Looking for some advice

Status
Not open for further replies.
PapaBear434 said:
Taking a proper assessment and knowing what questions to ask, mostly. Moving a patient, properly driving the rig L&S, dealing with a wide array of patients, and generally seeing things in real life. Seeing SVT in real life is a lot different from just reading it in a book.
Click to expand...
Since you have not put anything about your level of practice or education (or anything else for that matter) in your profile, you'll have to excuse us for having to make assumptions. But if you think you really learned anything about proper assessments in EMT school, that would suggest that it is the only level that you have attained. Assessment in EMT school is nothing but vital signs and asking a bunch of questions that you are not taught the relevance of, much less how to interpret the answers. And I have yet to see an EMT school that teaches anything about assessment or SVT that is not taught and practiced in paramedic school. And if you think that reading a book is all you learn about SVT in paramedic school, that is further evidence that you know nothing about paramedic school.

Moving a patient and driving L&S are indeed learned with experience. What I do not understand is what leads you to believe that this experience is essential to have before you attend paramedic school. It's as if you believe that, once you enter paramedic school, you no longer run emergencies or see patients. There is simply no logic to this assumption. None. It's just that, an assumption. And in over twenty years as a paramedic educator, I have found it to be a completely invalid one.

Reaper is absolutely correct. There is nothing positive learned as an EMT in the field that puts you ahead of an inexperienced EMT as a paramedic student. And if it is taking you years of experience to figure out how to do any of those basic skills, you probably are not cut out to be a medic.
 
Last edited by a moderator:
BossyCow said:
And yet another thread in the BLS forum morphs into ALS
Click to expand...

Bossy the person asked a question and the answer was given. As the various points to that answer are debated it is hard not to include discussion of ALS because that is what his question related to.
 
Seriously. There was no morphing involved. It was asked as an ALS educational question in the first place. I suppose we could have ignored his question and told him all sorts of happy things without ever addressing his concerns, but that wouldn't be very neighborly.
 
in MA as of now there are no accredited paramedic training programs. As of 2012 you will not be able to become NREMT certified as a paramedic unless you are graduating from an accredited program. NEEMSI in Manchester (NH) is accredited and approved by MAOEMS. I've heard good things about it, but that's coming from a small sample size, and I don't' know how reliable that is.

Unfortunately that is not a degree program. Northern Essex has an AS program including most of the classes you were advised to take earlier, but it's not accredited. That said, the rule requiring accreditation by 2012 is pretty new, and I can't imagine they wouldn't become accredited, so you might want to call and ask if they plan to go through the process. Same story for the other community colleges around.

I don't think you should worry about working as an EMT (I've got far less experience than Rid or many of the others, but I'm familiar with your area). You'll get just as much exposure during your clinicals in hospital and in the field. Go for the medic right away.

Where you are unless you volunteer the only sort of experience you'll get as an EMT is doing IFT's and maybe the very odd 911 call. That's certainly useful in terms of getting used to dealing with patients and other providers and doing assessments, but far from irreplaceable. The BLS 911 jobs (on ALS crews) will generally go to the EMT's with years in, from what I've heard. Where are you going to be "getting your experience" over the next 7 months?
 
AJ Hidell said:
Since you have not put anything about your level of practice or education (or anything else for that matter) in your profile, you'll have to excuse us for having to make assumptions. But if you think you really learned anything about proper assessments in EMT school, that would suggest that it is the only level that you have attained. Assessment in EMT school is nothing but vital signs and asking a bunch of questions that you are not taught the relevance of, much less how to interpret the answers. And I have yet to see an EMT school that teaches anything about assessment or SVT that is not taught and practiced in paramedic school. And if you think that reading a book is all you learn about SVT in paramedic school, that is further evidence that you know nothing about paramedic school.

Moving a patient and driving L&S are indeed learned with experience. What I do not understand is what leads you to believe that this experience is essential to have before you attend paramedic school. It's as if you believe that, once you enter paramedic school, you no longer run emergencies or see patients. There is simply no logic to this assumption. None. It's just that, an assumption. And in over twenty years as a paramedic educator, I have found it to be a completely invalid one.

Reaper is absolutely correct. There is nothing positive learned as an EMT in the field that puts you ahead of an inexperienced EMT as a paramedic student. And if it is taking you years of experience to figure out how to do any of those basic skills, you probably are not cut out to be a medic.
Click to expand...

I practice as an EMT-B right now, working on my ALS qualifications with a preceptor right now, thanks. But as you seem outwardly hostile to me (for being a volunteer rather than taking a stand and refusing to work until I get paid or having the audacity to say that BLS is just as important to the EMS service as paramedics, I suppose), I'm just going to cease discourse with you for a while.

