FDNY EMS - Basic to Medic and More...

[ERDoc]

BLS ALWAYS BEFORE ALS,NURSE,DOCTOR!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Sorry, this is incorrect. Doctors and nurses practice medicine, there is no ALS or BLS. ALS and BLS are a prehospital phenomenon that has outlived its usefullness.

To the OP, sorry this has gotten off topic but you will find this is a very active debate on this site. Spend as little time as an EMT as you can, it will not help you become a better medical provider. The only benefit is you will learn how to drive an ambulance. If you have a worthwhile paramedic program you will have a significant amount of field time where you will work one-on-one with a medic. I do not know where you are located, but if possible, check out the Stony Brook program. It is a tough program but turns out great medics.

[mobey]

Personally I feel you should have at least 3 yrs being an EMT before becoming a medic....... . 10 month's just school. Something to think about.

Wow ... this just boggles my mind.

So your standpoint is 120hrs + 3yrs of doing the same thing over and over, + 10 months = A competent Paramedic? That is the "Best case scenario"?

Hmmm..... I guess I FAIL then.

1yr full time BLS edumacation, 2 yrs rural low call volume experience (which I wish I did not have), + 2yrs full time ALS education..... and by your math I am going to be a half arse medic?

[sarcasm] Yup all of those bls OPA insertions and BVM runnin sure helped me understand V/Q relationships, and changes thereof as effected by gravity, disease, altitude, trauma etc. etc. in Paramedic school.... I am sure happy those patients were laid out in front of me so I could get "good" at practicing bls skills rather than wasting time treating thier respiratory arrest adequatly with definitive airways the first time.... [/sarcasm]

Sorry, this is incorrect. Doctors and nurses practice medicine, there is no ALS or BLS. ALS and BLS are a prehospital phenomenon that has outlived its usefullness.

We should have a forum spot for greatest quotes of all time made on EMTCity.

This should definatly make the top 5

[JPINFV]

New doctors spend a year internship right out of medical school and then progress to their residencies. They are evaluated by veterans, their skills are verified and honed. Same with nurses. Most shadow veterans for awhile before they are turned loose to work on their own.

That internship is, in most cases, the first year of residency. That said, it's not really applicable. A more proper analogy would be to say that physicians would have to work as physician assistants before going to medical school. Residency would be likened to internship/ride time that a paramedic student does.

[Richard B the EMT]

NYCEMS said:

My first time stepping into an ambulace was working 911. First call of my career was a shooting to the face in the south bronx.

Some folks have all the luck

I started out in a VAC, stayed there when I started working non 9-1-1 ambulance service providers, and was still in the VAC when I started Municipal 9-1-1 employment.

I know some EMTs who stopped counting after their 40th OB-Labor. Me? In 36 years of ambulance time, I've only delivered 2. I have a buddy, who, as his very first call in the FDNY EMS, delivered twins. He also earned his first overtime as the department insisted he be available for photoshoots and soundbites.

Can we agree that there is no rhyme or reason as to who, or how, gets the heavy duty work, and who cruises in easy (or easier) calls. The guy who does 10 patients in 8 hours every day might want to switch with the guy who seems to get one call per 8 hours, and vise versa, but where is anything written on anything that is strictly luck? My next call might be a feverish baby, or another plane crash (had 4, please, no more!). I'll only start to worry when my soothsayer sees me, and starts running away screaming.

Explain to me how I work the New York Marathon for 10 hours, and nobody even asks for a band-aid from me, yet on the way home, due to it happening right in front of me, I end up being first in for an overturned car while in my POV (with some equipment aboard)? NJobody can.

Edited April 21, 2009 by Richard B the EMT

[NYCEMS]

We're just asking that you pay attention to your grammar per the site rules you agreed to... is that so much to ask?? It is difficult for tired eyes and minds to comprehend your posts sometimes due to the poor spelling and grammar. I apologize if it seemed that I was attacking you, and maybe I did let my frustrations get the best of me... Welcome to the site and I hope you find it useful!

Thanks I appreciate that. I'll be a little more patient with my writing. If I offended you at all I also apologize.

NYCEMS said:

Some folks have all the luck

I started out in a VAC, stayed there when I started working non 9-1-1 ambulance service providers, and was still in the VAC when I started Municipal 9-1-1 employment.

I know some EMTs who stopped counting after their 40th OB-Labor. Me? In 36 years of ambulance time, I've only delivered 2. I have a buddy, who, as his very first call in the FDNY EMS, delivered twins. He also earned his first overtime as the department insisted he be available for photoshoots and soundbites.

Can we agree that there is no rhyme or reason as to who, or how, gets the heavy duty work, and who cruises in easy (or easier) calls. The guy who does 10 patients in 8 hours every day might want to switch with the guy who seems to get one call per 8 hours, and vise versa, but where is anything written on anything that is strictly luck? My next call might be a feverish baby, or another plane crash (had 4, please, no more!). I'll only start to worry when my soothsayer sees me, and starts running away screaming.

