Experience before Paramedic

[hogwiley]

Career?

Anyways, go work as an EMT for 6 months first. It's just 6 months, but it will make a world of difference. It will give you a little time to ensure you a.) want to do this; b.) can do this; c.) know the basics and how to apply them; d.) can take a set of vitals without breaking out into a cold sweat and making up numbers while everyone has their eyes on you as a new medic.

No matter what people say or how smart you think you are... Book smarts and street smarts are two different things.. Just put in 6 months. It's a blink. You'll thank yourself.

This isn't entirely bad advice, but I should remind you of something. As a medic intern you WILL face more stressful situations than taking a set of vitals with everyones eyes on you, so being used to the EMT stuff isn't going to take much stress off you.

I was much more concerned about being handed the airway kit on a cardiac arrest and told to tube this patient WITH EVERYONES eyes on you, or starting an IV on a patient with crap for veins and a blood sugar of 28 who is unresponsive, with everyones eyes on you. THAT is what is make or break, and EMT experience will not aid you really. Or when you are handed a drug box you've never opened and are expected to choose the right drug and draw up the right dose under your precepters watchful eye. Its not the EMT stuff that will stress them out, which by their third week of Paramedic rides will be second nature even without emt experience. It is the ALS stuff from my experience. Experienced EMTs might be able to bluff competence in their first few rides better than a newbie, but that wont matter much by the end.

 

[rodoni]

This isn't entirely bad advice, but I should remind you of something. As a medic intern you WILL face more stressful situations than taking a set of vitals with everyones eyes on you, so being used to the EMT stuff isn't going to take much stress off you.

I was much more concerned about being handed the airway kit on a cardiac arrest and told to tube this patient WITH EVERYONES eyes on you, or starting an IV on a patient with crap for veins and a blood sugar of 28 who is unresponsive, with everyones eyes on you. THAT is what is make or break, and EMT experience will not aid you really. Or when you are handed a drug box you've never opened and are expected to choose the right drug and draw up the right dose under your precepters watchful eye. Its not the EMT stuff that will stress them out, which by their third week of Paramedic rides will be second nature even without emt experience. It is the ALS stuff from my experience. Experienced EMTs might be able to bluff competence in their first few rides better than a newbie, but that wont matter much by the end.

I agree and disagree.

*Disclaimer*: everything I'm about to say about the internship is not from first hand experience, it is just from what I've heard from my instructors. My instructors' curriculum was to make their students "real paramedics" (complete understanding as to what's going on, why it's happening, and what it takes to fix it) not "cookbook medics" (the book says to do this because of this sign or symptom) IE: treating a patient for a heart dysrhythmia and bypassing the fact that a patient's dysrhythmia is being caused from a traumatic event or it's a ped.

I think what sandpitmedic was trying to emphasize is similar to what I was trying to emphasize on my previous post. Having the EMT experience of actually doing vitals, assessments and basic treatments on real life patients will help with your paramedic internship. Why? Because you'll be used to interacting with random people that are in need. If you have those suuuuuuper basic skills down then that is a lot of the battle accounted for. Yes, I agree that all eyes will be on you for treatments, tubing, drawing up and pushing meds, getting an IV, etc. BUT (at least for us here in CA) during your internship, the intern owns the call. If you're a newbie walking into this role with 0 experience, you're most likely going to POOP the bed on the "hello mam/sir, what seems to be the problem". Being an EMT is where you're going to hone those skills outside of the safety of a classroom. I'm not speaking for everyone in that sense because I know there are some people out there that just excel in everything they do, but I would put money on at least 80% of paramedic interns out there that have (and would) benefit off of having some sort of EMT training prior to their paramedic internship.

