EMT-B straight to Medic?

[Asysin2leads]

This is the way I look at it.

Take two EMT's of comparable training and skill at a similar point in their career.

One goes into a 911 BLS service, and one goes to paramedic school.

The first gets hands on field experience with other senior BLS providers, learning the tricks of the and procedures from people who have always been at the BLS level.

The second gets hands on field experience with senior BLS providers, senior ALS providers, hard core didactic sessions, clinical experience, plus the opportunity to follow up and discuss with physicians, nurses, and a variety of other healthcare professionals.

Now, I ask you, who will be better prepared to hand a call at the end of a year?

[Dustdevil]

My feeling on this topic has always been completely based around your area, region, and how things are done.

If you live in an area like Texas, where most of your 911 crews are strictly ALS, with limited availability of BLS 911 experience, then by all means go straight to Medic school. Not doing that will only hurt you.

In a large part of the country, 911 BLS exists, and in some, they are included in busy metropolitan systems. Until you have enough time under your belt, know the system, how EMS works, are comfortable with this being the direction you want to go, seen patients, understand patient care, etc etc etc, you can only be helped by BLS 911 time.

Completely intrinsic on the area you work is all...

You are misunderstanding me all the way around. First, other than Dallas county, most EMS around here is mixed basic/medic crews. Therefore, there are 911 jobs for basics. But in most areas of the country as a whole, there are MANY more basics than there are 911 jobs for them. This is not a local issue. This is a nationwide issue of supply and demand. All one has to do is read this board daily to see how many basics are not working 911 and cannot find a 911 job.

And my major point is that even if a basic does get a 911 job, the positive effect it has on him being a medic is still negligible at best, and more likely it will have more negative effects than positive. Again, that is not a local issue.

Arguing for bls experience prior to paramedic school is simply ludicrous and without any sound reasoning. They are getting experience IN paramedic school. And the faster they get there, the fresher their basic education will be in their mind. The currency of that information is much more important than how long they've been doing it. The knowledge you gained in basic school begins to deteriorate the day you graduate. Sure, you *might* learn a little so-called "street smarts" (whatever that is) while practicing as a basic, but "street smarts" is not an asset in paramedic school. Knowledge is an asset. Remember, we want to EDUCATE paramedics, not train them.

So, what is the solution to the poor state of preparedness of new medics? Do we require two years of basic experience that we really have no way of qualifying? Do we let in the basic with five years on a dialysis truck because he has more "experience" than the basic with 6 months of 911 experience? How do we qualify their "experience"? How do we know that they really learned anything during that time? How do we know that they got anything more than bad habits and bad attitudes over those two or so years? Simple. We don't. We can't. You know as well as I do that once a basic hits the field, he is more concerned with being like everybody else than he is with capitalising on his education. I have yet to hear anybody explain how we qualify this "experience", or how to explain how the thousands of medics who simply cannot find a 911 job are supposed to get the "experience" you are asking for.

It's just common sense that the problem of unpreparedness would be better addressed at the educational level. That is what school is for, preparing students for practice. If schools are taking the time to adequately educate their medics with field and clinical exposure, then they can give their students more relevant "experience" in a few months of internship than the basic would have gotten in a few years of unsupervised, unstructured on-the-job "experience," especially considering that the chances they got quality, high volume 911 experience with a qualified partner is slim to none.

And of course, your argument can be applied all the way down the line? Shouldn't somebody have a couple years as a first responder before they go to EMT school? Shouldn't they have a couple years as a first aider before going to FR school? Funny how I never hear any basics making that argument. Where do you draw that line?

[PRPGfirerescuetech]

You are misunderstanding me all the way around. First, other than Dallas county, most EMS around here is mixed basic/medic crews. Therefore, there are 911 jobs for basics. But in most areas of the country as a whole, there are MANY more basics than there are 911 jobs for them. This is not a local issue. This is a nationwide issue of supply and demand. All one has to do is read this board daily to see how many basics are not working 911 and cannot find a 911 job.

And my major point is that even if a basic does get a 911 job, the positive effect it has on him being a medic is still negligible at best, and more likely it will have more negative effects than positive. Again, that is not a local issue.

Arguing for bls experience prior to paramedic school is simply ludicrous and without any sound reasoning. They are getting experience IN paramedic school. And the faster they get there, the fresher their basic education will be in their mind. The currency of that information is much more important than how long they've been doing it. The knowledge you gained in basic school begins to deteriorate the day you graduate. Sure, you *might* learn a little so-called "street smarts" (whatever that is) while practicing as a basic, but "street smarts" is not an asset in paramedic school. Knowledge is an asset. Remember, we want to EDUCATE paramedics, not train them.

