Pre EMT-I Class

[devanmills]

Merry Christmas to all, i will be starting EMT-I in August, and i was looking for some advice on what i could do to be better prepared for class. some things i could study, and have better knowledge on, any help would be very greatly appreciated thanks!

[Lone Star]

Merry Christmas to all, i will be starting EMT-I in August, and i was looking for some advice on what i could do to be better prepared for class. some things i could study, and have better knowledge on, any help would be very greatly appreciated thanks!

Oh ye of little information!

The following information would be slightly helpful in answering your question:

Location

Level of education

Current certification/license level

EMT-I 85 or EMT-I 99?

Are you planning on going on to medic?

I can tell you this....acid/base will drive you insane!

Hypotonic/isotonic/hypertonic can get confusing

You'll find that in EMT-I, there is not alot of 'new information' being presented. As long as the NREMT keeps it's focus on 'minimum hours required', your EMT-I class will be woefully lacking in new material, and severely lacking.

I would suggest that you bypass EMT-I (unless its integrated into your EMT-B class), and go straight for your degree in Paramedicine. Not only will the degree make you more marketable, but there is a wealth of education that is required along with your paramedic course (ie: Anatomy & Physiology I/II).

[chbare]

Oh ye of little information!

The following information would be slightly helpful in answering your question:

Location

Level of education

Current certification/license level

EMT-I 85 or EMT-I 99?

Are you planning on going on to medic?

I can tell you this....acid/base will drive you insane!

Hypotonic/isotonic/hypertonic can get confusing

You'll find that in EMT-I, there is not alot of 'new information' being presented. As long as the NREMT keeps it's focus on 'minimum hours required', your EMT-I class will be woefully lacking in new material, and severely lacking.

I would suggest that you bypass EMT-I (unless its integrated into your EMT-B class), and go straight for your degree in Paramedicine. Not only will the degree make you more marketable, but there is a wealth of education that is required along with your paramedic course (ie: Anatomy & Physiology I/II).

I just want to point this out as many people continue to have this misconception. The NREMT does not mandate numbers of hours for an EMT curriculum. The NREMT simply tests people who have successfully passed a course that meets DOT guidelines. I am sure at some level the NREMT has input when the curricula are designed; however, the official agency is the DOT.

I agree that taking a course in A&P and going into a paramedic programme is possibly the best option for somebody looking for a career in EMS.

Take care,

chbare.

[paramedicmike]

Add another vote to the column of bypassing EMT-I and going for admission into a paramedic program.

There are several classes you can take to help prepare you for paramedic school. A&P is certainly high on that list. Also included are, algebra, english, writing/composition, nutrition, general bio, general chem, psychology (general and developmental), sociology, microbiology and nutrition.

These are just a few of the basic classes that would prove to be beneficial prior to enrolling in a paramedic class. Yes, the list is a bit long. With your current program starting in August there is plenty of time to complete a good number of these courses, however. If, as has been strongly recommended, you elect to skip EMT-I and go straight to paramedic, you'll probably have a little while longer to complete these classes before the start of paramedic school.

There is no such thing as too much education. There *is* such a thing as too little education. The more you can get the better off you and your patients will be. Please don't skimp on this.

Good luck!

[Lone Star]

There are several classes you can take to help prepare you for paramedic school. A&P is certainly high on that list. Also included are, algebra, english, writing/composition, nutrition, general bio, general chem, psychology (general and developmental), sociology, microbiology and nutrition.

While I can see the logic in these classes:

Algebra (for critical thinking skills)

A&P (for obvious reasons)

English, Writing/Composition (for intelligible PCRs and other forms of communication)

Psychology

Sociology (both for obvious reasons)

Chem, Bio,Nutrition and microbiology: Maybe you can explain to me how they're actually beneficial in the field. Unless you're planning on working in the lab, or becoming a dietitian; I see no practical purpose for field applications.

If you're interested in the effects of the medications and how they affect the body and interact with other medications, wouldnt organic chemistry be more relevant than just Chem 101?

[paramedicmike]

Chem, Bio,Nutrition and microbiology: Maybe you can explain to me how they're actually beneficial in the field. Unless you're planning on working in the lab, or becoming a dietitian; I see no practical purpose for field applications.

If you're interested in the effects of the medications and how they affect the body and interact with other medications, wouldnt organic chemistry be more relevant than just Chem 101?

General chem is the basis and prerequisite for organic chem. While I do recommend organic chem, the OP is inquiring about preparation for an EMT-I class. While we are actively encouraging paramedic school, I can only comment about the question he asked. Were the OP to ask about paramedic school I would have suggested o-chem, too. The OP is, so far anyway, working on a limited time frame.

General bio, in all of the many colleges/universities I've attended, has been a prerequisite for A&P. It lays the foundation for scientific thinking (often times in combination with general chem). It also lays the groundwork for a general understanding of life sciences. A good bio course will include information on basic genetics, cell function, metabolism and other basic functional concepts that are vital to understanding how the human body works but were not included in any of the undergraduate or graduate level anatomy courses I've taken.