As a paramedic intern, you shouldn't be doing basic vitals. Sure there will be times where you'll need to take them, and as a paramedic, you should be taking your own lung sounds, but those basic skills *should* be delegated to crew members/EMT on board IMO. Now, getting to your statement about doing the ALS skills. I completely agree that "all eyes" are on you for the ALS skills. But again (speaking for my experience/training in CA), your clinical time is where a student should be getting most of their IV sticks, a good amount of their intubations, etc. In my program, we did concurrent clinicals. While in didactic, we were scheduled time in the OR just to spend our day intubating patients for surgeries, scheduled in L&D to help with deliveries, and we were told our remaining 140 hours of clinicals were to be spent in the ER/ED doing anything and everything we can. Most of those things would be IVs, reading EKGs, experience with PT contacts etc. We were told our internship is less of us actually DOING and more of us DELEGATING. Every day during our internship (aside from the first 2 or 3 shifts, as these are bonding shifts with our preceptor) we as a student run every single call. If we have a code, us as a student is running it. We delegate the tube, the iv, the compressions, etc. We are the brains behind the operation. We interpret the EKG, voice what drug, dose, and when to administer, and run it quarterback style. Again, I am speaking from how my program has told us about how things are supposed to go. Of course it is up to the student's preceptor on how things are going to be run.

IMO, anyone could teach a monkey how to do a paramedic's ALS skills. The thing that is the hardest to teach is how to deal, cope, and approach a situation while still being the man (or female) in charge while everyone is staring at you waiting for an order. Clinical time is where you should hone your skills (of course you're going to tube in the field, IV in the field, etc, sometimes) but I believe your internship is 75-80% more about how you treat people on a personal level, how you think on your feet, how you work as a team leader, how you delegate, and your overall skill providing good patient care from start to finish.

Regarding what you mentioned about being handed a drug box that you've never seen and having to draw up meds on the spot: that should NOT happen. You as an intern have the responsibility to know where the stuff is on an ambulance. As I mentioned above, our first 2-3 shifts are *bonding* shifts. We are not to run the calls yet (of course we are supposed to do our BLS/ALS skills as appropriate). This is the time where we get to know our rig, our preceptor and his/her partner, how they run their calls, and general SOGs. IMO, your very first shift you should be asking your preceptor where everything is, having him/her quiz you on the rig, and if you know you struggle with medicine conversions, you should be asking your preceptor for help.

 

[hogwiley]

I agree and disagree.

*Disclaimer*: everything I'm about to say about the internship is not from first hand experience, it is just from what I've heard from my instructors. My instructors' curriculum was to make their students "real paramedics" (complete understanding as to what's going on, why it's happening, and what it takes to fix it) not "cookbook medics" (the book says to do this because of this sign or symptom) IE: treating a patient for a heart dysrhythmia and bypassing the fact that a patient's dysrhythmia is being caused from a traumatic event or it's a ped.

I think what sandpitmedic was trying to emphasize is similar to what I was trying to emphasize on my previous post. Having the EMT experience of actually doing vitals, assessments and basic treatments on real life patients will help with your paramedic internship. Why? Because you'll be used to interacting with random people that are in need. If you have those suuuuuuper basic skills down then that is a lot of the battle accounted for. Yes, I agree that all eyes will be on you for treatments, tubing, drawing up and pushing meds, getting an IV, etc. BUT (at least for us here in CA) during your internship, the intern owns the call. If you're a newbie walking into this role with 0 experience, you're most likely going to POOP the bed on the "hello mam/sir, what seems to be the problem". Being an EMT is where you're going to hone those skills outside of the safety of a classroom. I'm not speaking for everyone in that sense because I know there are some people out there that just excel in everything they do, but I would put money on at least 80% of paramedic interns out there that have (and would) benefit off of having some sort of EMT training prior to their paramedic internship.

As a paramedic intern, you shouldn't be doing basic vitals. Sure there will be times where you'll need to take them, and as a paramedic, you should be taking your own lung sounds, but those basic skills *should* be delegated to crew members/EMT on board IMO. Now, getting to your statement about doing the ALS skills. I completely agree that "all eyes" are on you for the ALS skills. But again (speaking for my experience/training in CA), your clinical time is where a student should be getting most of their IV sticks, a good amount of their intubations, etc. In my program, we did concurrent clinicals. While in didactic, we were scheduled time in the OR just to spend our day intubating patients for surgeries, scheduled in L&D to help with deliveries, and we were told our remaining 140 hours of clinicals were to be spent in the ER/ED doing anything and everything we can. Most of those things would be IVs, reading EKGs, experience with PT contacts etc. We were told our internship is less of us actually DOING and more of us DELEGATING. Every day during our internship (aside from the first 2 or 3 shifts, as these are bonding shifts with our preceptor) we as a student run every single call. If we have a code, us as a student is running it. We delegate the tube, the iv, the compressions, etc. We are the brains behind the operation. We interpret the EKG, voice what drug, dose, and when to administer, and run it quarterback style. Again, I am speaking from how my program has told us about how things are supposed to go. Of course it is up to the student's preceptor on how things are going to be run.

