Head start on medic program

Loki Grim

Loki Grim

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Hey everyone,

I just passed my NREMT exam a few days ago and now I don't know what to study. Where I currently live I need 2,000 hours of work experience to qualify for the medic program, in that time I thought it would make sense to study for medic. Youtube a lot of good stuff, hands on things not included obviously. Right now I'm watching a play list on Youtube for ECG interpretation, is there anything that I could learn that is not hands on that would be a good use of time?

Thanks
 
"A college level A&P class"

I need to do that regardless as a prerequisite, I have a few months to go until I can register for a class. You probably need to know things like how pH effects the body right? I'm trying to find specific skills that I can pickup in the meantime like ECG interpretation.
 
Much more then just the pH of the body. How do muscles work. How does the movement of things in and out of cells work. What bones are where. What organs are where.

Personally I would wait until you learn about EKGs in class before trying to learn by yourself. EKGs tend to be a very hard subject to grasp.
 
I agree... start with a college-level A&P program and I don't mean "Airframe & Powerplant" program either. ;) By taking an Anatomy & Physiology course of study (look at your local RN program as you'll want the same level A&P they require) you'll gain a much greater understanding of how the body works and why so that when you're studying the abnormal stuff in your Paramedic program, you'll understand the why behind the abnormal stuff. This may not seem like much now but you'll start understanding this later on when you are much more quickly able to grasp the significance of some subtle sign you're seeing.

Yes, I'm an RN. This does NOT give me greater abilities than I had when I was a Paramedic... I have the ability to use different viewpoints into patient care than I used to but assessment is assessment regardless of level. It's up to the clinician to be able to make heads or tails of the data gathered. What I do have that Paramedics normally don't is a LOT of backup right at my fingertips. Usually the providers order labs or have protocols that cover lab work so that I have that available to me as well. One last thing that I am developing that Paramedics rarely get to is an ability to prioritize multiple patients. It's the norm for me to have 3-4 patients at the same time, all shift long where as a Paramedic I usually had only one patient at a time.

As far as "picking up skills" go, you could start learning to read things like ECGs but it'll be tough to teach yourself this stuff. Most courses in ECG interpretation (at least those that I've seen) concentrate on teaching you to recognize STEMI and the arrythmias and not much else. There's a whole lot more to reading an ECG than just looking for STEMI and doing rhythm interpretation.

What I would suggest you do more than anything (besides taking A&P) is focusing on sharpening your BLS skills. The reason for this is that the vast majority of patients you'll see as a medic will be at the EMT level. You want to sharpen your skills in moving the patient around. You need to learn all those operational things so that when you do become a Paramedic Student and later become a Paramedic you don't have to learn that stuff. You'll already know it like the back of your hand so you won't be fumbling about how to take a blood pressure while attempting to assess a patient that clearly needs some kind of intervention beyond that of mere hand-holding, positioning/pillows, oxygen, and splinting.
 
Akulahawk said:
I agree... start with a college-level A&P program and I don't mean "Airframe & Powerplant" program either. ;) By taking an Anatomy & Physiology course of study (look at your local RN program as you'll want the same level A&P they require) you'll gain a much greater understanding of how the body works and why so that when you're studying the abnormal stuff in your Paramedic program, you'll understand the why behind the abnormal stuff. This may not seem like much now but you'll start understanding this later on when you are much more quickly able to grasp the significance of some subtle sign you're seeing.

Yes, I'm an RN. This does NOT give me greater abilities than I had when I was a Paramedic... I have the ability to use different viewpoints into patient care than I used to but assessment is assessment regardless of level. It's up to the clinician to be able to make heads or tails of the data gathered. What I do have that Paramedics normally don't is a LOT of backup right at my fingertips. Usually the providers order labs or have protocols that cover lab work so that I have that available to me as well. One last thing that I am developing that Paramedics rarely get to is an ability to prioritize multiple patients. It's the norm for me to have 3-4 patients at the same time, all shift long where as a Paramedic I usually had only one patient at a time.

