EMT-B straight to Medic?

[Guest]

Hey everyone thanks for your comments they are all appreciated

[nsmedic393]

I really think it's up to the individual. I for one am one who went straight from BLS into ALS. (Literally, I had a weekend between the end date of my PCP schooling and the start date of my ACP schooling.) I had talked to many people before starting the program, and the general consensus I had reached was that it was a bad idea for me to go right into ALS right away ... however, being the youngen that I am (only 22) I think part of me was quite stubborn and I took the ALS program anyways with an attitude of "oh, you don't say I can do this? well watch me ... "

I was really apprehensive during my first few weeks of classes, but once we got into the swing of things, I noticed the other students were actually quite welcoming. There was a few people in my class that had been BLS providers for about the same amount of time that I've been alive, and they were very helpful in encouraging me and told me it was refreshing to see someone take such an interest in EMS. It also helped, because we were all on the same playing field academically and when it came to scenarios. Whether you had 20 years of experience or none (as in my case) we were all treated the same by the faculty of the school, and everyone tortured in the same ways ... haha

If you think you can do it, then do it. Remember, it's your choice, and many people (especially those who will feel intimidated by you) are going to try and discourage you from it, because it's not the 'norm'.

Zach

Zach, It sounds to me like you have not yet completed the ACP course. In some ways you have an advantage and in some ways you don't. You have the advantage of just completing a quite rigorous PCP program and you have all that knowledge fresh in your head. That is a good thing.

The huge disadvantage, and this goes for prissyemt as well, is that unlike your classmates you have no experience sitting in the box and looking at sick people. You learn alot in school but the real education starts when you ride the trucks.

I really don't think you guys will be so confident when you are looking at a sick patient while all the other BLS providers are looking at you for direction. I gotta tell you it might sound simple in class but when you are assesing a 90 y/o lady for SOB and trying to defferentiate between a pneumonia and CHF and treat accordingly you are going to be lost and that is where the rookie ALS providers make their mistakes.

Since you guys are already well into your programs, i'm assuming, this advice probably won't help, but kount... please listen and spend some time figuring out what sick people look like and getting some good solid EMS experiences under your belt before mooving on.

[Dsmittty911]

The one thing that I haven't heard mentioned here is working on rig doing bls stuff while in school learning the als stuff. I don't know about any of you but I have wife and 2 kids to support. I can't afford to just go to school. I have bills to pay. I'm not in medic school yet (working on getting back in) but I'm in process of finding bls job that I can work while I'm learning. Honestly to me that really seems the way to go. Also if you get good partner they will help you by showing you the bls ways of doing things and how it will be different with your als skills. That's my 2 cents worth. Take it for what it's worth.

[JakeEMTP]

The one thing that I haven't heard mentioned here is working on rig doing bls stuff while in school learning the als stuff. I don't know about any of you but I have wife and 2 kids to support. I can't afford to just go to school. I have bills to pay. I'm not in medic school yet (working on getting back in) but I'm in process of finding bls job that I can work while I'm learning. Honestly to me that really seems the way to go. Also if you get good partner they will help you by showing you the bls ways of doing things and how it will be different with your als skills. That's my 2 cents worth. Take it for what it's worth.

That is exactly the way it is done here Dsmitty. We work doing transports or volly 911 while attending the medic program. While transports may not be ideal for observing ALS, at least you have pt contact and also keep your debtors happy.

[PrissyEMT]

I really don't think you guys will be so confident when you are looking at a sick patient while all the other BLS providers are looking at you for direction. I gotta tell you it might sound simple in class but when you are assesing a 90 y/o lady for SOB and trying to defferentiate between a pneumonia and CHF and treat accordingly you are going to be lost and that is where the rookie ALS providers make their mistakes.

Good point- there is no way I can guarantee that I'll be as confident as any other paramedic who went about their education differently. That is something that does come with time. But I do feel that the particular program I'm in gives me so much clinical time, and so many different clinical opportunities (not to mention an extensive internship with our EMS agency), that I'll come out of it feeling a sense of comfort/confidence in what I'm doing. Granted, I may be relatively "new" at it all, but everyone's different. I'm sure some people benefit from waiting to begin ALS courses, and some prefer to jump in head first like I do. You know what you can accomplish, and only you know what works best for you. If after going through BLS you aren't ready to continue right away, then don't. If you feel you can do it, then go for it. You know your own limits and abilities.