Microbiology is directly applicable to the many microbes we encounter every day both on the job and off. Sure, we can spout back the patient has MRSA but do you really know what it is? Do you understand how it works? How it grows? How it survives? How to kill it in your ambulance? How about strains of Mycobacterium? How about the many bacterial sources of PID? Did you know you can get gonorrhea in your eyes? It's true! Kind of reinforces the idea that we should be washing our hands for both patient and self protection. A good micro class will lay the ground work for understanding things we can't see but can still make us sick.

Lastly, nutrition is important. How many diabetics do we encounter? Wake them up with some D50 and then what? Give them some orange juice with sugar mixed in? Why? Because you saw someone else do it? If we have a basic understanding of food and how the body processes it we can suggest something a little more appropriate to their immediate needs. This isn't to suggest we become a dietary consultant. But if we can't understand the bigger picture in terms of physiological process, including types and processing of nutrients, then we have failed our patients.

Every class I've listed I consciously use every day at work. I even held back in terms of what I use and what I think is important (e.g o-chem).

Hope this helps answer your question.

And I hope nobody routinely gives their diabetic patients OJ with sugar mixed in after waking them up. Seriously!

Edited December 27, 2010 by paramedicmike

[Eydawn]

Chem and bio lay the foundation for understanding what's actually going on in A & P. If you don't understand basic chemistry and biology, the material is much less readily understandable and less deeply absorbed. For example... the concepts of hydrophilia/phobia, acid/base relationships, cellular functioning and the electron transport chain... all of these come from basic bio and chem. Sure, they get covered in anat and phys... but if you've already learned it in basic bio and chem it then becomes easier to understand.

As far as asking whether or not microbiology is useful for someone in a medical field, what a redonkulous question. Seriously. Absolutely microbiology is useful! How else will you begin to understand the difference between gram negative and positive bacteria, biofilms, antibiotic resistance and how it develops, viral illness mechanisms... there's so much in there that is amazingly useful to any medical provider.

Human nutrition... once you understand how important many different nutrients are and how significantly they impact health, you begin to see just where deficiencies cause or significantly contribute to many of the illnesses we see.

You need to start thinking as a holistic provider. The whole body, even down to these microscopic levels, is what we treat. If you don't understand all these microscopic levels, how can you hope to treat the macroscopic level?

Wendy

CO EMT-B

[chbare]

Chem, Bio,Nutrition and microbiology: Maybe you can explain to me how they're actually beneficial in the field. Unless you're planning on working in the lab, or becoming a dietitian; I see no practical purpose for field applications.

If you're interested in the effects of the medications and how they affect the body and interact with other medications, wouldnt organic chemistry be more relevant than just Chem 101?

You cannot appreciate organic chemistry without a good foundation in general chemistry. Much of organic chemistry revolves around electron interactions (well, most of chemistry). However, in organic chemistry, you deal with carbon based compounds, molecules and substances. Carbon is truly unique. You will learn a little about the quantum mechanics of chemistry in general chemistry and will probably cover Lewis and VSEPR theory. However, these fail in certain cases and Carbon happens to be one of these cases. Basically, we know carbon can form up to four single covalent bonds; however, traditional theory would not predict this. If you examine the electron configuration of Carbon, you would find it's valence electrons exist in P orbitals. Each P orbital has one electron and conventional wisdom would assume three bonds are possible with Carbon. Unfortunately, we know up to four are possible, and they have the same energy. This is were your traditional chemical concepts begin to break down. What we actually have to do is go back to gen chem when we talked about the basics of treating the wave aspect of an electron with something known as a wavefunction. When we do this, we actually are able to combine the wave function of the P orbitals with the wavefunction of the S orbital that is at a lower energy than the P orbitals. When properly treated this way, we get something known as constructive interference and we can hybridise the singe S orbital and three P orbitals into four SP3 orbitals. When this occurs, we can account for four bonds at the same energy levels. To make matters even more complicated, Carbon can have SP2 hybrid, SP hybrid and P orbital bonding. I believe Carbon may be a unique atom in this regard. I may be corrected as my O-chem is not all that strong.

The take home point of all that is, you need to have a very strong foundation in general chemistry before you try to tackle something like O-chem.

As far as explaining the importance of microbiology and chemistry outside of the lab? I am afraid the importance of these subjects is pretty much an axiom. Numerous implications exist here form understanding what giving an amp of bicarb will do to carbon dioxide levels to understanding wat a + acid fast bacilli screen means. Also, you cannot truly understand the significance of any of the medications you give without chemistry. Even something as fundamental of ATP production through oxidative pathways cannot be appreciated without an understanding of chemistry.

Take care,

chbare.