As far as "picking up skills" go, you could start learning to read things like ECGs but it'll be tough to teach yourself this stuff. Most courses in ECG interpretation (at least those that I've seen) concentrate on teaching you to recognize STEMI and the arrythmias and not much else. There's a whole lot more to reading an ECG than just looking for STEMI and doing rhythm interpretation.

What I would suggest you do more than anything (besides taking A&P) is focusing on sharpening your BLS skills. The reason for this is that the vast majority of patients you'll see as a medic will be at the EMT level. You want to sharpen your skills in moving the patient around. You need to learn all those operational things so that when you do become a Paramedic Student and later become a Paramedic you don't have to learn that stuff. You'll already know it like the back of your hand so you won't be fumbling about how to take a blood pressure while attempting to assess a patient that clearly needs some kind of intervention beyond that of mere hand-holding, positioning/pillows, oxygen, and splinting.
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That is a very long response, I applicate that very much :)

Sorry about the grammar in advance, I haven't slept for awhile.

The basics is not something that I have overlooked, my assumption was that I would become more efficient in those skills the more that I worked regardless of how much time I spent studying. The thing with ECG interpretation is it's something that I could pick up really fast, it's very specific, visual and to the point unlike the A&P which is very broad and I would need to be in a classroom for. My splinting skills are something that need to work on, now that you reminded my I'll try to touch up on that before I'm employed.

Unfortunately I would likely be one of those that have a hard time working with 3 or 4 people at a time, probably comes from training where we had one MCI drill but practiced working with one person every week. I think what I'll do for the basic stuff is make a checklist, Bp and taking a pulse are things that I can do fast but splinting, triage and lung sounds are three things that I can think of right now that would not hurt to touch up on. And it wouldn't hurt to review the chapters on operations.

Anyways I appreciate the response from you and desertmedic66.. I'll try to get some basic grasp on A&P before classes start and even more difficult try to find someone that will let me splint them up.
 
ECG is not something that is fast or easy to pick up. In my medic school we spent well over 200 hours just on ECGs and that made us barely competent at reading them.
 
DesertMedic66 said:
A college level A&P class
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I second A&P. Things started to make more sense to me after I took A&P.

You can take a ECG class if you so desire. I however wouldn't recommend it because its something that you'll learn in medic school. Plus A&P will go into what a P wave, QRS complex and T waves are. Whats depolarizing and whats re-polarizing. I learned the AV blocks: 1st degree, 2nd degree type 1&2, and 3rd degree. STEMI was also taught as well as NSR but I'm not counting those as I already knew what they were. Point is A&P teaches you what the body does and why, its a good foundation for being a solid EMT and I wish I had taken it sooner.
 
Learn how to be a good EMT in those 2000 hours. That's not a smart-*** response, it's actually something you have to put a bit of effort into. Be really good at the operations side of the job. Learn how to talk to other responders, staff, and patients. Get comfortable on the radio. Get used to moving patients without having to spend 5 minutes coming up with a plan. Be able to do a good EMT assessment and be totally comfortable and efficient with the healthy patients that you will no doubt end up transporting many of.

These are all things you do not want to learn while also learning to be a paramedic if you have the time to, and you do because of the hour requirement. Lots of people can get by in paramedic school without this, but you might as well give yourself a leg up. I think my program is awesome and can make most students into a decent medic, but it's pretty nice to not have to worry about little things like how to call a patch or move a patient to the hospital bed.

Take the prereq A and P. My program let you take AP2 after the didactic portion. That' silly, don't do that if it's an option. In the months leading up to the class I memorized most of the drug cards. I didn't really know how to use them, but it made drug proficiency tests much easier to study for.
 
Loki Grim said:
That is a very long response, I applicate that very much :)

The thing with ECG interpretation is it's something that I could pick up really fast, it's very specific, visual and to the point unlike the A&P which is very broad and I would need to be in a classroom for.
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I don't think that EKG interpretation is particularly "specific." Yes you could look at flash cards of different rhythms and learn what the differences are, but I found that this to be less than helpful with my medic program. A good program will start at the beginning and show you why what you see on the monitor happens. This will give you the reasoning skills to work your way through most any rhythm. Also, it is not a quick process.
 
