Outside the EMT Book, What we SHOULD HAVE learned

[RanchoEMT]

Can you guys shed some light on some medical problems/issues that commonly pop up but are not within the EMT scope of knowledge?(What we were not taught in EMT school)?

i.e. Low Hemoglobin Level(associated with anemia)- Probable Iron deficiency or if post surgery probably means an internal bleed. Male= 14-18 Women= 12-16 Child= 11-13

Thank You Preemptively.

 

[thegreypilgrim]

Let's see, prior to being able to practice prehospital medicine, we should probably learn:

General Chemistry
General Biology
Introductory Physics
College Algebra
Gross Anatomy
Physiology
Microbiology
General Psychology
Lifespan Development


Then, I guess if you want to learn about specific disease processes this is good:

 

[Lola99]

Let's see, prior to being able to practice prehospital medicine, we should probably learn:

General Chemistry
General Biology
Introductory Physics
College Algebra
Gross Anatomy
Physiology
Microbiology
General Psychology
Lifespan Development

My pre-reqs for medic include:
College Algebra (M014+), Anatomy (A215) Physiology (P215), Psychology (P100+), Lifespan Development (Not prereq, but recommended -F150), EMT-B, Elementary Composition (W131), Oral Communication (C121,122), and Sociology (S100) off the top of my head.

I can see introductory physics, but beyond that, I'm not sure.
Microbiology, hmm... not sure about that one.

I defffffinitely think there needs to be more education pre-field though. DEFINITELY.

 

[thegreypilgrim]

My pre-reqs for medic include:
College Algebra (M014+), Anatomy (A215) Physiology (P215), Psychology (P100+), Lifespan Development (Not prereq, but recommended -F150), EMT-B, Elementary Composition (W131), Oral Communication (C121,122), and Sociology (S100) off the top of my head.

Cool. Nice to see a forward-thinking paramedic program in the US that values a broad education.

I can see introductory physics, but beyond that, I'm not sure.
Microbiology, hmm... not sure about that one.

Surely, foundational knowledge of microscopic life is essential to understand infectious disease? I can definitely see the benefit of that.

I defffffinitely think there needs to be more education pre-field though. DEFINITELY.

+1 for truth.

 

[Lola99]

Surely, foundational knowledge of microscopic life is essential to understand infectious disease? I can definitely see the benefit of that.

Don't get me wrong. The more education, the better IMO, but I also think EMS needs to stay EMS. If we get too bogged down with knowing every little disease, I feel like we're going to lost sight of the things we can actually deal with. It's like a balancing game.
I'd always err on the side of education though, so on second thought, I agree.
If you start suggesting A&P400-something though, then I'll start to question.

 

[thegreypilgrim]

Don't get me wrong. The more education, the better IMO, but I also think EMS needs to stay EMS. If we get too bogged down with knowing every little disease, I feel like we're going to lost sight of the things we can actually deal with. It's like a balancing game.

I hear you, but what exactly do you mean by "EMS needs to stay EMS"? Surely, you're aware that the current model of EMS in the US is untenable? It was designed to mitigate the problems of accidental or otherwise out of hospital death from 30-40 years ago. Public health measures have done more for those problems than EMS, as it turns out though. As a result, the only things we can actually deal with in EMS (the true "life-threatening emergencies") only account for about 10% of our call volume (probably less).

It follows EMS has little of any substance to offer the vast majority of patients who access its services (as I'm sure you know, starting a line, putting someone on the monitor, and driving them to the nearest hospital is fairly representative of what we do on most calls and this really does not contribute much to the patient's overall outcome). We then bill insurance for some outrageous amount (probably >$1000) to cover the cost of our service. How is that a fair deal? Eventually insurance will catch onto this and just refuse to even consider payment of such an invoice.

EMS needs to become something else with much greater capabilities, I think, if it is to continue to exist.

I'd always err on the side of education though, so on second thought, I agree.

Cheers.

 

[Lola99]

I hear you, but what exactly do you mean by "EMS needs to stay EMS"? Surely, you're aware that the current model of EMS in the US is untenable? It was designed to mitigate the problems of accidental or otherwise out of hospital death from 30-40 years ago. Public health measures have done more for those problems than EMS, as it turns out though. As a result, the only things we can actually deal with in EMS (the true "life-threatening emergencies") only account for about 10% of our call volume (probably less).