Nothing personal, you understand. But this place is a great resource for information for me, being a student, and I'd rather not receive a ban for getting dragged into constant conflicts with you. So until you can get over your undeserved righteous indignation and just have a certain level of civil discourse, I think I'm just going to back off for a while.
 
Your loss.
 
I thought the same as you in regards to having BLS experience before going to paramedic school...but all it really did was prevent me from learning more - and properly. The problem with some of the medics out there is that they have developed bad habits, ones you will invariably learn while working alongside them over time. You will get plenty of experience as you do your clinical time. I wouldn't worry too much about the driving part...that stuff is rather easy. Lastly, find an accredited medic program, and absorb it. Immerse yourself in the study and devote your life to it. You will be a better clinician for it. Shop around for a medic class like you would buying a car. Ask other providers for their recommendations, go online and look around, etc. Just don't pick one class over the other because it's shorter or easier...your career will suffer for it. Put in the extra time and effort now...reap the rewards later.
 
el Murpharino said:
I thought the same as you in regards to having BLS experience before going to paramedic school...but all it really did was prevent me from learning more - and properly.
Click to expand...
For the record, just like Murph, I believed all that too at one point. And my development also suffered for it. With real education, you finally learn how wrong you were. Hopefully.
 
el Murpharino said:
I thought the same as you in regards to having BLS experience before going to paramedic school...but all it really did was prevent me from learning more - and properly. The problem with some of the medics out there is that they have developed bad habits, ones you will invariably learn while working alongside them over time. You will get plenty of experience as you do your clinical time. I wouldn't worry too much about the driving part...that stuff is rather easy. Lastly, find an accredited medic program, and absorb it. Immerse yourself in the study and devote your life to it. You will be a better clinician for it. Shop around for a medic class like you would buying a car. Ask other providers for their recommendations, go online and look around, etc. Just don't pick one class over the other because it's shorter or easier...your career will suffer for it. Put in the extra time and effort now...reap the rewards later.
Click to expand...

Like I said, but maybe it was in another thread, that it all depends on who you are as a person, what you thrive on, and what your area is set up around. My area is a very densely populated area with a lot of traffic. Driving isn't as easy as you would imagine, what with having to navigate crowded streets, underwater tunnels, bridges, airport standbys...

And in my area, medics are told to tell the BLS what they are doing, and why, so not only do they learn but it acts as a witness of record. Someone to back you up as to what you were doing.

However, some areas may not be set up this way. Understandable, as EMS is a very fractured division of the medical community and there really isn't a national standard, despite the National Registry's best efforts. Thus, if the "zero to hero" route works for you due to your personallity, your area, or any other reason, more power to you. I'll see you out on the road just the same, no matter how we choose to get there.

I don't see what the big deal is, really. The extra two months it took me to run as a trainee and get released EMT-B within my agency certainly didn't hurt my knowledge. It certainly didn't act as a detriment to my patient care to learn how to deal with different personalities, situations, protocols, and yes, even how to drive something with the approximate weight distribution and dimensions of an oversized can of Spam at high speeds through dense traffic. But I imagine the flip side would be true as well, that NOT taking that extra two months to master the "menial" work that a particularly smart monkey could do isn't going to hurt you either. It's something that can be picked up along the way during clinicals and experience after the fact.

Just because people may be doing it slightly different from you does not mean they will end up a terrible medic. Hell, they might end up better than you. Just so long as they meet the same qualifications and levels of knowledge, what does it matter that they decided to take an extra couple weeks to work the basics down?

Bottom line: For some people, getting general experience as a basic will help them. For others, it won't do a damn thing but waste their time. Which one you are depends on you alone.
 
Just for clarification and to educate the NREMT has NO standards and yes, there is a National Standard. The national standards are called the NHTSA EMT curriculum, etc. In fact new standards are to be released this year.

Just to keep the information correct.

R/r 911
 
Ridryder911 said:
Just for clarification and to educate the NREMT has NO standards and yes, there is a National Standard. The national standards are called the NHTSA EMT curriculum, etc. In fact new standards are to be released this year.

Just to keep the information correct.

R/r 911
Click to expand...

I stand corrected. I just got that newsletter and read up on it myself. What I was referring to was the fact that so many agencies can have so many different protocols and even states can have completely different qualifications. Here in Virginia, we have EMT-E, that is a step below EMT-I that allows for IV access, certain basic drugs like D50, Epi, and the like, and intubation. My agency, however, doesn't let them intubate, even though the state itself does. Back in my home state of Michigan, they teach intubation to Basics and individual agencies decide if they are allowed to do it depending on the rural nature of the area. Which, for the record, I believe is wrong. Intubation is WAY to invasive a procedure for Basics to be doing...

So, bad phrasing on my part. But my overall point of having a few months of training vs. going all the way to paramedic before running remains valid, no? Then, seeing your background in nursing and your previous posts, you strike me as an "All or Nothing" type of guy. Nothing wrong with that, but I just don't think it matters that much. So long as you don't spend years at the Basic level, that is. I do know those that have done that, and they have made pretty luke-warm medics in my newbie opinion.
 