Explain to me how I work the New York Marathon for 10 hours, and nobody even asks for a band-aid from me, yet on the way home, due to it happening right in front of me, I end up being first in for an overturned car while in my POV (with some equipment aboard)? NJobody can.

You know this is the kind of conversations I was looking forward to in this site. Work related, and friendly. I like hearing war stories. It shows people like, not going to mention but he thinks EMT's are useless, what type of calls we get and how we handle it.

Sorry, this is incorrect. Doctors and nurses practice medicine, there is no ALS or BLS. ALS and BLS are a prehospital phenomenon that has outlived its usefullness.

To the OP, sorry this has gotten off topic but you will find this is a very active debate on this site. Spend as little time as an EMT as you can, it will not help you become a better medical provider. The only benefit is you will learn how to drive an ambulance. If you have a worthwhile paramedic program you will have a significant amount of field time where you will work one-on-one with a medic. I do not know where you are located, but if possible, check out the Stony Brook program. It is a tough program but turns out great medics.

So the truth comes out. To you we're just ambulance drivers. I guess you didn't work in a place where EMT's made a difference. I do and the babies I delivered and cardiac arrest That I brought to the hospital breathing would agree.

I've got no problem staying as an EMT. Sure I'd like to be a medic. I'd also like to be a doctor. But I'm not and I don't let that stop me from doing the best I can in what I love doing.

[WolfmanHarris]

So the truth comes out. To you we're just ambulance drivers. I guess you didn't work in a place where EMT's made a difference. I do and the babies I delivered and cardiac arrest That I brought to the hospital breathing would agree.

I've got no problem staying as an EMT. Sure I'd like to be a medic. I'd also like to be a doctor. But I'm not and I don't let that stop me from doing the best I can in what I love doing.

I think you're confusing being against EMT remaining as a level in EMS with cutting the number of Ambulances or something. Were the BLS ambulances that are ill-equipped for dealing with the full scope of pre-hospital medicine (not even having defibrillation in some areas apparently) and replaced with ambulances only staffed with two well-educated (no medic mills) professional Paramedics that the public and the profession would be better served.

This is the biggest dead horse on this forum, but as you're new I'd like to illustrate a couple of key points to consider. Not because I hope to change your mind, or to bash you, but in hopes that you'll understand some of where we are coming from. The rest you'll be able to find easily through the search function or by swinging a dead cat, lord knows you can't do that without hitting a thread on why EMS education sucks.

First, anecdotal evidence. I'm sure you've had some good outcomes with patients, but this doesn't mean that you necessarily provided the best and most appropriate care for them. Personal experience is powerful because it feels more real, but it does not reflect reality. For example, if you have a patient with SOB from asthma that you give oxygen to and transport and arrive with at hospital with no difficulty breathing you may believe that this improvement is a result of your treatment. However, if you look at the patho, it becomes clear that while oxygen will help, the improvement was going to happen regardless as the histamine release was limited and passed without intervention. Were their condition to worsen your treatment would be of limited effectiveness without salbutamol and/or epi to counteract the bronchoconstriction and counteract bonchial edema.

Second, cardiac arrest. While BLS care is linked to the best chance of survival for SCA an EMT cannot provide ACLS and thus cannot use the full range of treatment options. While these may be of unclear effectiveness, not being able to provide the full range of treatment for a cardiac arrest means you have to transport all of your arrest patients thus putting the public and yourself at risk by running L&S while doing CPR. A proper ALS system can work these patients safely in place, with more effective CPR and no risk to the public transporting dead bodies.

Third, knowledge. Step one, know enough to know how much you don't know. No one is saying you as an EMT cannot help people, we're saying that care is not the best available and by not being the standard is doing the public a great disservice. As a profession if you're to advance (meaning EMS in the USA) and earn more than the low wages you currently do, you have to have the education. No one's going to pay high wages for a job that can be trained for in a couple of weeks and that almost anyone can get the cert for.

I think I've managed to sum up the thrust of every education discussion we've had in the last few months in there. Hopefully that saved us a few dozen more pages of argument ending in the usual trolling. Maybe we should let every member post their own essay on this topic and sticky it or something, I've been getting major deja vu.

[Donavan]

Okay, as an EMT I feel I need to add a few thoughts.

One - I do believe you should have to work a few years as an EMT before becoming a paramedic. Being an EMT is more than just driving. As an EMT I have learned to talk to people of all walks of life, and make them feel comfortable telling me things they won't tell their spouse. I can also keep people calm during what may be the most stressful time of their life. I think this is quite an accomplishment, and a basic skill you should acquire before trying to practice medicine of any sort. This skill will make you a much better paramedic. Some people come with these skills from outside of EMS, but most don't. As an anecdotal note, most of the better paramedics I know spent a 5-10 years as an EMT first.

Two - To those who draw the LPN-RN or PA-MD analogy, that is a poor comparison. RNs and MDs have to work with an experienced medical provider before they are allowed to work on their own. Even after they go through this training they will have a safety net of more experienced personnel to draw upon. As a new medic with all this training and a few weeks to months (if you're lucky) of riding with an experienced medic you can easily find yourself on your own and overwhelmed with no backup available. If you work with another medic who can bail you out, good for you, but what about medics who work with EMT partners? I don't know how to be a paramedic, so if my paramedic partner can't hack it, the patient suffers. All that education comes for nil if you can't apply it.