Tigger said:
I don't think that EKG interpretation is particularly "specific." Yes you could look at flash cards of different rhythms and learn what the differences are, but I found that this to be less than helpful with my medic program. A good program will start at the beginning and show you why what you see on the monitor happens. This will give you the reasoning skills to work your way through most any rhythm. Also, it is not a quick process.
Click to expand...
While I tend to agree with this, I must modify things just a little bit. You can learn to interpret the basic rhythms pretty quickly. Unfortunately, it's just the basic rhythms. Once you know how the heart works normally, and why, it's much easier to interpret the not-so-basic rhythms just by looking at them.

If things were able to be done easily and specifically, I could be an expert at ECG interpretation in about 2-3 days and I'd be as good as any cardiologist. Guess what? I'm not that good... even though I'm reasonably good at it. There are many subtleties to ECG reading that I'm still learning and unless I spend quite a bit of time learning to read these things, it's going to take a long time for me to do so. Since I do know the basics and what's normal, I can at least detect that something is different from normal and refer to someone who is more expert than I am at it. Also, just by knowing what was normal, I did manage to get a patient to the cath lab (no major complaints yet) before his heart really started complaining of a problem. Turns out he needed 4 stents... and he may have otherwise been heading out the door to be discharged home if nothing showed itself. Yes, he would have returned soon enough when he started having chest pain/pressure... I call that one a good save through early detection.
 
Loki Grim said:
"A college level A&P class"

I need to do that regardless as a prerequisite, I have a few months to go until I can register for a class. You probably need to know things like how pH effects the body right? I'm trying to find specific skills that I can pickup in the meantime like ECG interpretation.
Click to expand...

As others have said, focus on learning to be a good EMT (patient assessment, primarily - learn to do a good field H&P), and Anatomy & Physiology.

A&P is not something to gloss over. If you take the time to get as much as you can out of the course, you'll have a good knowledge base that will make everything else you learn easier. Including EKG's.
 
I also agree with the folks who have previously said to work at being a great EMT prior to P school. Everyone above has covered the reasons well so I won't repeat them here. That said, if you want to get your P sooner consider going to a different school. Why are you locked in to your location/program? I don't have a lot of time to wait and I certainly don't have time to travel a great distance 2-3-5 times a week for class while working full-time. So I looked for alternatives. I found a couple and picked the one that's accredited and has the best rep/results. I got accepted to NMETC to start in September. So I'll have about 6 months of active EMT experience until then. Didactic is online, practical is on site in MA for 10 days prior to clinicals, then clinicals and field internship locally.

While I absolutely agree with a requirement of EMT experience prior to P school, using an arbitrary limit like 2000 hours has always seemed like a nebulous limitation to me. Some people can become very good EMTs in much less time than that because they put the work in. Some will never become good EMTs no matter how long they work because they never put the effort in. I would argue that if the individual puts forth the right professional effort, you would find them competent and ready to succeed in P school with as little as 500 -1000 hours of EMT experience - maybe less. Just like P school, how far/fast you go is dependent on you. But to think someone is ready just because they've done 2000 hours of ambulance work is ludicrous IMO. They could be a booger-eating troglodyte. Better to assess their ability and make a subjective determination. But I digress...

To follow up some of the other comments, though, they're all good advice. I asked a bunch of people the same questions and received the same answers. So I'm taking the college A&P, I am still getting my AEMT - just to keep me in the learning mode and to knock some of the intermediate skills out before P school. I don't remember the entire slew of stuff the AEMT course covers, but I know IV admin is hit, IO is covered, and supraglottic airways. In my area, AEMT's are allowed to do ET's, too, so I may have that done. Not sure. As mentioned, I am working as an EMT. I had my wife line out the pharmacology stuff that needs to be memorized (she's a RN), so I'm doing that during my drives to/from work. Learning classes, actions, routes, doses, indications, contraindications, etc. It's a crap-ton of info to memorize - and the only aspect of it that's likely to be different in P school is the dosing! So why not learn all the drug "facts" beforehand rather than have to cram it in during P school?

Anyway, just a few thoughts. Take them for what they are - words on a screen. I'm new too, and I'm sure lots of folks may disagree with my approach. That said, it works for me.
 
DesertMedic66 said:
A college level A&P class
Click to expand...