It follows EMS has little of any substance to offer the vast majority of patients who access its services (as I'm sure you know, starting a line, putting someone on the monitor, and driving them to the nearest hospital is fairly representative of what we do on most calls and this really does not contribute much to the patient's overall outcome). We then bill insurance for some outrageous amount (probably >$1000) to cover the cost of our service. How is that a fair deal? Eventually insurance will catch onto this and just refuse to even consider payment of such an invoice.

EMS needs to become something else with much greater capabilities, I think, if it is to continue to exist.

Cheers.

I think it needs to evolve with the times, yes. I'm very aware (though I'm a full-time college student and don't work much and when I do, usually non-emergent) that most calls don't really require an ambulance, but to those patients that do, they're very glad we're there.
EMS needs to stay EMS as in it needs to fulfill that prehospital purpose, keeping with the times, of course (and though I won't say we're failing, we're definitely not in peak condition).
Meanwhile... I'm off to class. We should probably un-hijack this thread. PM me if you want to keep the discussion going later?

 

[JPINFV]

I think it needs to evolve with the times, yes. I'm very aware (though I'm a full-time college student and don't work much and when I do, usually non-emergent) that most calls don't really require an ambulance, but to those patients that do, they're very glad we're there.
EMS needs to stay EMS as in it needs to fulfill that prehospital purpose, keeping with the times, of course (and though I won't say we're failing, we're definitely not in peak condition).
Meanwhile... I'm off to class. We should probably un-hijack this thread. PM me if you want to keep the discussion going later?

Should the fire service be doing inspections, preventions, and advocating for better building codes since it's original purpose was to fight fires, not engineering?

 

[socalmedic]

besides anatomy and physiology i feel the microbiology was one of the best classes that helps me as a paramedic. i feel that it should be a pre-req for all paramedic programs.

 

[RanchoEMT]

Update.

Guys, I guess I missed the point in OP, What small things are good to know at the EMT knowledge level, im not asking for very general "take biology, chemistry, A&P" I was asking for one or a few of your guys' tips/advice on the little things that pop up every now and again.
Example:
What a low hemoglobin level means?
...Or if a drug has "lol" in its name or "stat" what does it mean?

Again, the time will come when i read and take pre-medic courses, but i'm looking for the little tid bits that you guys found useful or had to figure out on your own.
Example:
1.)"If your patient has severe facial trauma, look for bubbles, that's where the airway is."
2.)"If you can't auscultate and hear anything because the unit is moving, take your foot off the ground and put it onto the gurney."
3.)"Skins DON'T lie, during assessment"

you know..... from a vet to a noob ...stuff like that......

 

[socalmedic]

all the little tidbits you could ever ask for...are covered in those classes posted above. there is not much else to say other than if you take one class per semester you will be much more prepared than your counterparts.

if you want to know about drug suffices (-lol, -ine) take a pharmacology class, not only will you know what they are, but what they treat, how they interact with each other. goldenwest college has this class ONE NIGHT per week. yea it may be an hour drive for you but it is well worth it.

knowing why your septic patient has a BP of 60/palp and is flushed, take microbiology, you will learn all about infectious diseases, including why gram negative sepsis yields these assessment findings.

the list could go on and on, I know you are only looking for snipits of info but the info you are looking for is best shown not told. i know there are plenty of medics in rancho who are willing/want to mentor h34r:, let one of them take you under their wing and show you everything they know. never be afraid to ask questions on scene. if any of the Rancho fire medics give you crap tell all 10 of them to go sit in the engine. and lastly, find a good anatomy and physiology, none of this intro crap or AP for medics, look into loma linda or UCI and get into a real class with cadaver dissection.

 

[firetender]

I'll list TEN and hope you get the point:

Can you guys shed some light on some medical problems/issues that commonly pop up but are not within the EMT scope of knowledge?(What we were not taught in EMT school)?

1) If the protocol says "this" and my gut says "that", which should I follow?
2) How should I handle my burned-out partner when he/she consistently delivers lousy care to the patient?
3) If ER personnel are obviously breaking the continuity of my care by making remarks that scare hell out of my patient, or handling the traumas with less care than myself, should I step in and advocate for the patient?
4) How do I define "overtreatment"? What are MY limits and boundaries?
5) I flew off the handle at a "faker". Nobody saw me. Should I talk to someone about this?
6) That code should never have been worked up; HOW do I tell my partner?
7) How do I figure out who here I could talk to if I really felt like crying?
8) Should I avoid talking to my significant other about my work or should I gradually let him/her in to the level of his/her comfort?
9) What is the call that would be most likely to freak me out?
10) When does doing this become too much?

