Should EMT even be a prerequisite to paramedic?

[teedubbyaw]

It is an if this do that education.

100% correct on that.

 

[NYMedic828]

100% correct on that.

Which is contrary to the concept of paramedic

In my eyes, that means an EMT class teaches the opposite of a paramedic program.

(I'm not saying many paramedics are ultimately better than a line cook but they are meant to be)

 

[Tigger]

I see no reason why the paramedic course course needs EMT as a prerequisite. I would like to paramedic programs revamped so that after a bit of schooling students could begin to do clinical time on the ambulance during the didatic portion. This would be in addition to a final "full scope" clinical period at the conclusion of the didactic period. As mentioned, this is how it is done at degree based programs in AUS and NZ, which I think is more effective.

 

[TheLocalMedic]

Where I'm at there's even a prerequisite for EMT called 'First Responder', and to enter the medic program you must pass the First Responder and EMT classes as well as completing an A&P course and a basic arrhythmia course.

Yet I posit that even this isn't enough. I think that any student who wishes to become a medic should also be required to have 2 years of field experience as an EMT in a 911 system (so BLS transfer companies wouldn't count). Yeah, there are things you may be told at the EMT level that you "unlearn" as a medic, but I think that working as an EMT is invaluable for a number of reasons...

1. You have the opportunity to work with a lot of different medics and get to see different styles of practicing medicine.

2. You gain an understanding of what it is like to be an EMT and assisting a medic. When you are a medic this helps you to understand the potential limitations of your partner as well as understanding how they may see you.

3. Being an EMT helps you stay humble. Having a very limited scope and number of tools available to you gives you an appreciation of how much is available to you as a medic.

4. Having EMT experience helps you learn so much about the ALS game and how a medic is supposed to operate that it really gives you a leg up when it comes time to go into your internship. I recall that the only people in my medic program that had a difficult time were the ones that lacked any EMT experience.

Anyhow, these are the thoughts running around in my head that I thought I'd air. I'm sure there are other benefits to being an EMT that I'll remember later...

 

[Christopher]

Where I'm at there's even a prerequisite for EMT called 'First Responder', and to enter the medic program you must pass the First Responder and EMT classes as well as completing an A&P course and a basic arrhythmia course.

We're EMT + A&P minimum.

Yet I posit that even this isn't enough. I think that any student who wishes to become a medic should also be required to have 2 years of field experience as an EMT in a 911 system (so BLS transfer companies wouldn't count).

My industrial fire brigade counts as a 911 system and I saw probably 15 patients in 1.5 years...years of field experience doesn't mean a lot.

Yeah, there are things you may be told at the EMT level that you "unlearn" as a medic, but I think that working as an EMT is invaluable for a number of reasons...

You only unlearn them because the EMT classes were poorly taught. In retrospect there was very little I had to "unlearn", I just had no clue about how little I actually knew.

1. You have the opportunity to work with a lot of different medics and get to see different styles of practicing medicine.

Yep, that certainly helps.

2. You gain an understanding of what it is like to be an EMT and assisting a medic. When you are a medic this helps you to understand the potential limitations of your partner as well as understanding how they may see you.

I guess having never worked in CA (and never will) I will never know the joys of the dysfunctional BLS scope available.

EMT's are Paramedics are EMT's. It doesn't take a rocket surgeon to figure all of that out, nor experience.

3. Being an EMT helps you stay humble. Having a very limited scope and number of tools available to you gives you an appreciation of how much is available to you as a medic.

This is a pretty fair statement. I explain it like this: to an EMT, the world has four walls, a floor, ceiling, and a door. Behind the door is the Paramedic, who has nothing to catch them, left instead to drift out into space.

4. Having EMT experience helps you learn so much about the ALS game and how a medic is supposed to operate that it really gives you a leg up when it comes time to go into your internship. I recall that the only people in my medic program that had a difficult time were the ones that lacked any EMT experience.

Our program was pretty comprehensive, and by the end you could not tell who had no experience and who were the veterans. A quality program doesn't need you to have experience. Programs which require experience are generally weak educationally and clinically.

I think the generally poor level of education given to EMT's and Paramedics is why folks advocate for "experience" as an EMT or "working up the ranks".

