Straight to Paramedic

[R0B]

I have worked with a ton of different paramedic partners, some of which have spent time at every level, and some who have went all the way through to paramedic without ever spending a day on the box. I am an EMS Instructor, as well as CPR/AED, and ITLS; and I give this same advice to my students. The best ones I have worked with spent time at every level. I spent over a year at every level before certification, and in between classes took smaller classes at higher knowledge levels to better prepare me for the next level, for example I took an emergency airway management class as an EMT- Basic, and a comprehensive 12 lead EKG class as an intermediate. Going straight through can make the test easier, but nothing can compare to experience in the field. How can you expect to perform a surgical airway when you have not put in an OPA? And one of the toughest problems you will encounter will be accurrate, confident assessment of your patients. All the drugs and procedures in the toolbox, but it takes you the whole ride to the ED to figure out which one you should have used. Plus, if you get on the box where you have good partners they will help to build your knowledge. Anytime we run a decent call I always recap the call with my partners, whether they're EMT's or 30 year paramedics, not only to help them, but to help myself and pick up anything I missed or could have recognized earlier. Those classes are not that expensive, and you can always take out small student loans or work weekends on the box to pay for them while in class, as I did through B, I, and P. Best of luck man! Rob

-"Give me 6 hours to cut down a tree and I'll spend the first 4 sharpening the axe." -Abraham Lincoln

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?

It is possible, I usually don't recommend it because most people are not willing or capable of putting forth the effort it takes to do all of the studying; and it will require ALOT of studying. My best advice is to try to find a company where you can work as a Paramedic with a paramedic partner for a while, or that has a strenuous program where you ride 3rd out for a while (paid of course) until you are checked off in certain areas. I was a Paramedic Lieutenant at a small Fire Department based EMS, and have recently applied for a larger municipality. As a new hire I will have to sit for a 3 week classroom refresher, then ride 3rd out for ten 24 hour shifts, then spend a year with a paramedic mentor. Alot of the guys there worked for me part time at the other company where I was the Sup., but it goes to show how dedicated the service is to providing top medical care to the people in the response district. If you apply for a company willing to throw you on the box with an EMT partner the first day, be wary. Keep your nose in the book, you will only be as good as you allow yourself to be. Best of luck girl!

Rob

"Give me 6 hours to cut down a tree, and I'll spend the first 4 sharpening the axe." -Abraham Lincoln-

[Dustdevil]

"Give me 6 hours to cut down a tree and I'll spend the first 4 sharpening the axe." -Abraham Lincoln

You seem to have misunderstood Mr. Lincoln. Four hours spent practising carrying the axe around isn't the same as sharpening it.

I spent over a year at every level before certification, and in between classes took smaller classes at higher knowledge levels to better prepare me for the next level, for example I took an emergency airway management class as an EMT- Basic, and a comprehensive 12 lead EKG class as an intermediate.

Congratulations on all your meaningless merit badges, but it seems that a couple of key points have escaped you.

First, before you started taking advanced skills courses on the weekends, did it ever cross your mind that it might be a good idea to go to college and learn the foundations of human anatomy, physiology, psychology, and microbiology first? Oh that's right, us firemen don't need all that book learnin'. Just give me a needle, an ET tube, and a cookbook and I can save the world. The most significant reason that EMS is still living in 1972 is the fire service, and their self-centred refusal (and often a mental inability) to accept advanced educational qualifications. Instead we get a constant stream of excuses, attempting to justify maintaining the forty-year old status-quo. Medicine has evolved greatly in that time, but EMS is still doing things the way they've always done them. Yet, we sit around and complain that we don't get enough respect. The scary thing is that so many of can't figure out why. Oh well, the IAFF will fix it for us!

Going straight through can make the test easier, but nothing can compare to experience in the field. How can you expect to perform a surgical airway when you have not put in an OPA? And one of the toughest problems you will encounter will be accurrate, confident assessment of your patients. All the drugs and procedures in the toolbox, but it takes you the whole ride to the ED to figure out which one you should have used. Plus, if you get on the box where you have good partners they will help to build your knowledge.

And how can YOU expect to perform a surgical airway when you have never seriously studied human anatomy?

Another example of the firemen ignoring the obvious realities. I guess reality isn't in the protocol book. News flash (sort of, actually it's been covered for 4 pages now): The original poster can NOT get experience. It is not an option for her. In fact, in the real world, most basics cannot obtain EMS experience, because there are simply no jobs for them. In better systems, basics are not even employed at all. It's been twenty-five years since I worked in an EMS system that hired basics. So what you are recommending is not only stupid, it’s just plain un-doable.

I fail to see how encouraging the OP to do something that cannot be done is constructive. I dunno, maybe I learned that in college or something. Logic 101 FTW.

Edited June 19, 2011 by Dustdevil

[tcripp]

In fact, in the real world, most basics cannot obtain EMS experience, because there are simply no jobs for them. In better systems, basics are not even employed at all. It's been twenty-five years since I worked in an EMS system that hired basics. So what you are recommending is not only stupid, it's just plain un-doable.