So, what is the solution to the poor state of preparedness of new medics? Do we require two years of basic experience that we really have no way of qualifying? Do we let in the basic with five years on a dialysis truck because he has more "experience" than the basic with 6 months of 911 experience? How do we qualify their "experience"? How do we know that they really learned anything during that time? How do we know that they got anything more than bad habits and bad attitudes over those two or so years? Simple. We don't. We can't. You know as well as I do that once a basic hits the field, he is more concerned with being like everybody else than he is with capitalising on his education. I have yet to hear anybody explain how we qualify this "experience", or how to explain how the thousands of medics who simply cannot find a 911 job are supposed to get the "experience" you are asking for.

It's just common sense that the problem of unpreparedness would be better addressed at the educational level. That is what school is for, preparing students for practice. If schools are taking the time to adequately educate their medics with field and clinical exposure, then they can give their students more relevant "experience" in a few months of internship than the basic would have gotten in a few years of unsupervised, unstructured on-the-job "experience," especially considering that the chances they got quality, high volume 911 experience with a qualified partner is slim to none.

And of course, your argument can be applied all the way down the line? Shouldn't somebody have a couple years as a first responder before they go to EMT school? Shouldn't they have a couple years as a first aider before going to FR school? Funny how I never hear any basics making that argument. Where do you draw that line?

Ok, maybe I misunderstood. But, you have made yourself completely clear before about how basics are pointless because the only jobs that use them are transport services. This was during EMTcity's "phase out basics" not too long ago.

Something to keep in mind in future arguments.

Moving to the subject at hand.

To suggest we lose knowledge the day we leave basic school as your reasoning for your stance in similar to fighting fire with fire. Heres what I mean. According to your statement, basics lose information and knowledge when leaving school. So, thus, we should go straight to medic. I must ask, if this is your baseline issue, then you are treating a symptom of a bigger problem completely inappropriately. So, im going to change my previous statement to further fit the situation.

A drastic improvement of EMT basic education is required before mandating a requisite BLS time before entry to paramedic school. We've beat Basic education improvement to death here, and I hope not to have to revisit it.

Moving on....

So, what is the solution to the poor state of preparedness of new medics? Do we require two years of basic experience that we really have no way of qualifying? Do we let in the basic with five years on a dialysis truck because he has more "experience" than the basic with 6 months of 911 experience? How do we qualify their "experience"? How do we know that they really learned anything during that time? How do we know that they got anything more than bad habits and bad attitudes over those two or so years?

Quantification of experience must be made on a case by case basis, at the point of entry and acceptance to a accredited paramedic program. Similar to applying for a job, where experience is needed, there are processes that one can go through to quantify any experience. If not, no one would have to interview, resumes wouldnt exist, pre employment exams, blah blah blah. Im sorry, this arguement doesnt hold up.

You know as well as I do that once a basic hits the field, he is more concerned with being like everybody else than he is with capitalising on his education.

Opinion, not fact. Even if this was true on a "all-basic" encompassing level, standard changes in education, a shift to collegiate level education, and standards of admittance to BLS programs would be simple changes need to rectify this issue.

And of course, your argument can be applied all the way down the line? Shouldn't somebody have a couple years as a first responder before they go to EMT school? Shouldn't they have a couple years as a first aider before going to FR school? Funny how I never hear any basics making that argument. Where do you draw that line?

That line is simple actually. In order to be considered a true medical provider, in my opinion, your scope of practice has to involve several things. One of which is patient assessment. The first responder program does not include that. This is why its a first responder program, and as simple in nature as it is. That, is MY OPINION.

I think I got everything.

*Waits patiently for a reply*

PRPG

[Dustdevil]

Ok, maybe I misunderstood. But, you have made yourself completely clear before about how basics are pointless because the only jobs that use them are transport services. This was during EMTcity's "phase out basics" not too long ago.

You misunderstood that issue too. The point was not to phase basics out. The point was to elevate their education to where they were no longer just basics. Huge difference. And some states are already doing this by converting their basic courses to intermediate courses so that everybody enters the field with greater understanding and scope of practise.

