What happened to paramedic students?

New trainees are supposed to be exuberant weenies, then get that energy bent into constructive avenues by good instructors and better mentors/OJT trainers.

Ultimately there is no substitute for a good character. Unfortunately youngun's are hard to gauge for that since society now values superficiality more than heart.

PS: welcome back Ryder.
 
Most of the the paragod attitude comes from within.

Part of it can come from a "inferiority complex" they developed throughout their lives and want to prove that they "are better"

Part of it is some EMS academies, where they make students believe that they are the best since day 1.

Paragod goes 2 ways. One they get rolled and humbled, and then they realize that they are not the best or know all. Or they become flushed out of the field

when I started the Paramedic program my coordinator made it very clear. what you get here is the entry level requirements to become a paramedic. This is far from the end of your education. If you want to become a good paramedic theres plenty of courses and additional college courses that will supplement that. If you want to stop educating yourself find another career.
 
Burritomedic1127 said:
Higher education standards will decrease the amount of medics which will raise salaries and respect for those who went the extra mile.

Take for example a pt who has a syncopal episode on exertion, you can have a medic that will scoop them into their office aka the back of the bus and get vitals and look for signs of ischemia or infarct on the 12, and if the vitals were fine and no elevations/depressions are noted just monitor and transport the pt. Or you could have a medic that picks up the same pt and recognizes hypertrophic cardiomyopathy on the EKG that suggest you tell your PCP and schedule an appt. with a cardiologist because they recognize theyre more susceptible to sudden cardiac death. Yeah this is a pretty specific case and there's no protocol for hypertrophic cardiomyopathy but this is an example of going above and beyond for THE PT.

Doing more for the pt's after and outside of the ambulance adventure is what EMS should strive for

Just my two cents
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I guess this depends on the area that you work. Busy metro area with short transport times are not going to increase the requirements nor pay. Working in an area that does not support many of the optional skills due to potential liability for infrequently used skills, the trend is likely to go the other way. The fact of the matter is, even in a busy system you maybe have 3-5% of your calls that are truly emergent. Maybe 20% actually need to go to the hospital. A medic can study and train all they want, but there is no substitute for calls.
As for recommending that a pt see their cardiologist for the less obvious ekg reads, I'll leave that to the ER cardiologist. Either way, that pt is going for a ride.

If you want PA's on the rigs, have a blast getting that through.
 
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My partner and I called for an ALS intercept the other day and we got two medics on board (one precepting the other). You could tell which one was the new medic because he was shaking in his boots the entire time. Poor guy tried to get an IV going but just couldn't manage it, and was about to cut the patient's shirt off before my partner just lifted it out of the way. They don't all come out of the academy cock-sure :lol:
 
Ridryder911 said:
Just ask a Paramedic about the importance of anion gap ratio; or some basic general medical questions (other than trauma & or cardiac) and they immediately throw up the old .. "It's not my job (also another demonstration of ignorance of emergency medicine). All medicine is our job; we just specialize and should be better in certain areas.
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Why would you ask that? Other than to prove how smart you are over a new paramedic?

Don't get me wrong, I understand what your intent is: to show that a paramedic doesn't know what he thinks he does. But much of the medic's education is in trauma (ok, maybe not so much), cardiac and respiratory emergencies. Why quiz them on something that has no impact on their job, and will have no impact on the patients that they treat?

Do you think psychiatrists quiz rookie psychiatrists on the best way to deal with a GI bleed that is coming out both ends? Or would he ask about something that is directly related to their field, like a medication reaction with the brain or what the S/S are of a mental disorder?

I'm all for education, but 46Young had a better question: how to (reasonably) rule in a STEMI in the presence of LBBB or a paced rhythm. That is directly related to their job, and if they don't know that, they are doing their patient's a disservice, because they could potentially misdiagnose the patient.

now about the Anion gap ratio? I have no clue what it is, and I'm pretty sure if I did, I couldn't deduce it in the field, and if it was off, I couldn't do anything to correct it.
 
Wondering

DrParasite said:
Why would you ask that? Other than to prove how smart you are over a new paramedic?

Don't get me wrong, I understand what your intent is: to show that a paramedic doesn't know what he thinks he does. But much of the medic's education is in trauma (ok, maybe not so much), cardiac and respiratory emergencies. Why quiz them on something that has no impact on their job, and will have no impact on the patients that they treat?

Do you think psychiatrists quiz rookie psychiatrists on the best way to deal with a GI bleed that is coming out both ends? Or would he ask about something that is directly related to their field, like a medication reaction with the brain or what the S/S are of a mental disorder?

