Straight to Paramedic

[Lone Star]

I think this goes back to the whole education debate that keeps rearing its ugly head. With the way the system is setup right now, yes you probably should have some experience as an EMT first. Only because there is an assumed level of competence in medic school. I would guess that most medic schools don't spend much time on how to take vitals and CPR. They probably assume that you know this already. This is where we need to chage the education system. Let people into medic class with no experience and with no EMT card. Start from the beginning and teach them everything. It will require more time than it does now, but so what. It sounds to me like we are starting to build a college level program. Let people select the level they want to go for. If you want to be an EMT, you take an EMT class. If you want to be a paramedic, you go to college and get your paramedic degree.

Of course someone with little experience is going to have a harder time in medic class, so what? It doesn't mean they can become good paramedics. As many have said in the past, we need to get over this whole ALS/BLS skill thing. There should be no such thing. It should be EMS skills.Just as a random thought, how does putting on 1000 KEDs in the field versus 10 in a class room make you a better candidate for paramedic school?

I highlighted a couple of points here. The underlined passage: we actually spent more time on the clinical exam techniques (otoscope, opthalmascope, etc) than we did on actually obtaining vitals in the field, because it WAS presumed that 'everybody should have learned how to do it in Basic class'.

I agree with the bolded section. I've seen more than a few medics who refuse to do things like take vitals on their patient because"...thats a BLS skill, and I'm strictly ALS!"

Far too often we draw that ALS/BLS line in the sand, and for the most part; it only causes a point of contention between EMTs and Medics (we're not even going to mention the 958 different BLS titles).

Granted, not all of the calls we answer are going to require pharmalogical interventions, IVs or advanced airways; but I'm begining to believe that we should just do away with the different 'levels of licensure', and make everyone a Paramedic through a degreed course.

With the exception of nursing, EMS is about the only medical care provider that has so many level delineations. How many levels of Doctor are there (I'm not referring to specialists)? How many times have you been seen by an MD-Basic, or 'Advanced DO'?

[ERDoc]

That's like asking why people can't learn to intubate from only mannequin experience. Simulation always fails to capture the challenges of the real world, and it is never about the isolated skill. When we KED someone out of their car, there are many other concerns such as safety, directing resources on-scene, managing other injuries, multiple patients, deciding on a hospital, figuring out what level of care the patient needs, etc etc etc. I've never seen an in-class simulation that really captures all of the forces that exist on a real emergency scene.

Fair enough, but why can't someone be a medic and learn to do this? What is so special about gaining the experience in the field as an EMT?

[Tiff]

I am just as concerned about this as the OP.. I am "green" as well. My problem is I do not have the option to work in the field before I get my paramedic. I got my basic certification and moved directly toward my paramedic classes (in class now). I am a single mom in a program that provides housing for single mothers as long as we are in college, kind of like a dorm. I do not feel I could make enough money to support my kids alone only having my basic cert. I am very worried about whether or not I will be good in the field, but I do have MANY hrs in clinicals from basic, which started last August, to Paramedic, which ends in December. The paramedics I "shadow" actually let me be lead on the calls now that I am done with Intermediate. I pray I am the best I can be but I know I will still have a lot to learn and only experience will teach me. I would have liked to work in the field before getting my Paramedic cert, but that was not in the cards. Is it possible to be a decent medic and not have the field experience?

[ERDoc]

I've seen more than a few medics who refuse to do things like take vitals on their patient because"...thats a BLS skill, and I'm strictly ALS!"

Maybe those medics should be reminded that vitals are medical care and that as paramedics they are practicing medicine, however with that attitude they are not practicing very well.

Granted, not all of the calls we answer are going to require pharmalogical interventions, IVs or advanced airways; but I'm begining to believe that we should just do away with the different 'levels of licensure', and make everyone a Paramedic through a degreed course.

With the exception of nursing, EMS is about the only medical care provider that has so many level delineations. How many levels of Doctor are there (I'm not referring to specialists)? How many times have you been seen by an MD-Basic, or 'Advanced DO'?

I agree that we should have one, degreed level.

[paramedicmike]

Is it possible to be a decent medic and not have the field experience?

It is very possible to be a decent medic and not have any prior experience as a basic or intermediate. I'll even take that a step further and say it's possible to be an excellent medic with no prior BLS or ILS experience. If you want to be a decent medic or better, and it sounds like you do, then you will push yourself to make that happen. It sounds, too, like you have the motivation to make it happen. So don't lose sight of that goal and keep working. You will get there.

I'm a little disappointed, too, in how many people are arguing for prior experience based on the educational requirements of their local training programs. Just because local training programs do it a certain way doesn't mean that's the best way. Advocating for a substandard program based on substandard experiences isn't the way to improve things. BLS experience is not, nor should it be, required as a determination of who can be a paramedic. A proper educational program will cover the necessary education and skills while providing the necessary ride time to ensure a competent entry level paramedic.

Unfortunately, judging from several of the responses, it seems that many locations still insist on substandard and inadequate training. This is one of the reasons EMS is still stuck in the dark ages.