This. If you can get into a nursing pharmacology class I would do that as well! Pathopharm too depending on how much time you have.
 
I'd recommend working on your patient assessments and the protocols for common calls.
Each time you're bored/have some free time... try writing out in bullet points how you're going to treat your patient. 'Shortness of breath' or 'chest pain'- write an A to Z protocol covering what you're going to ask and what interventions you'd apply. Also learn common medications patients tend to be on.
 
In addition to the A&P class, id also recommend that you take a microbiology class. It helped me immensely during paramedic school.
 
Much what is above about A&p and such is what I would also agree with.

And now I am going to say something I wish I had been told before my training.

There is such a thing as too much enthusiasm in the pursuit of getting that jumpstart. I noticed some social and training related obstacles to both my class and my preceptors because I was quick to discuss a new technique or study and was not concentrating on setting the foundation. I was not wrong necessarily, but my timing was. As a student, focus on being a student and try to learn along with your class despite the feeling to explore further. I am not saying close your eyes and don't seek out information, I am saying that should you want to dive deeper into a topic, do it along the timeline of your program and do it with the conscious thought that those around you may not be as poised to digest all the new and exciting stuff you have learned or have seen.

This may not even apply to you but it may to someone else. Be humble, be a student, and keep your fire burning bright enough so that when you do finish, you can read and explore whatever you like on the tenets of your personal license.

You may find that sitting in the ECG portion of your training, and not knowing much, might be more enjoyable. Conversely you might sit there and battle your brain against the 2 or 3 or 10 inaccuracies that you perceive during lecture.

Best of Luck.
 
You don't need to worry about trying to learn things like EKG's and all that. When they say that you should take a college level A&P, it's because they're right. A&P builds on EVERYTHING you are going to learn. Pharm? Calcium Channel blockers. EKG? There are the pathways and electrolye balances. Medical conditions such as diabetes, renal failure, etc which will also tie in to your pharm. If you have a solid A&P foundation, so many other things will make a lot more sense. Things like EKG's are easy to learn the basics of, so don't worry about that.
 
I agree with what the majority have said so far. I would invest my time in anatomy and physiology. If possible, you could have a more in depth anatomy and physiology knowledge if you study other science based courses such as biology and chemistry, but it is not necessary to be an expert in these subjects to learn a decent amount of anatomy and physiology.

I love ECGs! That said, I personally consider it low yield/not very rewarding. In my opinion, most paramedics (or even healthcare providers in general) aren't very good at ECG intepretation. For this reason, I feel like your future field training officers, CES department, and so on won't recognize if you are deficient in ECG intepretation. If you play it on the safe side and "treat the patient, not the monitor" (makes me cringe to say it) you are probably still going to be okay.

Real ECGs can be hard to interpret. It can be hard to get a clean 12-lead. ECGs can have many abnormality combined making it more difficult to interpret. I think the best thing for new people to do when learning ECGs is not to focus on interpretation at all. Instead they should focus on the individual details eg

What's rate?
Is it regularly regular?
Are their p-waves?
If so, are the p-waves associated with QRS complexes?
etc...

Doing it this will set up for being good at recognizing details and making good intepretations.

I consider it a newbie mistake to make an intepretation withoug ever looking at these details. I am okay with making an initial intepretation/form a general impression of the ECG initially... it may dictate what order I look at the ECG eg if the rate is fast like >130 and looks funny to me, I'll look at the inferior leads and V1 for signs of atrial flutter because I will be thinking atrial flutter already, but people often make interpretation based on what it looks like at a glance and stop there without breaking it down further to confirm.

Sometimes I can go through all of that and still not be confident in an intepretation. In my opinion, that's okay. I don't think it is possible at my level to make a good intepretation. I am okay with saying "I don't know" when it comes to ECGs.

Picking up subtle details and coming up with intepretation (eg figuring out the rhythm, spotting a STEMI, recognizing abnormalities and associating them with something eg epsilom wave, Brugada, etc) will come with time and practice. There are lots of things you can see in ECGs, but a lot of them probably won't be appreciated by your future FTO, CES, etc. and you will likely not have the capability to do somethinf about what you see anyway.

Good luck.
 
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