I'm all for education, but 46Young had a better question: how to (reasonably) rule in a STEMI in the presence of LBBB or a paced rhythm. That is directly related to their job, and if they don't know that, they are doing their patient's a disservice, because they could potentially misdiagnose the patient.

now about the Anion gap ratio? I have no clue what it is, and I'm pretty sure if I did, I couldn't deduce it in the field, and if it was off, I couldn't do anything to correct it.
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Was this directed at me? Ok I see where this was directed.. I get it and I wouldn't ask that question either.. lol
 
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gotshirtz001 said:
I guess this depends on the area that you work. Busy metro area with short transport times are not going to increase the requirements nor pay. Working in an area that does not support many of the optional skills due to potential liability for infrequently used skills, the trend is likely to go the other way. The fact of the matter is, even in a busy system you maybe have 3-5% of your calls that are truly emergent. Maybe 20% actually need to go to the hospital. A medic can study and train all they want, but there is no substitute for calls.
As for recommending that a pt see their cardiologist for the less obvious ekg reads, I'll leave that to the ER cardiologist. Either way, that pt is going for a ride.

If you want PA's on the rigs, have a blast getting that through.
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There's always a chance, hopefully small, that the resident/PA/MD does not catch the less obvious EKG and it goes unnoticed. Then its a good thing for everyone that EMS brought it to attention. Why do we start IVs on pt's that don't need fluid or medications? Should we just leave that to the ER?

Yeah anion gaps may be a little intense and wont be useful in most cases, but it can't hurt to know. We, EMS, dont need PA's just strong provider. The main point is having higher levels of education to provide better care for pt's.
 
Halothane said:
I always do :unsure:
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Unless they need fluids, meds or something else that dictates the need for IV access (CVA, ACS/STEMI etc) I generally won't stick people. Why are drunks and minor traumas always coming into the ED with IVs? It's a waste of supplies and time.
 
TheLocalMedic said:
Unless they need fluids, meds or something else that dictates the need for IV access (CVA, ACS/STEMI etc) I generally won't stick people. Why are drunks and minor traumas always coming into the ED with IVs? It's a waste of supplies and time.
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There was a thread on this very topic a while back where I questioned the need for "just because" or "courtesy" IV's on several bases, and lets just say those who see things the way you and I do seemed to be a pretty small minority.....
 
Halothane said:
There was a thread on this very topic a while back where I questioned the need for "just because" or "courtesy" IV's on several bases, and lets just say those who see things the way you and I do seemed to be a pretty small minority.....
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Then let us be the shining beacon of rationality amidst a sea of ignorance and guide those poor sailors to the safe harbor of intelligent prehospital emergency medicine.

Felt like using some flowery metaphor.
 
gotshirtz001 said:
Haha... Not saying you're wrong in any way, but just how long ago was this? :) Your profile still says "Paramedic Student".
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I started paramedic school last july,, I'll be finishing this year, barring no complications.

(I was in a program and had to drop near the end due to becoming a single parent at the last minute)
 
I got my EMT-P on 12/31/13. I start my Field Training with my company on 2/3. I'm nervous as hell, and I've been working as a basic on an ambulance for nearly 3 years. I've actively tried to avoid falling into the know-it-all mentality, and am excited to start working as a medic. We had a few people in my class who already developed the "paragod" mentality, but they were squashed hard with our 10hr cardiac midterm and 11hr class finals before getting to move on to clinicals...
 
Lets get back to anion gap ratios and Scarbosa's criteria. This is how we become better providers and evolve EMS.
I'm loving this discussion.

There are plenty of other threads on when and whether or not to get an I/V.
 
SandpitMedic said:
Lets get back to anion gap ratios and Scarbosa's criteria. This is how we become better providers and evolve EMS.
I'm loving this discussion.
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I don't remember specifically learning about anion gaps during paramedic school (though we may have; it was quite a while ago), but we did cover basic acid/base balance and basic blood gas interpretation pretty thoroughly. As a concept, the AG is a very simple and uncomplicated, though somewhat peripheral component of acid-base assessment. Not being aware of it probably means you simply weren't taught it - I don't see how it's a reflection of an overall lack of knowledge. It certainly doesn't take a medical degree or an in-depth background in physiology to understand.

Lots of paramedics are very knowledgeable about EKG's, and I think understanding and remembering all the rules and criteria you have to know in order to interpret 12-leads is a lot more complicated than a basic understanding of ABG's.

Drawing ABG's and assessing acid base status may not be something we actually do on the ambulance, but it is very important physiology and terminology to understand.
 
Burritomedic1127 said:
Why do we start IVs on pt's that don't need fluid or medications? Should we just leave that to the ER?
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Depends on the hospital. If the nurses want to park a guy in the waiting room and I bring them in with an IV started, I get the stink eye.
 
unleashedfury said:
I started paramedic school last july,, I'll be finishing this year, barring no complications.

(I was in a program and had to drop near the end due to becoming a single parent at the last minute)
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Strong work. You seem to have a pretty good head on your shoulders.
 
SandpitMedic said:
Lets get back to anion gap ratios and Scarbosa's criteria. This is how we become better providers and evolve EMS.
I'm loving this discussion.

There are plenty of other threads on when and whether or not to get an I/V.
Click to expand...

Sgarbossa = actually pretty relevant to prehospital paramedic practice
Anion Gap = a little relevant for critical care/interfacility paramedic practice (minimal to no relevance for prehospital)
Delta ratio = not relevant
 
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