except by supervisors that got promoted because they couldn't make it as street paramedics.
 

DrParasite

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I am not an EMT/Paramedic/Firefighter so I might be a bit ignorant. But are you saying that paramedics who work for fire departments are poorly trained?

I thought the EMT qualifications were uniform across the board and Fire Service EMTs drive ambulances - it just so happens that the fire service provides paramedic/EMT services in a particular city??
Not at all; in fact, everyone who takes the national registry paramedic exam takes the exact same exam, whether you be a firefighter, ambulance driver, cop, or garbage man. And, in theory, everyone's paramedic (and EMT) training is the same.

And I will say that I have seen some great full time FFs and FF/PM on the engine; usually, they worked as a single role paramedic or EMT earlier in their career.

The issue I have seen (and this is strictly my own experience) is many FF/PMs and FF/EMTs want to be firefighters, and only do EMS because it's part of the job. Many of them are horrible clinical providers, have no interest in learning anything more about EMS other than what is required (their initial training and mandatory con ed), because they are firefighters. They don't do any critical thinking, know very little about human anatomy and physiology, and their patient assessments often leave a lot to be desired. In my experience, the only good Firefighters when it comes to EMS are those who worked as EMS providers in a single role entity before or during their time on the engine. CMM (and for the record, @FiremanMike did convince me that his department wasn't like that at all).

All too often, the FD based paramedics are just waiting until they can transfer over to the supression side. At many departments, the junior FFs are assigned to the ambulance, and they are waiting until a new junior FF gets hired so they can move to the engine full time. There is no incentive for the providers to do anything more than the bare minimum, and if you look at the reports out of FD based EMS around the US, it shows.
 

DragonClaw

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I am not a fan of this mindset. As @NomadicMedic mentioned.

#OneWifeInMyLife.

I don't know what woof means

I also abhor this mindset. It's utterly disrespectful to one you've devoted yourself to, or claimed/promised to. It devalues that title/relationship and the person you're supposed to honor.

I would never claim a "Work hubby"
 

FiremanMike

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Not at all; in fact, everyone who takes the national registry paramedic exam takes the exact same exam, whether you be a firefighter, ambulance driver, cop, or garbage man. And, in theory, everyone's paramedic (and EMT) training is the same.

And I will say that I have seen some great full time FFs and FF/PM on the engine; usually, they worked as a single role paramedic or EMT earlier in their career.

The issue I have seen (and this is strictly my own experience) is many FF/PMs and FF/EMTs want to be firefighters, and only do EMS because it's part of the job. Many of them are horrible clinical providers, have no interest in learning anything more about EMS other than what is required (their initial training and mandatory con ed), because they are firefighters. They don't do any critical thinking, know very little about human anatomy and physiology, and their patient assessments often leave a lot to be desired. In my experience, the only good Firefighters when it comes to EMS are those who worked as EMS providers in a single role entity before or during their time on the engine. CMM (and for the record, @FiremanMike did convince me that his department wasn't like that at all).

All too often, the FD based paramedics are just waiting until they can transfer over to the supression side. At many departments, the junior FFs are assigned to the ambulance, and they are waiting until a new junior FF gets hired so they can move to the engine full time. There is no incentive for the providers to do anything more than the bare minimum, and if you look at the reports out of FD based EMS around the US, it shows.
We just hired a batch of new guys that I'm orienting right now. One of the first things I remind any group of newbies is that they knew when they signed up that we do a lot more EMS than fire. If they choose to be bitter and angry when the medic tones drop, it's going to be a LONG 25 years for them.

They seem like a good group, I like where their heads are at..
 

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