Better education, longer education, more clinical time, real educators, etc etc. You probably wouldn't have that mindset if that were the case.

Although, it may just be a quirk of where I work that I have my views. My biggest problems are making sure my EMT's get V4R correct or V7-V9 if asked. Or that my medics correctly apply Sgarbossa with Smith's modification for STEMI+LBBB...

 

[Tigger]

Where I'm at there's even a prerequisite for EMT called 'First Responder', and to enter the medic program you must pass the First Responder and EMT classes as well as completing an A&P course and a basic arrhythmia course.

Yet I posit that even this isn't enough. I think that any student who wishes to become a medic should also be required to have 2 years of field experience as an EMT in a 911 system (so BLS transfer companies wouldn't count). Yeah, there are things you may be told at the EMT level that you "unlearn" as a medic, but I think that working as an EMT is invaluable for a number of reasons...

It would take many in urban areas at least a year (and probably a bit more) for many basics to get onto a 911 truck. There are just not that many spots, 911 agencies are selective, and many private company 911 slots are filled by people with years of seniority that aren't going anywhere.

Also, how do you define 911 system? My company has a 911 contract, and any truck can be called into coverage. This is not an everyday BLS occurrence, but am I still in a 911 system?

1. You have the opportunity to work with a lot of different medics and get to see different styles of practicing medicine.

As an EMT, how do I have any idea if I am seeing crappily practiced medicine or something else? Don't we encourage our new providers to work to find their own style?

2. You gain an understanding of what it is like to be an EMT and assisting a medic. When you are a medic this helps you to understand the potential limitations of your partner as well as understanding how they may see you.

Many places do not operate in a medic/basic configuration. As a result an EMT crew doesn't do a lot of assisting the medics.

3. Being an EMT helps you stay humble. Having a very limited scope and number of tools available to you gives you an appreciation of how much is available to you as a medic.

Such an attitude also encourages gross overtreatment for the simple of reason of "I can, therefore I will."

4. Having EMT experience helps you learn so much about the ALS game and how a medic is supposed to operate that it really gives you a leg up when it comes time to go into your internship. I recall that the only people in my medic program that had a difficult time were the ones that lacked any EMT experience.

I don't see how you can understand how a medic is supposed to operate until you have the medic's education. Otherwise you are just guessing.

It seems to me that experience at the basic level would be useful in that a student would already have grasped the non-medical aspects of EMS prior to their internship and first job. Stretcher operation, driving, patient moves, and that sort of thing wouldn't be an issue and wouldn't add any extra stress.

 

[DrParasite]

Well why are EMT students taught to do things wrong? Why not teach them right from the beginning, instead of assuming every EMT student is an idiot who cant be trusted to think for themselves and instead have to be just taught to go by memorization.

I think this is one of the best thing that needs to be repeated. If you teach EMT students the wrong things, you can't fault them for doing the wrong thing. If you teach them the right thing, they might (shockingly!!!) do the right thing.

It's like if you teach in paramedic school that every patient needs an IV, than you can't fault them when every patient arrives in the ER with an IV.

Maybe we need to have a higher failure rate on EMT programs, to weed out those who shouldn't be EMTs. maybe we should have a mandatory clinical ride time (100 hours), so EMT students should be evaluated and confirm they know what they are doing by a qualified preceptor.

I know very few people who started their paramedic program without being an EMT first, and finished their course and were immediately ready for a 911 truck. Not to say they don't exist, but most people with EMT experience do better as paramedics. Maybe they make good IFT medics, idk, but very few right off the street 911 medics. Or you can just add another 300 hours onto the paramedic program, consisting of 150 hours of EMT classroom time and 150 hours of ambulance shifts on a busy 911 truck (at least 8 patient contacts in a 12 hour shift).

The biggest advantage to EMT being a prerequisite is that paramedics get a taste of what they are doing before they get into class. They know what it's like to work in a moving ambulance. they have interacted with patient in a non-classroom environment. They know what it's like to deal with multiple agencies, how to perform an assessment (well, in theory anyway), and they should be able to tell the difference between sick and dying and not sick and not dying (again in theory).

They have some experience to put on a resume, so they aren't trying to get a job and no one want to hire a newbie with no experience.