I fail to see how encouraging the OP to do something that cannot be done is constructive. I dunno, maybe I learned that in college or something. Logic 101 FTW.

Hmmm...andhere I thought I worked in a "better system" since we have progressive standards of care and a lot of autonomy in our decision making capabilities...and we work an EMT/Paramedic truck.

Dang...guess I'll have to rethink my position.

Edited June 19, 2011 by tcripp

[Dustdevil]

Hmmm...andhere I thought I worked in a "better system" since we have progressive standards of care and a lot of autonomy in our decision making capabilities...and we work an EMT/Paramedic truck.

Dang...guess I'll have to rethink my position.

Definitely.

A better system gives you a partner, not just a driver.

[zippyRN]

Definitely.

A better system gives you a partner, not just a driver.

it depends on your 'emt' doesn't it ...

if we are talking 110 hours EMT-B they are a glorified first aider - as i've said be fore we have 'first aiders' in the uk we nearly as much training and our PTS Ambulance crews often have 120 + hours of clinical calssroom training plus their driving course ...

Volunteer crew and the 'bag monkey' ECA and Asssistant practitioner grades have 200 -300 hours of training ...

it also seems that those who aresaying that people need experience between EMT and paramedic are talking aobut systems where there is limited or NO placement experience , the direct entry Paramedics or Uni Paramedic Students in the Uk have thousands of hours of placements as part of their course ...

[fiznat]

Did the OP ask us our opinions on how we might redesign worldwide paramedic education? I didn't get that from his post.

Every discussion here seems to devolve into this "problem X would be solved if we just had better education" trap. Sure, we all agree. We can definitely improve on the educational system we currently have. That doesn't mean that those considering entering the field NOW (like the OP....) don't need reasonable, practical advice for the current state of things.

I still think its a good idea to get out in the field before you move on to a more advanced level. Paramedics, among their other duties, are managers. I've never met a good manager who didn't put his time in on the line.

[DwayneEMTP]

...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? ...

I have the same problem with the experience conversations as I do with the spanking conversations. They can go on for pages without ever defining the terms.

What do you consider 'experience?' Getting experience isn't exactly like buying a gallon of milk. When someone mentions that they bought some milk I can have a reasonable expectation that it is white, loaded with calcium, relatively clean and pasteurized, etc. I can draw reasonable conclusions from their one simple declaration. Experience does not come with the same reliable parameters. Very, very few of the people that get their EMT will ever use it, and of those that do, very few will get experience with it in a quality system as opposed to some knuckle dragger service or good ol' boy volly fired dept. Those opportunities do no offer quality, productive experience in my opinion.

My last Basic partner was super smart, competent, and I would have trusted him with most calls, but he is not the standard in my limited experience but the exception. Where these conversations tend to go off into the ditch I think is that side A assumes that all basics have gained 100% of their experience at Knuckle Dragger Volly Fire Dept, while camp B believes that all basics are gaining experience in quality systems, like the ones that they work in, and they're both wrong. But again, my experience is that camp A is more often than not more correct in their assumption.

I'm all for some experience before moving up the food chain assuming that it can reliably be expected to be good experience, with good mentors and preceptors, focused on moving forward. And I believe that I have a solution to making that happen. Starting the 1st of next year make an EMT cert expire perminantly after two years. Unless proof is given showing that the basic is irrevocable financially committed to an AAS in EMS program. That way we move out the career basics, opening quality spots for the up and coming medics student, and begin to populate the labor pool with people that are serious about EMS and intend to move forward instead of staying as lifelong helpers.

People will be less likely to become EMTs simply because it looks fun, employers will be less likely to hire people that they believe they will have to replace in two years, experience will become a non issue, many more basics will have as their original intent a desire for medic school and higher education, the fire depts will run from EMS in droves, (after spending a few years whining about shackling their heros), and soon the country could be populated with degreed, motivated, non fire dept medics. Then we'd have a population that we could use to create real change.

It might be ugly at first, but over 10 years, maybe much less, I believe that it would completely change the face of EMS.

But either way...as long as the majority of available basic slots will be in systems that are detrimental to the educational development of an individual, it's just really hard to make the argument for demanding it.

Dwayne

[Dustdevil]

Starting the 1st of next year make an EMT cert expire perminantly after two years. Unless proof is given showing that the basic is irrevocable financially committed to an AAS in EMS program. That way we move out the career basics, opening quality spots for the up and coming medics student, and begin to populate the labor pool with people that are serious about EMS and intend to move forward instead of staying as lifelong helpers.

I like it.

Some people still seem to see this as an either/or situation. It isn't. Nobody is arguing that education replaces experience. It doesn't (although many seem to be arguing the reverse). Both are absolutely crucial to the development of a competent practitioner. The point that too many are missing here is that both education and experience need to be obtained in a logical order to maximise the result.

I'm not sure how anyone here could have missed it, but I'll go back to the ultimate analogy: Building a home. You must lay the foundation first before constructing the house. Sure, you can just by a pre-fab home and roll it up on any old lot and you'll still have a home. You can even go back and pour a slab later, and maybe put brick veneer over the whole thing. But even then, it can never be as good as if you had done it right the first time. You're still just trailer trash.