[tcripp]

I'm a little disappointed, too, in how many people are arguing for prior experience based on the educational requirements of their local training programs. Just because local training programs do it a certain way doesn't mean that's the best way. Advocating for a substandard program based on substandard experiences isn't the way to improve things. BLS experience is not, nor should it be, required as a determination of who can be a paramedic. A proper educational program will cover the necessary education and skills while providing the necessary ride time to ensure a competent entry level paramedic.

Unfortunately, judging from several of the responses, it seems that many locations still insist on substandard and inadequate training. This is one of the reasons EMS is still stuck in the dark ages.

Mike, I do agree with your statement, "A proper educational program will cover the necessary education and skills while providing the necessary ride time to ensure a competent entry level paramedic."

However, since we can't change the system overnight, and with the system as it currently is, why is it considered substandard if one thinks that a little extra time in the field is a good thing prior to finishing the higher level? We are taught that most of our ALS care is is BLS, so how is taking a little time to get additional experience before moving on a bad thing? Obviously, I'm missing the big picture.

To throw in another wrench for everyone...what about those, like me, who didn't really know we wanted to be a paramedic and trained at each level. By the time I graduated, I had 2 years as an ECA, 2 years as a Basic, and 1 year as an intermediate. When I started my clinicals/rideout in school and had my first full time position on a truck, I felt comfortable because I knew I at least had my BLS skills to fall back on.

And, if we have only an ALS level, are you suggesting there be no more first responders?

[paramedicmike]

Good questions.

... why is it considered substandard if one thinks that a little extra time in the field is a good thing prior to finishing the higher level?

For starters it assumes a level of competence or knowledge that may, or may not, exist. We've all seen people who've spent years with their local squads who can't so much as tie their shoe laces much less take a competent set of vitals. Field time does not equate to adequate experience. Nor does it equate to good habits in the realm of patient care.

However, if you take everyone and start them at the same level, create an educational foundation and build from there then you are almost guaranteed to produce people who can competently function as an entry level paramedic.

We are taught that most of our ALS care is is BLS, so how is taking a little time to get additional experience before moving on a bad thing? Obviously, I'm missing the big picture.

Because this isn't a BLS vs ALS issue. The issue, or big picture as you put it, is "adequate and appropriate patient care". EMS is the only field of medicine where I hear people arguing about BLS vs ALS. Treat your patient appropriately, regardless of the interventions, and you will do well. Treat them inappropriately because one's paramedic program assumed a level of BLS competence that didn't exist and you've harmed everyone including, and most importantly, the patient.

If we can get away from this silly, territorial notion of BLS or ALS we would start to grow as a profession. Unfortunately, this industry is full of people who are unable to separate their personality from their profession and become defensive to the point of digging in their heels because they're afraid of change on a level they can't comprehend.

To throw in another wrench for everyone...what about those, like me, who didn't really know we wanted to be a paramedic and trained at each level. By the time I graduated, I had 2 years as an ECA, 2 years as a Basic, and 1 year as an intermediate. When I started my clinicals/rideout in school and had my first full time position on a truck, I felt comfortable because I knew I at least had my BLS skills to fall back on.

People like you would be forced to face the same decision that almost every other profession must face. Do I want to do this job or don't I? In some cases people will persevere and succeed. In some cases, we as an EMS community, as well as our patients, would lose out. It's called life.

And, if we have only an ALS level, are you suggesting there be no more first responders?

I'd be perfectly happy with this.

[chbare]

Does the "real world," "wholistic" understanding not come from good clinical experience? This is the case for many other programmes such as respiratory therapy. Yet, somehow EMS is different?

Maybe, we need to look at improving paramedic education instead of augmenting and going around educational failures by mandating EMT experience to fill in the gaps?

Take care,

chbare.

[burntfromcommercial]

this is definately a question that is hard to answer. It would depend on where you are taking the Paramedic course. I am a NYS EMT-B. I have been in the business long enough to see a lot of medics come and go. In my region, there has been allot of ppl going straight to paramedic without first experiencing the back of an ambulance, and they are terri\ble. But there is always the option of getting your paramedic and working 6 mos to a year depending on your call volume as a basic in an ambulance before you go online. I am not sure what type of system you live in. If you are sure EMS is what you want to do, and you have the time to keep up the cert, then pace yourself. Just because you have the medic cert. doesn't mean you have to work as a medic right away if you aren't comfortable. Don't rush yourself to get online.

[Dustdevil]

Maybe, we need to look at improving paramedic education instead of augmenting and going around educational failures by mandating EMT experience to fill in the gaps?

^ This. End of story.

We all agree that it takes experience to become a competent provider. Nobody disagrees with that, so focus on the point here. What we are arguing -- for reasons beyond me -- is whether that experience should come before or after the student has obtained a didactic foundation from which to manage that experience. And I really can't believe that any intelligent professional would think that the vulnerable, sick and injured people who trust us with their lives, should serve as the Guinea Pigs for 3-week basics to experiment with to determine if they are really interested or not. That is absolutely criminal thinking.

And, as already made abundantly clear, there is no chance of most basics getting a real EMS job to get that experience, even if they wanted to. That's why half the posts on any forum are n00bs complaining that they can't get a job. And NO, you guys running private transfers for three years before medic school are NOT getting EMS experience, so get over yourselves.

Edited June 17, 2011 by Dustdevil