 

[Tigger]

I think this is one of the best thing that needs to be repeated. If you teach EMT students the wrong things, you can't fault them for doing the wrong thing. If you teach them the right thing, they might (shockingly!!!) do the right thing.

It's like if you teach in paramedic school that every patient needs an IV, than you can't fault them when every patient arrives in the ER with an IV.

Maybe we need to have a higher failure rate on EMT programs, to weed out those who shouldn't be EMTs. maybe we should have a mandatory clinical ride time (100 hours), so EMT students should be evaluated and confirm they know what they are doing by a qualified preceptor.

I agree, with the caveat that failure rates are not especially great predictor of who will be successful and who will not.

I know very few people who started their paramedic program without being an EMT first, and finished their course and were immediately ready for a 911 truck. Not to say they don't exist, but most people with EMT experience do better as paramedics. Maybe they make good IFT medics, idk, but very few right off the street 911 medics. Or you can just add another 300 hours onto the paramedic program, consisting of 150 hours of EMT classroom time and 150 hours of ambulance shifts on a busy 911 truck.

The biggest advantage to EMT being a prerequisite is that paramedics get a taste of what they are doing before they get into class. They know what it's like to work in a moving ambulance. they have interacted with patient in a non-classroom environment. They know what it's like to deal with multiple agencies, how to perform an assessment (well, in theory anyway), and they should be able to tell the difference between sick and dying and not sick and not dying (again in theory).

They have some experience to put on a resume, so they aren't trying to get a job and no one want to hire a newbie with no experience.

In your experience, do basics who worked doing IFT make for better 911 medics? Realistically many basics are getting experience only in IFT and that's all they can ask for before moving on to medic. If someone wants to go to medic school I can't imagine they want to work for a few years to get onto a 911 truck and then finally go to medic school. That just takes too long.

If medic students worked on a 911 truck as part of class do you think that would be effective? How much experience does one need?

 

[DrParasite]

In your experience, do basics who worked doing IFT make for better 911 medics? Realistically many basics are getting experience only in IFT and that's all they can ask for before moving on to medic.

in my personal experience (and again, this is only MY experience, others might have taken more from it) of doing IFTs full time for 3 months, then doing 911 per diem for several years, and then doing IFT & 911 (depending on the truck assignment and the nature of the call) for about a year (and 911 per diem on the side), before doing 911 full time, I can honestly say that my IFT time did not help me be a better EMS provider at all. in fact, it made me a very bored, very lazy, and very apathetic provider, who was more concerned with doing the minimum needed to not get fired and get my paycheck than anything else. It was mindless, boring, and I hated it. an untrained monkey could have done my job... furniture movers would have been better at it, if they could write a chart. It's akin to being a trained law enforcement officer, but all you do is function as a security guard in a nice quiet area. you get complacent, your investigative skills dull from lack of use, and despite having the shiny badge and gun, are you really working as a cop?

I had quite a few of my coworkers go to medic school; almost all who were assigned to full time 911 trucks. I stayed in contact with some friends from my first IFT job, as well as made new friends with others in the IFT world; many of them were awesome people, but I wouldn't have trusted them to apply a C-collar to me, let alone go through medic school. The same could be said for some of my IFT/911 people who only worked on IFT trucks.

I will say one thing about the IFT people; they were much better hand holders than the 911 providers. they knew the names and histories of all their regular patients, they knew their families, and they always showed up on time, never rushing. They would always do whatever was needed to make the patients and their families happy. but if their patients crashed, or started circling the drain, they were often totally lost on what to do, or lost on even identifying it.

If someone wants to go to medic school I can't imagine they want to work for a few years to get onto a 911 truck and then finally go to medic school. That just takes too long.

If medic students worked on a 911 truck as part of class do you think that would be effective? How much experience does one need?

In this case, hour don't really matter; patient contacts do. Seeing muti system traumas, penetrating traumas, respiratory failures, MIs, baby deliveries, asthma attacks, and even the taxi rides (drunks, assaults, sicknesses, EDP, etc), lets people see what is going on, often the the point of realizing that their isn't anything else they can do except transport to a higher level provider.

spending 200 hours and just dealing with drunks is a waste of a student's time, since there is little you can do for them (other than smell the alcohol, and transport them to the ER to sober up). you need to have quality patient contacts and see sick people for them to be beneficial to the educational process.