Second Ride Along

[Just Plain Ruff]

I don't want to bash on students, but what do you expect to happen. You don't have a basic cert yet so anything you do will be under the cert of the EMT's you are riding with. It would depend on how comfortable they felt with you as to what they let you do if anything.

Me personally, I would have a hard time letting an EMT student touch my patient. That doesn't mean I wont explain things to the student and I might let them listen to lung sounds or get the second set of vitals. But, ultimately my name is attached to that patient and I am responsible.

Sit back, observe what the EMT's are doing, ask appropriate questions AFTER the call. If you are lucky enough to get hands on experience, great. That means they trust you and your abilities. BUT, if you don't get hands on experience don't sweat it. Just pay attention and learn what you can. Ride out time is meant to give you first hand experience as to how we operate in the field.

In a perfect world students could get hands on time. However, legally speaking it is not in the best interest and can get people in trouble.

Good luck to you and enjoy your ride along. Remember to thank the crew.

So Mike did you get any hands on experience when you were doing you ride time?

Why do you think that students are in class and doing ride time? You are there to evaluate them, you are there to help them on a real world patient. If you don't trust them then you should not have them on your truck.

I'm having a little bit of a hard time understanding why you are precepting students. That's what preceptors do, they help students with their skills.

I'm not bashing you because it's your prerogitive to not let them touch your patient but they have to learn it sometime.

Does your service just put students with you and that's it. If so that's a shame.

But I will tell you this.When and if you go to medic school you will be expected to perform skills and get them checked off, what happens if you get a medic preceptor who thinks like you "i'm not going to let them touch my patient because my name is attached to that patient so they can't touch them so all this medic student gets to do on this shift is sit back and observe" How are you going to feel?

If you are truly observant of the student doing the skill on the patient and not just letting them do the skill then you can stop them when they begin to do it wrong. You also inform the patient that this is the student doing the skill and is it ok for the student to do it. The patient can say no or yes.

Frankly Mike, I'm disappointed in your response. Every preceptor I had when I was going through both EMT rides and Medic rides allowed me to perform whatever skills I had been trained on in class.

But you are entitled to your position and I'm not busting your balls about that position, just disappointed is all.

I am also very leary of basic students assigned to me that I haven't even met previously, I have them show me their skills in the station prior to touching a patient. We start out checking the truck together, I am surprised how many of them don't have a clue as to what some of the equipment is, much less how to use it. I have them take vitals of people in the station to ensure they are competent, then we do some splinting and run through some scenrios and what I expect of them on the truck. It may take your preceptor a few shifts to become comfortable with you.

My advice is to ask questions when the time is appropriate. If you don't know how to do something just ask, we don't expect you to know everything. I would rather you ask than fumble aroud not knowing how to use something.

Good luck!

I did double the required clinical hours trying to get my calls. I know how frustrating it can be to have a slow day as a student.

I'm not saying that they be able to do all the skills that you do as an emt on a regular basis but come on, EMT skills are not rocket science in the knowledge it takes to do so. How much knowledge does it take to put a couple of 4x4's on a wound and then wrap it with some kling?

But you should be showing them how to put on a splint and allowing them to help. Not just letting them observe. I'm sure they've done it dozens of times in the classroom setting.

Putting on a hare traction splint, that takes two or more people to do, why not get them involved in putting it on.

Not allowing them to get in and help and just making them observe is to me just tanatmount to a wasted 12 hour shift.

If you need to have them prove to you that they can do the skill before they get to do it in the field under your supervision, that's great, but to refuse to let them touch your patient except for lung sounds or a second set of vitals, is just silly.

[Curiosity]

I'm not clear about whether this is her preceptorship or ride outs.

Based on what she's saying I'm thinking these are meant to be observational shifts and not her being evaluated on any skills. Some medics don't mind letting them get their feet wet on ride outs, but some prefer the student to observe, take notes, ask questions and learn before being thrown in the deep end. I have to agree with not overwhelming a student with tasks and simply having them watch and learn.

I remember my ride outs, I was very content to simply observe, see how the medics asked questions, see where their priorities were. I also remember being fairly comfortable during my first preceptorship shifts because of that. I learned a lot about communication and history taking during my ride outs. Skills will be evaluated during preceptorship.