IMO, anyone could teach a monkey how to do a paramedic's ALS skills. The thing that is the hardest to teach is how to deal, cope, and approach a situation while still being the man (or female) in charge while everyone is staring at you waiting for an order. Clinical time is where you should hone your skills (of course you're going to tube in the field, IV in the field, etc, sometimes) but I believe your internship is 75-80% more about how you treat people on a personal level, how you think on your feet, how you work as a team leader, how you delegate, and your overall skill providing good patient care from start to finish.

Regarding what you mentioned about being handed a drug box that you've never seen and having to draw up meds on the spot: that should NOT happen. You as an intern have the responsibility to know where the stuff is on an ambulance. As I mentioned above, our first 2-3 shifts are *bonding* shifts. We are not to run the calls yet (of course we are supposed to do our BLS/ALS skills as appropriate). This is the time where we get to know our rig, our preceptor and his/her partner, how they run their calls, and general SOGs. IMO, your very first shift you should be asking your preceptor where everything is, having him/her quiz you on the rig, and if you know you struggle with medicine conversions, you should be asking your preceptor for help.

I agree, but ultimately everyone is different. I agree there are some people who NEED that time as an EMT, especially the younger ones with less life experience. Other people took to it like a duck to water even without the experience. A lot of it is self confidence. Yeah maybe you could teach a monkey to do ALS skills, but I definitely feel the same way about the Basic stuff, and with the hundreds of hours of hospital clinicals you are gonna have a lot of time to do the basic stuff as well as the ALS skills, and hopefully in lab. I know from my experience we had some really sharp people in my class who had zero time working as an EMT. They were up front with it in class and were up front with it during the start of their ambulance time, and it wasn't an issue, but we also did a LOT of ambulance time as well, so they had the chance to hone those skills and could go beyond the minimum hours to perfect it. I had a moderate amount of EMT experience before my internship and I didn't see it as hugely valuable since I had never worked ALS and 95% of my EMT experience was IFTs and dialysis.

Maybe I took the experience for granted but we also had some really experienced EMTs who failed medic badly, in fact the ones that did the worst seemed to be the more experienced ones for whatever reason. In a couple instances I think they had too much of their ego wrapped up in being an experienced EMT so they took it harder when they screwed up and put more pressure on themselves. The inexperienced ones were more receptive to constructive criticism(which you will get plenty of in the course of Paramedic school). Some experienced EMTs seemed to think things through less and didn't consider the whys. They had the mentality of ok in this situation we do X Y and Z without thinking through the WHYs. If anything they were more likely to do it cookbook, but maybe it was particular to those individuals.

Im not knocking EMTs either. Some of the smartest people in EMS I've encountered are EMTs. Medic school is long, time consuming, stressful and expensive, and to be honest isn't really worth the effort, so I wouldn't blame anyone for deciding on better uses of their time, money and energy.

 

[hogwiley]

Ill also add that while ALS skills are relatively easy to learn, they are not quite so easy to master. I can teach anyone the process of starting an IV and intubating a dummy, but on real patients the difficulty of these skills can vary greatly, and consistent success comes with practice and skill, especially in the less controlled environment you will operate in during your internship.

You'll also find if you haven't already that the ECG rhythms you see in the real world are not quite as neat and obvious as the ones in a textbook. In terms of making decisions, I also found the ALS interventions, when to do them and when not to do them, was one of the hardest things to learn, and EMT experience didn't really factor into it much.

 

[SandpitMedic]

Bro, go be an EMT for 6 months. The pros far outweigh the cons.

Forget the 101 reasons why & why not to. Anyone who didn't will say no, while anyone who did will say yes. You've even got folks in this thread who aren't even medics yet chiming in on it. I am not debating, again, my opinion against theirs.

From a medic (me)... go do it, preferably at the company which you'd like to be a medic with. The pros far outweigh the cons, and you'll already have your foot in the door.

Get your feet wet; it can't hurt.