Last edited by a moderator:
No problem, but too many place emphasis upon the NREMT' when in fact they are just a testing organization and that's all folks! Yes, they attempt to make recommendations (as many other national organizations does as well) but their only existence is to test.

You brought up the problem with EMS and why they (NHTSA) is attempting to remove some of the 100+ acronyms for EMT's. As long, as EMT's allows excuses for obtaining levels; states will develop titles.

R/r 911
 
Ridryder911 said:
No problem, but too many place emphasis upon the NREMT' when in fact they are just a testing organization and that's all folks! Yes, they attempt to make recommendations (as many other national organizations does as well) but their only existence is to test.

You brought up the problem with EMS and why they (NHTSA) is attempting to remove some of the 100+ acronyms for EMT's. As long, as EMT's allows excuses for obtaining levels; states will develop titles.

R/r 911
Click to expand...

We meet our middle ground, it seems. I would LOVE to see it uniform across the nation in the way that LPN and RN are. Three levels are fine, two would be better. But I also recognize that until pay goes up, it's going to be a hard press to get people to dedicate three years of their life and incessant amounts of hoops to jump through to get their Medic for such a small return. So until that time, volunteers at the Basic level are going to be needed to pad the lesser, more BS taxi calls to keep the Medics like yourself and my future self free for the more important, emergent calls.

I said it in another thread, but what I'd love to see is medic level training being similar to RN or even nurse practitioner, given treat-and-release powers and the ability to supply certain meds within standing orders and medical control, such as antibiotics and the like. Cut down on the ER being tied up, cut down on the amount of time that is tied up in transport of non-emergent cases... But unless Universal Health Care becomes a reality, allowing funding for these trauma-nurses on wheels, I don't see it happening.
 
PapaBear434 said:
I said it in another thread, but what I'd love to see is medic level training being similar to RN or even nurse practitioner, given treat-and-release powers and the ability to supply certain meds within standing orders and medical control, such as antibiotics and the like. Cut down on the ER being tied up, cut down on the amount of time that is tied up in transport of non-emergent cases... But unless Universal Health Care becomes a reality, allowing funding for these trauma-nurses on wheels, I don't see it happening.
Click to expand...

At this time a two year degree is reachable but not likely anytime soon across the U.S.

To prescribe meds, a DEA number must be approved for that profession. Until there are standard and higher education requirements, that will not be likely. There are two physician extenders, NP and PA, that have stepped up to the challenge by extending their education with many states requiring a Masters degree for these professions. Their education options have prepared them for either family practice or specialty including emergency medicine. Their national organizations have and are working together to find solutions for various health care situations. EMS providers are still squabbling amongst themselves about what to be called and how many "certs" or which service is better.

Non-emergent calls are also considered "BS" to many in EMS. Those that flock to EMS for the L/S glamour are not going to be happy spending shift after shift taking tempatures and prescribing antibiotics to runny noses. If they are annoyed and bored with BS calls now, what happens when they become a focus of EMS providers? What happens to the word "emergency"? Will there still be people wanting to be Paramedics without all that exciting stuff? And where does that leave the FDs and ambulance services who depend on quick education to get Paramedics on trucks? Is a Masters degree like the NP and PA an overkill for what a Paramedic is actually used for in emergencies? It will be a long time before EMS can change its attitude and focus as the NP and PA already have. Their strong national organizations have given them strength and unity as well as an acceptance by good PR with issues that appeal to the public as not being self serving.
 
PaulieThePirate said:
Most tell me that I’m to new to the field and that I should get more experience first.
Click to expand...
It's one of the most debated topics on this and other EMS-related forums.
I've been puzzled with the same question for a while and the more people I ask, the less I'm sure about the answer. I personally know EMS educators who told me what Rid said, and I know some who tell me to wait. I know medics who went straight to medic school and who feel it was the right choice, and I know medics who later wished they had more experience before that. Whatever you do, there will be enough people saying you made a bad choice.
 
I find it amusing that we are "squabbling" about a two year degree and want to "save" the Paramedics for the real thing. Especially since the P.A. and N.P. are usually focused to diagnose and treat those .."B.S." illnesses and they require master degree and now the the Nurse Practitioner will require a Doctorate degree in the near future.

Again, EMS demonstrates that they have no concept of what medicine really requires or has the basic knowledge of health care.

Whom is to say what compose of those B.S. calls are really? A person that attended a two week night school or one semester of a Vo-Tech? Would entrust your child health with such a person?For example; if your child was ill and you took them to the clinic and was dx. with otitis media (inner ear infection) and within 24 hours your child was dead because it was really meningitis; your opinion of the need to differentiate would be different. You see one is very simplistic and one is life threatening, unfortunately many of the times they are very similar in presentation in signs and symptoms.