[JPINFV]

Two - To those who draw the LPN-RN or PA-MD analogy, that is a poor comparison. RNs and MDs have to work with an experienced medical provider before they are allowed to work on their own. Even after they go through this training they will have a safety net of more experienced personnel to draw upon. As a new medic with all this training and a few weeks to months (if you're lucky) of riding with an experienced medic you can easily find yourself on your own and overwhelmed with no backup available. If you work with another medic who can bail you out, good for you, but what about medics who work with EMT partners? I don't know how to be a paramedic, so if my paramedic partner can't hack it, the patient suffers. All that education comes for nil if you can't apply it.

Do the medic schools in your area not require a field internship and do the ambulance companies not provide their employees with field training?

[NYCEMS]

I think you're confusing being against EMT remaining as a level in EMS with cutting the number of Ambulances or something. Were the BLS ambulances that are ill-equipped for dealing with the full scope of pre-hospital medicine (not even having defibrillation in some areas apparently) and replaced with ambulances only staffed with two well-educated (no medic mills) professional Paramedics that the public and the profession would be better served.

This is the biggest dead horse on this forum, but as you're new I'd like to illustrate a couple of key points to consider. Not because I hope to change your mind, or to bash you, but in hopes that you'll understand some of where we are coming from. The rest you'll be able to find easily through the search function or by swinging a dead cat, lord knows you can't do that without hitting a thread on why EMS education sucks.

First, anecdotal evidence. I'm sure you've had some good outcomes with patients, but this doesn't mean that you necessarily provided the best and most appropriate care for them. Personal experience is powerful because it feels more real, but it does not reflect reality. For example, if you have a patient with SOB from asthma that you give oxygen to and transport and arrive with at hospital with no difficulty breathing you may believe that this improvement is a result of your treatment. However, if you look at the patho, it becomes clear that while oxygen will help, the improvement was going to happen regardless as the histamine release was limited and passed without intervention. Were their condition to worsen your treatment would be of limited effectiveness without salbutamol and/or epi to counteract the bronchoconstriction and counteract bonchial edema.

Second, cardiac arrest. While BLS care is linked to the best chance of survival for SCA an EMT cannot provide ACLS and thus cannot use the full range of treatment options. While these may be of unclear effectiveness, not being able to provide the full range of treatment for a cardiac arrest means you have to transport all of your arrest patients thus putting the public and yourself at risk by running L&S while doing CPR. A proper ALS system can work these patients safely in place, with more effective CPR and no risk to the public transporting dead bodies.

Third, knowledge. Step one, know enough to know how much you don't know. No one is saying you as an EMT cannot help people, we're saying that care is not the best available and by not being the standard is doing the public a great disservice. As a profession if you're to advance (meaning EMS in the USA) and earn more than the low wages you currently do, you have to have the education. No one's going to pay high wages for a job that can be trained for in a couple of weeks and that almost anyone can get the cert for.

I think I've managed to sum up the thrust of every education discussion we've had in the last few months in there. Hopefully that saved us a few dozen more pages of argument ending in the usual trolling. Maybe we should let every member post their own essay on this topic and sticky it or something, I've been getting major deja vu.

You guys just don't get what I'm saying. I'm not bashing medics. I know they can do much more than I can. Just like a doctor can do so much more then they can. But for someone to say to me go back to school EMT's are useless. That I resent. I'm a EMT for 20yrs now and I love it. You can say all you want that I'm not doing anything for the patient and I'll say you dead wrong. I've seen a lot of good outcome because of what I know and i've been able to help alot of people. Sure I'm limitted to what I can do as a tech,but what I can do I do the best I can. The best compliment I ever got was from a medic co-worker. No one can ever say to me that I don't pull my own weight. So save that BS about the patient would have been fine for someone who hates there job cause I don't. And the way you sound it seems anyone under the title of doctor is useless to you. Fine doc get in an ambulance and do it yourself.

[Donavan]

Do the medic schools in your area not require a field internship and do the ambulance companies not provide their employees with field training?

Medic students spend some time in the ED, but most of what they do there is practicing IVs. They also go to ORs to practice intubation. I don't know the exact figure, but I think they spend < 200 hours riding with various paramedic services in the area, some of which don't do a whole lot of ALS calls. Having had medic students riding with me and my partner, I can say they don't get a whole lot of experience this way.

I can't speak for other services, but the commercial ambulance I work for require new medics to ride as a third with a paramedic preceptor for one or two months, and experience varies. Keep in mind that I work for a commercial for-profit ambulance service, so precepting medics aren't immune to interfacility transfers, even when they and their preceptors throw a huge fit.

Even if they have very productive ride time during school, and their precepting goes well, they have about three or four months of practice before being let loose on the unsuspecting public. While for some people this is enough oversight, and we do get some good medics right out of the gate, it still doesn't compare to the support a new nurse or physician can expect.