Experience to become a paramedic

[fiznat]

Honestly I feel that anyoen who is competent enough to become a medic is competent enough to build that foundation of scene management, working with patients etc.

I'm not saying it isn't possible. I just think it is ill advised. You're not supposed to build a foundation at the same time you build a house. That's why it's called a foundation- it needs to be there first.

The "respect for the job" that I mentioned earlier should come an honesty about how much a person can/should handle at once. Managing the medicine is stressful enough. The stress of being new to scenes and ambulance operations shouldn't be piled on top of that. ...And I think doing so could potentially be dangerous to both provider and patient.

[emsboy_2000]

I'm not saying it isn't possible. I just think it is ill advised. You're not supposed to build a foundation at the same time you build a house. That's why it's called a foundation- it needs to be there first.

The "respect for the job" that I mentioned earlier should come an honesty about how much a person can/should handle at once. Managing the medicine is stressful enough. The stress of being new to scenes and ambulance operations shouldn't be piled on top of that. ...And I think doing so could potentially be dangerous to both provider and patient.

I wasn't going to respond to this thread anymore than what I already have, but I agree with you. It's interesting to note, that the majority of the most respected paramedic programs across the world (including many of our own programs) design the entire process in parts (EMT-B, EMT-I and EMT-P). I wonder why? I know these classifications primarily exist in the United States, but you get my point.

Edited May 21, 2009 by emsboy_2000

[Dustdevil]

Wrong. Most programmes in the U.S. do not include the Intermediate step.

And the reason that schools do it in steps is simply because that's the way they've always done it. The reason other countries do this is because they are blindly following our lead. That is no statement whatsoever about the quality or theoretical soundness of that process. In fact, the most well educated systems in the world do NOT utilise an EMT-B > EMT-I > EMT-P structure at all. And the best of the best begin with nurses, then transition them into field practice.

Fiznat, you are on the right track with your foundation theory. However, you have it reversed. MEDICINE is the foundation, not operations. A proper foundational approach would be to learn MEDICINE -- which is a constant, no matter where it is practised -- and then integrate that into the finer points of field applications after that foundation is achieved. Think about it; does it make any sense whatsoever to learn the finer points of field operations before you even have a reason to be in the field to begin with? Of course not.

Medicine > operations. That's how it should work, not vice versa.

[chaser]

My experience has been that the difference between a good paramedic and a bad paramedic boils down to one thing: respect for the job. I have found that respect for this work tends to motivate people to pursue additional study, encourages people to be constructively critical (and honest!) about their mistakes, and instills a sense of humility that so many in this field seem to lack...

Well said fiznat, I agree.

Passion and respect.

[fiznat]

Medicine > operations. That's how it should work, not vice versa.

Ahhhhhhh I'm not so sure. Believe me, I understand where you are coming from, but I think we ought to be honest about what we actually do out in the field. I'm all about the medicine, I subscribe to and read academic journals, I research things I don't know, and I care a lot about the quality of my care. Still, I've found that the decisions I make in the field often have much more to do with operations than they do with medicine. I make decisions about WHEN to do things, and less often WHAT. I make many more decisions about HOW to do a procedure, and less frequently WHICH procedures to perform.

I think it is a bit dangerous to assume that we are out there actually practicing real *medicine.* We're not. There is a reason why we have such detailed protocols and algorithms: because the education is simply not there for us to make truly independent decisions regarding plans of care. The area where I feel like I actually make independent (and important!) decisions is in operations. This isn't to say that medicine isn't an important part of the job, and shouldn't be emphasized and respected, but I really feel like operations is at least as important, and is something that people new to this field should establish first.

[emsboy_2000]

Wrong. Most programmes in the U.S. do not include the Intermediate step.

And the reason that schools do it in steps is simply because that's the way they've always done it. The reason other countries do this is because they are blindly following our lead. That is no statement whatsoever about the quality or theoretical soundness of that process. In fact, the most well educated systems in the world do NOT utilise an EMT-B > EMT-I > EMT-P structure at all. And the best of the best begin with nurses, then transition them into field practice.