Edited November 29, 2012 by Curiosity

[MikeEMT]

So Mike did you get any hands on experience when you were doing you ride time?

Why do you think that students are in class and doing ride time? You are there to evaluate them, you are there to help them on a real world patient. If you don't trust them then you should not have them on your truck.

I'm having a little bit of a hard time understanding why you are precepting students. That's what preceptors do, they help students with their skills.

I'm not bashing you because it's your prerogitive to not let them touch your patient but they have to learn it sometime.

Does your service just put students with you and that's it. If so that's a shame.

But I will tell you this.When and if you go to medic school you will be expected to perform skills and get them checked off, what happens if you get a medic preceptor who thinks like you "i'm not going to let them touch my patient because my name is attached to that patient so they can't touch them so all this medic student gets to do on this shift is sit back and observe" How are you going to feel?

If you are truly observant of the student doing the skill on the patient and not just letting them do the skill then you can stop them when they begin to do it wrong. You also inform the patient that this is the student doing the skill and is it ok for the student to do it. The patient can say no or yes.

Frankly Mike, I'm disappointed in your response. Every preceptor I had when I was going through both EMT rides and Medic rides allowed me to perform whatever skills I had been trained on in class.

But you are entitled to your position and I'm not busting your balls about that position, just disappointed is all.

I'm not saying that they be able to do all the skills that you do as an emt on a regular basis but come on, EMT skills are not rocket science in the knowledge it takes to do so. How much knowledge does it take to put a couple of 4x4's on a wound and then wrap it with some kling?

But you should be showing them how to put on a splint and allowing them to help. Not just letting them observe. I'm sure they've done it dozens of times in the classroom setting.

Putting on a hare traction splint, that takes two or more people to do, why not get them involved in putting it on.

Not allowing them to get in and help and just making them observe is to me just tanatmount to a wasted 12 hour shift.

If you need to have them prove to you that they can do the skill before they get to do it in the field under your supervision, that's great, but to refuse to let them touch your patient except for lung sounds or a second set of vitals, is just silly.

I don't train students, I'm just off of FTO myself. We didn't do ride alongs we went to Harborview for our Clinical time. We weren't allowed to touch patients unless we were under direct supervision of a MD or RN. Even then it was limited to positioning patients. I helped log roll a patient and man were those doctors nervous - even though its a teaching hospital.

The point I am trying to make is I hear students all the time saying they are going for a ride along and you hear their expectations. The expectation of a student on a ride along is that they are there to observe what is going on. Hands on skills are developed on FTO.

One has to remember that an EMT works under local protocals where as a student is working under national standards, which can be conflicting. For example National standards teaches CPR to one set of standards, however here in King County we do a variation of High Performance CPR.

I think people get student ride alongs and new hire FTO mixed up.

Would I let a student touch my patient? I don't know, that would depend on my evaluation of the student, the patients condition and my gut feeling. Would I teach a student and explain things to them? You bet.

Bottom line, students should not expect to be involved in patient care.

[Just Plain Ruff]

This is where you and I disagree. I fully believe that students should be involved in patient care to the extent (and this is the caveat) to the extent of the person watching over them or in charge of them felt comfortable with them doing what they allowed them to do.

Let me ask you this, how do you think medic students get their skills checked off? They are students and by your reasoning they should not be involved in patient care so there is no way in your reasoning that they should be able to get their skills checked off. Right? So if they are not involved in patient care then how do you expect that medic student to get any of their skills or assessment skills checked off which is a critical part of their paramedic curriculum completed?

Again, I'm just asking the question, not jumpin on you. I'm just trying to see how you expect for medic students to get their skills checked off?????

I disagree with your premise but don't disagree with you having that premise.

[paramedicmike]

If you aren't willing to let students learn then don't accept students.

Students are there for exposure, for practice, for experience. Failing to allow any of that means you are a poor preceptor/instructor. So what if your name goes on the chart? Did you not observe the student? Did you not supervise? Did you not step in immediately if they were making a mistake?

Some students need more guidance and teaching than others. They do not need preceptors who are too afraid of themselves to let anyone else get involved.

[MikeEMT]

This is where you and I disagree. I fully believe that students should be involved in patient care to the extent (and this is the caveat) to the extent of the person watching over them or in charge of them felt comfortable with them doing what they allowed them to do.

