Second Ride Along

[MikeEMT]

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.

We don't follow AHA because we are a research area. We are conducting different methods of CPR to figure out what works better. Not a whole lot of difference at the BLS level moreso at the ALS level. Where do you think AHA gets their facts? You think they just pull them out of their butt? They get their information by reviewing peer provided documents and making recommendations based on what works.

I said it once already and I'll say it again. WA does not recognize EMT Students. Our clinicals are meant to observe not go hands on. If a provider, RN, or Doctor chooses to let the student go hands on then that is at their risk and discretion.

There was a couple of EMT students doing their clinicals at Harborview a couple of years ago, back when they let them go hands on. The students moved a patient and ended up breaking the patients neck. Now students don't touch.

When you are hired and on FTO then that is your handson time.

[spenac]

There was a couple of EMT students doing their clinicals at Harborview a couple of years ago, back when they let them go hands on. The students moved a patient and ended up breaking the patients neck. Now students don't touch.

When you are hired and on FTO then that is your handson time.

I have heard of a couple of emts that moved a patient and killed them so now emts can only observe. I have heard of a couple of Paramedics that gave the wrong med and patients died so now they can only observe. I have heard of a couple of nurses that pushed to big a dose and killed a patient so now they can only observe. I have heard of a couple of doctors that chose the wrong treatment and patients died so now they can only observe. See how ridiculous the logic given for why students can't touch just observe. No matter the level there will be mistakes made. Waiting to have hands on until hired in my opinion is idiotic. If the students did harm it was allowed by the supervising emt. If the supervising emt is not watching they deserve to be held responsible for the students mistakes. Part of training is being there to stop students from harming or killing patients.

[paramedicmike]

Mike, I have to agree with Spenac here. As ill suited as EMTs are to EMS work (and another topic, altogether) this is still medical education. Denying hands on education while still a student is dumb. All it does is turn out observers.

Harborview has a good reputation. But please don't drink the kool-aid. They have their faults, too.

[Arctickat]

There was a couple of EMT students doing their clinicals at Harborview a couple of years ago, back when they let them go hands on. The students moved a patient and ended up breaking the patients neck. Now students don't touch.

I'm gonna go out on a limb here and speculate that the patient's neck was already broken when the EMT students moved him. You don't mention whether or not the cord was damaged, but I am assuming so. His spinal cord likely would have been damaged regardless who moved him, ER staff included. Kneejerk reaction by someone looking for a scapegoat.

[DFIB]

I let students lay hands on the patients and encourage them to perform all of the skills that are appropriate to their level of training. I observe, correct, modify and improve their technique. That is how they learn. The patient is never at risk because I am there, directing and supervising their actions. Even doctors learn this way, "See one, do one, teach one" I have heard many a resident say while learning a new technique from the nurse, PA other medical personnel that are way below their educational level.

When I get green students that are timid and shy I get them to talk to the patient, interact, and begin exercising the skills that have learned in school. Just because they they do not have a cert does not mean they are not competent.

Moving back to the OP, you might try to volunteer for other things that are not necessarily EMT related; take out the trash, tidy the living areas in the station. Make sure you do these things well and expeditiously. This gives your preceptor an opportunity to watch you move, observe your level of confidence, see your hand to eye coordination and begin to form an opinion on how you will move in the confined spaces of an ambulance. It also lets them see that you are eager to get at the task at hand.

Good fortune to you.

[Just Plain Ruff]

Let's not kill MikeEMt as he's really only doing what he's being told he is allowed to do which is truly unfortunate.

I'd like to hear from other preceptors in Wasthington state about if it's just a Harborview thing or a Statewide thing where EMT students aren't allowed to practice skills.

Mike, I would really be surprised if it is statewide that EMT students are unable to practice skills, and I'd bet it's specific to your system or area.

I find it truly, truly sad that your area will not allow emt students to practice the skills that they have learned on patients and only cranks out observers in your educational system. That is truly a sad state of affairs that is based solely on the fact that one bad apple spoiled it for the entire system where you work. I think that someone was sued and lost HUGE and ended up putting a directive in place (as stupid as it sounds) that should be revisited and possibly rescinded.

But I'm not in your system and I can only sit back and sort of chuckle that someone's paranoia at a repeat of the incident that might happen is guiding a system as progressive as Harborview is, especially if Harborview is such a pilot program.

I mean if you let your students touch patients and do CPR during your research program wouldn't that be much more dangerous to your research if they did it wrong than a student splinting a patient wrong? Just asking?

If you are doing research into CPR and are as truly as integral a part of the AHA and it's guidelines I'd be much more worried a EMT Student would mess up your research numbers than if a student were to put a 4x4 on a patient wrong.

Do you see where I'm going with this?

[island emt]

The harborview crowd has always thought of themselves as better than the rest of us mere mortal beings when it come to cardiac resuscitation numbers.

They have always posted numbers that are double the rest of the country.

I've always said that there are questions on how they come up with there numbers and what types of patients are being included in their data. If you only include cardiac arrest that are witnessed and have immediate CPR & defibrillation, the numbers will be better anywhere.

To openly state they don't follow AHA guidelines is just plain foolish , I can imagine a lawyer seeing that and waiting for the next non survivor to file a lawsuit.

[Curiosity]

I'll tell you how we run here. As of 3 years ago, our basics can no longer administer any meds or do a glucose reading during their preceptorship. They can do vitals, talk, splint if their preceptors want to, that's it.

Some of our services don't follow AHA guidelines either. They are enrolled in studies that compare different protocols.

I and many people I know went through this process and we are no worse than any other medic out there. I went on to do my ALS and I didn't feel I was lacking in any way.

Different strokes for different folks.

Edited December 3, 2012 by Curiosity

[DFIB]

I'll tell you how we run here. As of 3 years ago, our basics can no longer administer any meds or do a glucose reading during their preceptorship. They can do vitals, talk, splint if their preceptors want to, that's it.

Some of our services don't follow AHA guidelines either. They are enrolled in studies that compare different protocols.

I and many people I know went through this process and we are no worse than any other medic out there. I went on to do my ALS and I didn't feel I was lacking in any way.

Different strokes for different folks.

I agree with not administering most meds but (in my opinion)basics can and should administer O2, activated charcoal to say the least, but I can see your point although it seems extreme. I think Nitro should be banned from EMT level administration but don't see any reason why they could not do a D-stick.

This is in no way intended to bash you but I would be mire concerned about students splinting than checking BGLs.

[emtdennis]

"I think Nitro should be banned from EMT level administration"

I am just curious, Why?