OK, Dustdevil, let me clarify a few points. First, you are right, most programs don't include the intermediate level; however, I never implied that every program does in those particular steps. That's ridiculous. But I'm going to redirect this thread to my initial point. The context of my threads - and my point for that matter - is that most programs don't jump from basic to paramedic; instead, they progress through a series of steps to achieve the highest title. And again my question is, why? For example, in countries like Canada and South Africa, the different levels are distinguished by the terms primary or basic (e.g. Primary Care Paramedic) intermediate, or advanced (e.g. Advanced Care Paramedic). The United Kingdom also has similar classifications. So, having said that, I again say that most places (and yes, the places I mentioned are not most places, only a few examples few examples, but I think you get my point) go through a process to achieve the highest level because it works. If it didn't then why would it be the standard model for most places?

Oh yea, we continue to do it just because... . Really? You're going to stick with that?

On a different note, you state that everyone is "blindly following our lead"; however, I ask, why would everyone else want to follow our model when many have a far more advanced model than ours? So much so, in fact, that paramedics in both the U.K. and some Canadian provinces, for example, have been granted the legal status of self-regulated health professions. What is the possibility of that ever happening here? Perhaps we should blindly follow in their foot steps.

Lastly, I want to bring up one more thing you stated in your last post. You mentioned there is no "theoretical soundness" to a process that has been in play for a long time; but is there any theoretical soundness that this process doesn't work?

Edited May 22, 2009 by emsboy_2000

[Dustdevil]

We do it this way because this is the way we've always done it. Period. Your argument that it must be the best way to do things because it's the way we do it simply doesn't hold any water, and in fact is the most ignorant case I've ever seen made here. It is a system that was developed to put advanced first aiders in to ambulances run on the side by funeral homes. However, in the last forty years, our medical sophistication has progressed well beyond that point. Unfortunately, the educational system has not developed along with it. That's what many in EMS educational leadership, like RidRyder911 are trying to change. Unfortunately, the ignorant and selfish special interest stakeholders fight educational progress because it will inconvenience them. Provider organisations, from fire departments to private companies, want educational requirements to remain low so that the candidate pool remains large and undereducated, and they can continue to pay minimum wage to keep their ambulances on the road. That means maintaining these traditional "steps" of educating providers, instead of just doing it right from the beginning.

[emsboy_2000]

We do it this way because this is the way we've always done it. Period. Your argument that it must be the best way to do things because it's the way we do it simply doesn't hold any water, and in fact is the most ignorant case I've ever seen made here.

...and round n’ round we go……

Well, I have to agree you—imagine that! That is a pretty ignorant statement. Only one problem: You need to read things more carefully so that you don’t make incorrect assumptions. I never stated it was the “best” way; I simply stated that the reason we do things here, and many other places, is because it “works”. Is it the best way? Maybe, maybe not, but I never said it was. Anyway, Dusty, (you don’t mind I call you that, do you?) I’ve had fun firing you up—that’s what keeps these threads interesting! One thing I’m sure we can both agree on is that this system has been in effect for a very, very long time. And from what I can tell, it works pretty well: that is to say working your way up in steps. Having said that, I’m going to break away from this subject—for real this time, but you may have the last word (you sound like the kind of person that likes to/needs to anyhow).

Edited May 29, 2009 by emsboy_2000

[Fignewt345]

I never stated it was the “best” way; I simply stated that the reason we do things here, and many other places, is because it “works”. Is it the best way? Maybe, maybe not, but I never said it was.

No, it doesn't work because thousands of patients each year are not getting the optimal level of professional, prehospital medical care at the hands of providers not educated to the paramedic level.

But you are right, you never stated it is the "best" way. The best way would be having all providers educated at the highest level of prehospital medicine.

Denying patients the highest level of care based on what has always been done in the past is NOT the "best way."

[emsboy_2000]

No, it doesn't work because thousands of patients each year are not getting the optimal level of professional, prehospital medical care at the hands of providers not educated to the paramedic level.

But you are right, you never stated it is the "best" way. The best way would be having all providers educated at the highest level of prehospital medicine.

Denying patients the highest level of care based on what has always been done in the past is NOT the "best way."

Noted.

Edited May 29, 2009 by emsboy_2000