Let me ask you this, how do you think medic students get their skills checked off? They are students and by your reasoning they should not be involved in patient care so there is no way in your reasoning that they should be able to get their skills checked off. Right? So if they are not involved in patient care then how do you expect that medic student to get any of their skills or assessment skills checked off which is a critical part of their paramedic curriculum completed?

Again, I'm just asking the question, not jumpin on you. I'm just trying to see how you expect for medic students to get their skills checked off?????

I disagree with your premise but don't disagree with you having that premise.

Big difference between Medic students and EMT students. Most Medic students already have their EMT cert for entry into the program. Medic students tend to work more under the supervision of a doctor during their clinical time.

EMT students are usually entry level and are obtaining their first job in the healthcare field. Here in WA, an EMT student isn't allowed to practice.

As I stated, if I feel comfortable with the student, they have demonstrated a reasonable level of competency and the patient is stable with good vitals then maybe I will let them take a Blood Pressure. If I hear a strange lung sound maybe I will let the student listen so they can hear it too.

EMT students shouldn't have the expectation that they are going to be a "3rd provider" on the rig though. The expectation I have is that they are there to learn and observe.

I was a student myself a few months ago. I know how hard it is to get comfortable with your skills. But as a student you are an observer, not a provider. Many hospitals won't even allow students in the room to hear the Short.

Students haven't taken HIPPA, many of them aren't aware of local protocols or privacy issues.

Student Ride outs are designed to give the student a real world look into our field. See how equipment really works and how an ambulance is really set up. Once they get hired their FTO program will give them the hands on experience they need.

Medic programs are different and usually are under the immediate direction of a doctor which gives the student a little more legal protection. Basic programs are usually college programs under the direction of a college which offers no more legal protection than a standard good samaritan law. In fact many programs around me make the student sign a form that says they are to not practice what they learn until hired, may not refer themselves as an EMT and will hold harmless the institution should they violate any of that.

BLS and ALS is two different worlds.

If you aren't willing to let students learn then don't accept students.

Students are there for exposure, for practice, for experience. Failing to allow any of that means you are a poor preceptor/instructor. So what if your name goes on the chart? Did you not observe the student? Did you not supervise? Did you not step in immediately if they were making a mistake?

Some students need more guidance and teaching than others. They do not need preceptors who are too afraid of themselves to let anyone else get involved.

Guidance and teaching isn't necessarily giving a student free reign in the back of an ambulance.

Me personally, I would be more than happy to explain anything the student wanted. It is very doubtful that I would let and EMT Basic student touch my patient though.

Now if this was an FTO type of situation then that would be different.

Its not me being a jerk or not wanting them to learn, its me protecting them. WA doesn't recognize students and they could be held liable.

As I said in my above post, big difference between a BLS student and an ALS student. Different legal protections, different requirements.

[paramedicmike]

Guidance and teaching isn't necessarily giving a student free reign in the back of an ambulance.

Who's arguing for free reign in the back of an ambulance? That's where the preceptor's role of supervision comes into play. Fail to supervise a student and a preceptor should be fired.

Me personally, I would be more than happy to explain anything the student wanted. It is very doubtful that I would let and EMT Basic student touch my patient though.

Then you do not deserve to be a preceptor. If you currently are one, please, for the sake of your students, step down. You are only standing in the way of them taking care of people

Now if this was an FTO type of situation then that would be different.

We aren't talking about FTO type situations.

Its not me being a jerk or not wanting them to learn, its me protecting them.

It's you protecting you. If you were properly supervising their activities and intervening when necessary you would be protecting them and your patient. By refusing them anything more than observation you are doing them, and any future patient they may encounter, a HUGE disservice.

WA doesn't recognize students and they could be held liable.

Liable for what? You failing to be an attentive preceptor? You failing to intervene if necessary? You failing to teach? Any subsequent lawsuit won't come after a student. There's no money there. They'll come after you and your employer. So this goes back to you protecting you.

As I said in my above post, big difference between a BLS student and an ALS student. Different legal protections, different requirements.

I'm not talking about ALS vs BLS. This is a BLS oriented discussion. So we're talking BLS.

I have no idea if you are a preceptor or not. I'm inclined to think not. So any "you" reference was a general reference and not you individually.