To suggest we lose knowledge the day we leave basic school as your reasoning for your stance in similar to fighting fire with fire. Heres what I mean. According to your statement, basics lose information and knowledge when leaving school. So, thus, we should go straight to medic.

Correct. Just like you should take Chem II immediately after Chem I. If you wait two years to go back and take Chem II, it's going to kick your ass because you have forgotten most of what you already learned about protons and electrons. The very same thing applies to EMS education.

I must ask, if this is your baseline issue, then you are treating a symptom of a bigger problem completely inappropriately.

How exactly is improving education an inappropriate way to address poor education? Your logic escapes me.

We've beat Basic education improvement to death here, and I hope not to have to revisit it.

Not a problem. We're talking about medic school now, not basic school.

Quantification of experience must be made on a case by case basis, at the point of entry and acceptance to a accredited paramedic program. Similar to applying for a job, where experience is needed, there are processes that one can go through to quantify any experience. If not, no one would have to interview, resumes wouldnt exist, pre employment exams, blah blah blah. Im sorry, this arguement doesnt hold up.

The word is qualify, not quantify. Quantification is simple. But determining the quality of the applicants experience is nearly impossible. Again, just because an EMT has a job doesn't mean he is learning anything or growing professionally. It just means he has a job. We cannot assume that he spent any of that time with a qualified and experienced senior partner who took the time to impart important knowledge to him. So really, the time factor is completely without value unless you can qualify it.

Opinion, not fact. Even if this was true on a "all-basic" encompassing level, standard changes in education, a shift to collegiate level education, and standards of admittance to BLS programs would be simple changes need to rectify this issue.

That's exactly my point! You're exactly right. This can be fixed at the educational level, and it should be. Education can be both quantified and qualified. It is structured with a syllabus which tells us exactly what the student has covered, how long, and in what depth. And it assures that this was covered to a verifiable level. You have absolutely no way of doing that with work experience.

That line is simple actually. In order to be considered a true medical provider, in my opinion, your scope of practice has to involve several things. One of which is patient assessment. The first responder program does not include that. This is why its a first responder program, and as simple in nature as it is. That, is MY OPINION.

I agree with that too! But first responders do get a limited amount of assessment education. EMT's get a little more. And medics get a little more. But again, you are being contradictory. If experience is such a crucial factor, then why wouldn't you require it as a prerequisite for EMT school too?

[Nate]

Truth is that if the return rate on 911 calls was higher we would go to dual paramedic trucks, but since it isn't...we stick with EMT-basic drivers to assist the paramedic, and the paramedic is always in the back. In Texas it is very hard to get on a dual paramedic 911 system because every paramedic wants to be able to go call for call.

[Dustdevil]

In Texas it is very hard to get on a dual paramedic 911 system because every paramedic wants to be able to go call for call.

I'm not sure I agree with that. From what I see, most medics want to be the big cheese, so they want to work with a basic where they can dump all the BS runs on him. That's where the paragod syndrome comes from. Those who work dual medic ambos tend to remain more humble because they don't spend every shift in that situation of power disparity.

[Nate]

I'm not sure I agree with that. From what I see, most medics want to be the big cheese, so they want to work with a basic where they can dump all the BS runs on him. That's where the paragod syndrome comes from. Those who work dual medic ambos tend to remain more humble because they don't spend every shift in that situation of power disparity.

Okay, I mean services like mine where that isn't the case. We don't get to dump anything, we ride it all.

[Dustdevil]

Okay, I mean services like mine where that isn't the case. We don't get to dump anything, we ride it all.

I keep hearing about such services. Can this really be happening in many places? I really can't imagine it. It's crazy. Not only are you denying your basics experience, but you are creating an inevitable resentment of the basics by medics.

I would have zero respect for any administrator who pushed such a policy.

[PRPGfirerescuetech]

Okay, I mean services like mine where that isn't the case. We don't get to dump anything, we ride it all.

Absolutely as well as promoting paramedic burnout unnecessarily. Your admin is a member here, if memory serves me. He should exlain why this policy exists.

.....and Dust, i will respond to your lengthy post momentarily...lemme eat 1st...

[jenniemt]

If you live in an area like Texas, where most of your 911 crews are strictly ALS, with limited availability of BLS 911 experience, then by all means go straight to Medic school. Not doing that will only hurt you.

THANK YOU! That is the point I have been trying to make for a long time now. If I lived anywhere else I'd probably want to get some experience first, but alas I am stuck in TX and am in medic school after finishing my EMT class last semester.