[Guest]

nsmedic393,

I understand and appreciate completely what you mean with regards to considering differentials and such in the field, but quite honestly, the same argument could be made for any level. There are many services here in Ontario that still don't have ALS for whatever reason, so if I'm a brand new PCP or a brand new ACP, the challenge will still be there.

Actually while I was still in the theory portion of the ACP program, our instructors did a novel idea one day during a few of our labs. They combined the PCP students and the ACP students for scenarios. Basically, the scenario would start with the PCPs on scene first, the call would warrant ALS, but there was about a 12 minute lapse before ALS arrival. It was interesting to see how we all acted when partnered with people we've never met before. For me personally, it was a huge shock to be running the scenario with 2 PCP students and myself as opposed to me and another ACP student 'acting' as a BLS partner. Hopefully with time I'll develop better interpersonal skills .... haha

Two of my all time favourite quotes (which is true to more then just EMS) is this:

"Good judgment, comes from experience. Experience, comes from bad judgment."

and

"Whether you think you can, or you think you can't, you're right."

Zach

[nsmedic393]

hi guys,

Prissy, how much time does you program have for clinicals? hospital and ambulance?

Zach. You very well may be a great ACP you are right about the thinking you can or cant thing. You are also right that weather you are a brand new PCP or ACP you will have chalenges and I loke your quote about experience.

The thing is, that the challenges you face as a new PCP are going to be things like, how to deal with loss, good ontrapersonal skills, not getting attached, work a MCI, knowing when you are in over your head, tailoring your SAMPLE and OPQRST assesment to work for you and knowing what a sick person looks like. These are things you should master before jumping into a whole new set of chalenges as an ACP. Like the Rs of med admin, delegating, High risk skills and perfecting you assesment. I think that if you throw all of the new experiences ALS and BLS in together you wind up with a pretty unbalanced medic. I find new ACPs who have not spent any time as BLS lack alot of intrapersonal skills, and despite haveing all that school knowledge fresh in their heads they lack on the medical side of things because it is just too much to try and perfect everything at once.

"Good judgment, comes from experience. Experience, comes from bad judgment."

this is 100%true, but if you are a PCP the bad judgement leads to experience and good jugment, if you are a ACP the bad judgement leads to experience and good judgement but at the risk of someone dying. There is a whole lot more ways to kill someone as a ACP than a PCP and its not the place to be screwing around trying to get a handle on things.

All can say is that I hope you take this realy seriously because being ALS is not something to be taken lightly.

Good luck.

[PrissyEMT]

I'm in an 18 month, 5 semester program. Each semester, we're required to put in at least 48 clinical hours. These hours come from time in the ER, OR, the 5 ICU's, Cardiac Floor, going around with the Respiratory and IV teams, and a few shifts with the flight nurses/paramedics. During clinicals, we're also required to get 50 successful IV sticks, 20 intubations and 30 complete written patient assessments each semester. Even though we're only required 48 hours, this semester I'm putting in 60.

After that, at the end of the program, we must complete a 300 hour (25- 12 hour shifts) internship with our county EMS agency. It's not just going to be a ride-along type thing- we actually have to perform our paramedic skills and do assessments in the field.

Even after I've completed the program, and actually get my cert, I can only act as a basic during the first 90 days of employment with our EMS service, and I'm not able to actually be a crew chief until I've been there for more than 1 year.

ALS is definitely not something I take lightly at all. It's a serious job with the chance of serious consequences coming from mistakes you could potentially make. I completely understand that, and that drives me to learn everything I can now, and to get all the experience I can, even though right now in class it's all in a controlled environment. I still run with our volunteer service that also transports, and that's helped me incredibly just in the past 2 months that I've been doing it. I agree, you can learn everything in the classroom, think you've totally got it down, then get out on a call and realize how different the real world actually is. Everyone's different, and everyone has different abilities. If I didn't completely feel like this was something I could do, then I most definitely wouldn't have started school again right away. But I know I'm ready, and I know I can do it, so that's exactly what I'm doing.

[kemt217]

I wish you luck! EMS is a great field to be in. Going from a Telecommunications Supervisor to EMS....you will not make the same money at all. As for what to do, do what you feel comfortable with, what you feel you can handle. My hubby is a Cellular/RF Tech. and I don't even make half of what he does, that is why we can afford for me to work in EMS!!

[Guest]

you are very right kemt i have to wait 5 years in the other field just to have the funds to put me through ems school and the wife through nursing school at the same time , but for me it isn't money thing now i want to go into a field where get to make a difference and help people out the best i can

thanks for you comments guys