[MikeEMT]

Who's arguing for free reign in the back of an ambulance? That's where the preceptor's role of supervision comes into play. Fail to supervise a student and a preceptor should be fired.

Then you do not deserve to be a preceptor. If you currently are one, please, for the sake of your students, step down. You are only standing in the way of them taking care of people

We aren't talking about FTO type situations.

It's you protecting you. If you were properly supervising their activities and intervening when necessary you would be protecting them and your patient. By refusing them anything more than observation you are doing them, and any future patient they may encounter, a HUGE disservice.

Liable for what? You failing to be an attentive preceptor? You failing to intervene if necessary? You failing to teach? Any subsequent lawsuit won't come after a student. There's no money there. They'll come after you and your employer. So this goes back to you protecting you.

I'm not talking about ALS vs BLS. This is a BLS oriented discussion. So we're talking BLS.

I have no idea if you are a preceptor or not. I'm inclined to think not. So any "you" reference was a general reference and not you individually.

No I am not a preceptor. I fail to see how my opinion is a hinderance to a students education. Just because I won't let them touch my patient makes me a bad teacher? I'm not calling you a bad medic because of your differing opinion so at least show me the same courtesy. You don't have to agree with me, but my differing opinions don't make me a bad teacher.

I have been an FTO when I was a cop. I am new to the EMS game but I have already helped out several EMT students. I have even gone as far as to let the students observe me when they are on Clinical. I don't claim to have all the answers, but I will go above and beyond to help someone learn. Whether that person is a fellow EMT, Student or even patient / citizen that is just curious.

Maybe where you live things are different. Here, EMT students aren't allowed to touch patients. Harborview doesn't allow it, neither do we.

I think you have mis interpreted what I was saying. If you were a student on my ambulance, as a general rule I am not letting you touch my patient. That said if I trusted you, you showed a reasonable level of competence, and the patient was ok with it I might let you take a set of vitals. The rule though is you don't touch the patient. If its CPR I have no problem with letting a student do compressions if they wish - though we don't do CPR like is taught by AHA so that could pose a problem.

I don't know why it is such a difficult concept to grasp. I feel as if I am going in circles with this.

So, I will conclude my opinion with the following. To the OP, your role as student is to learn. Ask questions when appropriate. Take notes if you need to (never in front of a patient though). If you are allowed to do something then follow instructions. Don't go on your ride expecting to do something other than observe. If you do get hands on time, consider yourself lucky. Treasure any hands time you may receive and don't get upset by critisizm. Remember, school is nothing like the field - your real education begins when you enter the field.

Good luck.

Edited November 30, 2012 by MikeEMT

[Just Plain Ruff]

I still disagree with you but if thats the way things are done in your area thats the way its done.

But I gotta say I think the way you guys do it up there is doing a huge disservice to your students.

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[nypamedic43]

. If its CPR I have no problem with letting a student do compressions if they wish - though we don't do CPR like is taught by AHA so that could pose a problem.

AHA is a national standard...and you dont follow it?? I guess the science is invalid in Washington....And I thought NY was backwards in some things.

I allow basic students to do whatever they can...splinting, bandaging, vital signs, administering aspirin or albuterol. If they have been taught how in class, then I let them do it in the field. If they arent comfortable then I do it and they can observe. The only way to learn is to do in this field and most people in the basic class have never had any kind of contact with this kind of work. Never had real contact with trauma or critically ill patients. So why not let them practice taking vital signs on Gramma who stubbed her toe? I've had nursing students and medic students flip the f**& out in the back of my ambulance because they are completely unprepared to deal with patients on the streets and I had to make the driver pull over and put them in the front seat. I just don't see why basic EMT students cant do what they have been trained in class to do. Its one thing to put a traction splint on a leg that isnt fractured in class...quite another to actually see the effects of a fractured femur and the relief that the traction splint gives in the field.

To the OP...if you really want to do what you have been taught in class, then you need to be more aggressive in asking the crew you are riding with for the opportunity. Be a go-getter and be unafraid when asking...even if your scared shitless. The best advice I ever got in medic school was this...be the duck, smooth on the surface and paddling like hell underneath. Dont let 'em see you sweat.

Good luck to you and I hope you are able to get some practice in.