[Lone Star]

You cannot appreciate organic chemistry without a good foundation in general chemistry. Much of organic chemistry revolves around electron interactions (well, most of chemistry). However, in organic chemistry, you deal with carbon based compounds, molecules and substances. Carbon is truly unique. You will learn a little about the quantum mechanics of chemistry in general chemistry and will probably cover Lewis and VSEPR theory. However, these fail in certain cases and Carbon happens to be one of these cases. Basically, we know carbon can form up to four single covalent bonds; however, traditional theory would not predict this. If you examine the electron configuration of Carbon, you would find it's valence electrons exist in P orbitals. Each P orbital has one electron and conventional wisdom would assume three bonds are possible with Carbon. Unfortunately, we know up to four are possible, and they have the same energy. This is were your traditional chemical concepts begin to break down. What we actually have to do is go back to gen chem when we talked about the basics of treating the wave aspect of an electron with something known as a wavefunction. When we do this, we actually are able to combine the wave function of the P orbitals with the wavefunction of the S orbital that is at a lower energy than the P orbitals. When properly treated this way, we get something known as constructive interference and we can hybridise the singe S orbital and three P orbitals into four SP3 orbitals. When this occurs, we can account for four bonds at the same energy levels. To make matters even more complicated, Carbon can have SP2 hybrid, SP hybrid and P orbital bonding. I believe Carbon may be a unique atom in this regard. I may be corrected as my O-chem is not all that strong.

The take home point of all that is, you need to have a very strong foundation in general chemistry before you try to tackle something like O-chem.

And understanding covalent bonding, or other electron bonds really helps increase the survivability rates of cardiac arrest or trauma patients,… how? How does knowing the proper order and number of electrons in each orbit will help our respiratory arrest patient in what way?

As far as explaining the importance of microbiology and chemistry outside of the lab? I am afraid the importance of these subjects is pretty much an axiom. Numerous implications exist here form understanding what giving an amp of bicarb will do to carbon dioxide levels to understanding wat a + acid fast bacilli screen means. Also, you cannot truly understand the significance of any of the medications you give without chemistry. Even something as fundamental of ATP production through oxidative pathways cannot be appreciated without an understanding of chemistry.

I agree that knowing an acid can be neutralized by a base is a good thing. But honestly, how is knowing whether a microbe is gram positive or gram negative, or which color stain is used to prepare the slide really going to help our patients involved in an MVA? How many slides are we really going to be preparing and viewing in the back of the truck?

Since we neither diagnose nor prescribe, how is the knowledge of how a virus or bacteria develops a resistance to certain antibiotics going to really do anything for our patient?

Before I get branded as ‘anti-education’ again, I want to make this perfectly clear: I am NOT against education, however; I’m more of an advocate of RELEVANT education.

As an example: one of the required courses that I’ve had to take while pursuing my degree was “Computer Concepts and Applications”. While the course dealt with the differences between program and system software, and suggested ways to perform an internet search, I really found nothing that can be actually applied in the treatment of my patients. I don’t see how knowing how to create a spreadsheet, insert charts or how to format a paragraph in Microsoft Word is going to magically make my patient ‘all better’. Knowing the definitions of ‘shareware’ and ‘freeware’ and the differences between them isn’t going to benefit my patients either.

[chbare]

You don't know what you don't know bro. When you are running down your list of differentials for a raised anion gap acidosis, the causes directly relate to chemistry. How about dealing with certain types of overdoses? What does changing Ph have to do with protein conformation and ultimately protein binding? What will electrolyte abnormalities do to membrane potentials? How are anions and cations different from their parent atoms in nature? How about letting a trauma patient become hypothermic? What will chemistry dictate there? Will our interventions based on the chemistry lead to improved survival?

Another consideration is people may take you seriously and trust your judgment, ultimately that can lead to improved outcomes. When a physician asks you about energy production and all you can say is "well it has something to do with the Krebs cycle," they are going to be less inclined to trust you. It happens, several of the physicians in my area are involved with education. The pulmonary Docs love to grill students during rounds. It's also really embarrassing when somebody asks you to explain what's in a bag of NS (a med you administer all the time) and you cannot explain what the 154 miliequivalents of sodium and chloride means, even though it's on the front of the bag.

About microbiology; we are transporting more patients with infections and related complications. Perhaps you can help make a connection and ensure a patient receives proper antimicrobial coverage? Or is this something unimportant to the likes of EMS. Knowing what an acid fast positive sputum culture is may spare you some serious problems. Had a crew take a patient with a AFB + sputum culture from an ER that may or may not be local to me. Unfortunately, they did not know what AFB+ potentially implied and the hospital wanted the patient out. Oops...

EDIT:

Regarding computers; a paramedic friend just took a job doing trauma epidemiology tracking and research. Tell me she doesn't use computers? You need to look beyond your little area of the world and recognise the proliferation of paramedics into many others areas of healthcare.

Additionally, I am not saying we need to have a year of Gen-chem, a year of O-chem, a semester of P-chem and some analytical chem thrown in for fun. I would like to see a semester of chem with a lab required however.

I can go on and on; however,as I stated, sometimes you simply don't know what you don't know.

Take care,

chbare.

Edited December 27, 2010 by chbare