Here is the problem. As economic problems increase, more and more people tend to not go to see their PCP and follow ups. This will be increasing not only to related economic problems but the baby boomer age increases the number of patients will not only double but triple. Our role not will only have to change but is going to change. EMS will no longer be used just for emergencies. Our whole system will be going through a major overhaul. I predict the name of EMS will even be abolished. As more cities evaluate their budget of what is needed they will explorer what they can to maintain their services.

Anyone that has real experience in medicine recognizes it is not the medical community that ensures changes, rather those that hold the financial purse. The payers from the insurance companies and government funding are the major predictors of how medicine is performed and provided, and guess what; they are not happy about EMS.

Paying several hundred dollars to a thousand for a taxi ride; provided by a person that attends less school than a manicurist is not what they want anymore. Even if your service is volunteer; someone pays for it albeit taxes, federal reimbursement, etc.

If you have not reviewed the new NHTSA Paramedic curriculum; I suggest you do so. One complete section is over Public Health and another focuses upon specific elderly care and those of "special needs". Discussion of working and interacting with social workers and discharge planners will be addressed.

At this time, when hospitals and especially Emergency Departments are maxed out and there is NO room and waiting times are now an average based upon hours, not minutes.. so you see where the need and where the solution might be aimed at?

No, Paramedics are NOT qualified to assess and screen the majority of the illnesses out there and where do you think this places the EMT level? Yes, there will always be the need for the EMT. This again is the debate that many want to accept but the role will be strictly as a first response agency or in remote areas as the only first treatment available.

The main point, cities will evaluate what will provide for their citizens with the biggest bang and the cheapest buck. Insurance/Medicare would rather pay $500 for an evaluation and minor treatment than $500 for a taxi ride then another $1000 for an unwarranted ER visit.

The great momentum of the Fire Services attempting to incorporate EMS as a fund raiser and escape to maintain status quo will soon be over. Most of those entering Fire Services never really planned to enter the health care provider profession, and the Fire Service recognizes that it is over its head in this area. With cities eyeing any possibility to save its services, they will have to focus upon just justifying fire protection itself.

I do NOT believe it is in the far future. My state (which is primarily rural) is reviewing Advanced Paramedic Practitioner programs. American Ambulance Association is definitely excited about Medicare's approval for "consultation" fees. New technology with video and more in-depth medical telemetry will expand the assessment and treatments, the future is endless.

It will not be "us" that will change it, rather the ones that hold the "purse strings". I do believe we will see a major paradigm shift, and states like Florida, California will be scrambling to change. they may grumble and fight but their hearts will follow the $$$

R/r 911
 
Mr. Paulie, I can only offer you purely anecdotal experience, but as an EMT who went directly into medic school (And will be finished in a little over two weeks.) and worked in the field while attending medic school, I found that my experience in the field did nothing to enhance or supplement my medic school education. If you've had a good solid Basic course, and you do your work in medic and not play around, you'll be fine going directly into school. I don't regret it.
 
Sasha said:
Mr. Paulie, I can only offer you purely anecdotal experience, but as an EMT who went directly into medic school (And will be finished in a little over two weeks.) and worked in the field while attending medic school, I found that my experience in the field did nothing to enhance or supplement my medic school education. If you've had a good solid Basic course, and you do your work in medic and not play around, you'll be fine going directly into school. I don't regret it.
Click to expand...



I agree with this. I think you should go for it.
 
Foxbat said:
I personally know EMS educators who told me what Rid said, and I know some who tell me to wait.
Click to expand...
When evaluating this advice, it is important to know exactly who is giving it. That means it is important to differentiate between real "educators" and those who are just common "instructors". Those who have no more education or training than those they are attempting to teach are rarely "educators". They're just parroting whatever was taught to them with no more understanding than they are giving you. Those with actual education (as opposed to training) know a little more about educational theory and understand the concepts that maximize the process. Those who know nothing more than what they learned at their tech school and week long instructor's course generally have very little clue about the concepts of adult education, and are much less qualified to advise you on that process. Consequently, you get people telling you to do what they did, not knowing any other way.

Do not fall into the trap of putting all paramedic instructors up on a pedestal, as if they hold some magic keys to enlightenment. The sad truth in this country is that most of them know nothing more about medicine, education, or even EMS than you will after a year of medic experience. They just, for some reason, are in a classroom instead of an ambulance. This is one of the things that will be changing with the 2012 requirement for accreditation. More schools will have educators on staff instead of just a bunch of patches with an instructor card. Of course, if you are not in an NR state, you will not benefit from that. And I expect to see states leave the NR system just to avoid having to improve their educational standards. Very sad.
 
Status
Not open for further replies.
Back
Top