These medical problems/issues are the ones that affect YOUR health; therefore ability to do the work.

 

[clibb]

Personally, I think we should learn some of the most used Paramedic drugs and dosages as an EMT-B. I do ALS assist here since we run EMT-B and EMT-P. I've had to learn a lot about the drugs so that my assist with be as spot less as possible.
EKG- Basic for EMT class.

 

[tacitblue]

Transient global amnesia. Just a fun one to research. I have encountered it twice. The first time, I thought it was a stroke. The second time it was glaringly obvious. Clinical education is so important to build a library of patient contacts to draw from in your future practice. Make sure your paramedic program has strong hospital affiliations and aggressively seek learning opportunities.

 

[Sam Adams]

Can you guys shed some light on some medical problems/issues that commonly pop up but are not within the EMT scope of knowledge?(What we were not taught in EMT school)?

i.e. Low Hemoglobin Level(associated with anemia)- Probable Iron deficiency or if post surgery probably means an internal bleed. Male= 14-18 Women= 12-16 Child= 11-13

Thank

 

[medicRob]

medicine.

 

[MasterIntubator]

1) If the protocol says "this" and my gut says "that", which should I follow?
2) How should I handle my burned-out partner when he/she consistently delivers lousy care to the patient?
3) If ER personnel are obviously breaking the continuity of my care by making remarks that scare hell out of my patient, or handling the traumas with less care than myself, should I step in and advocate for the patient?
4) How do I define "overtreatment"? What are MY limits and boundaries?
5) I flew off the handle at a "faker". Nobody saw me. Should I talk to someone about this?
6) That code should never have been worked up; HOW do I tell my partner?
7) How do I figure out who here I could talk to if I really felt like crying?
8) Should I avoid talking to my significant other about my work or should I gradually let him/her in to the level of his/her comfort?
9) What is the call that would be most likely to freak me out?
10) When does doing this become too much?

One would think that these are all answered in school and the job, I know around here each one of those and more have come up and are in our guidelines. Unfortunate that the standard varies so much.

One area lacking in many services is a good set of work ethics and compasion. Not all are good at it, but it should be one thing stressed in school.

 

[firecoins]

Criminology 101 & Fire Science 101 since we work along side police, respond to potential crime scenes, fire scenes, HIPPA versus investigating police and quite possibly be a dual PD/FD/Medic.

Legal Writing 101 fir reports.

Emergency Management 101

 

[firetender]

One area lacking in many services is a good set of work ethics and compasion. Not all are good at it, but it should be one thing stressed in school.

I see it as solvable from a different angle.

All this stuff is about the art of living within the context of the work being done. If you have to go to school for it, you'll be given pat answers and more protocol. But if such stuff were regularly and openly discussed by the practitioners involved, which is NOT part of the culture, medics would be working this stuff out with each other.

 

[Ghost]

1) If the protocol says "this" and my gut says "that", which should I follow?
2) How should I handle my burned-out partner when he/she consistently delivers lousy care to the patient?
3) If ER personnel are obviously breaking the continuity of my care by making remarks that scare hell out of my patient, or handling the traumas with less care than myself, should I step in and advocate for the patient?
4) How do I define "overtreatment"? What are MY limits and boundaries?
5) I flew off the handle at a "faker". Nobody saw me. Should I talk to someone about this?
6) That code should never have been worked up; HOW do I tell my partner?
7) How do I figure out who here I could talk to if I really felt like crying?
8) Should I avoid talking to my significant other about my work or should I gradually let him/her in to the level of his/her comfort?
9) What is the call that would be most likely to freak me out?
10) When does doing this become too much?

These medical problems/issues are the ones that affect YOUR health; therefore ability to do the work.

I think these are the very things that many to most EMS workers come across and I feel that it's definitely something that all newer EMS workers should brainstorm ideas about. Put yourself in these positions and make an effort to plan upon them.

Therefor when the time comes you'll have somewhat of an ideal way to work with or around these situations. The things that you can't control just may be the thing that breaks or makes your career as an EMS worker.