A new type of Paramedic Internship (For AnthonyM83)

[Scaramedic]

Every now and then a good question or good point gets lost in a shitstorm. Take for example the excellent question poised by AnthonyM83 in the Dual Medics thread. We all know had that ended, but I thought this was a good point that needed to be discussed. Good job A83.

What do you think of this situation:

One of our recent EMT trainees said he had previously gone through medic school, but failed in his internship. He attributes it to not having been an EMT beforehand. I asked him specifically howso.

He said he just wasn't comfortable on-scenes or interacting with patients and it was to much figuring out how to do that AND practicing his ALS skills for the first time in the field. He gave the example of a lady hyperventilating and he wanted to start bagging her. He had never seen a patient breathing like that. He said if he had worked jut a few months as an EMT, recognizing her breathing as not an immediate threat requiring ventilations, he wouldn't have gotten so nervous.

A common counter to that would be that you'll learn that stuff along with your training, but being comfortable on-scene takes some time. Speaking to several people at my ambulance company, it seems 3 months is often a breakthrough point. I think 6months and a year are also....(though for me the best breakthrough point was taking the paramedic prep class...you're a lot more confident on scene when you actually know what's going on to some degree).

What do you guys think about preventing the above situations from occurring? I mean best answer would probably be a restructuring of the paramedic school programs and having concurrent ride-alongs during class, but what about within our current system.

Peace,

Marty

[vs-eh?]

This is a key point that I have made in the past regarding at least 1 year of BLS experience, prior to going ALS. While all of my US EMS information comes from this site (take that as you will), it also applies to PCP (BLS) experience here. Also keep in mind that PCP is 2 years college and includes 350-500 hours (average 400ish) preceptor experience as a PCP student prior to possible employment. From what seems to be the general consensus of 120-150 hours schooling as an EMT-B, that obviously cannot include (even above that length of schooling) a large amount of preceptor experience. I have seen numerous times people saying they have little (12-24 hours) to ZERO "road experience" prior to being available for employment.

You need at least a year of autonomous experience at a BLS level (whatever the scope may include) to learn the following:

1) Talking to patients and not seeing them as sets of numbers and a "do/don't do" list of possible treatments "by the book". Obviously the hyperventilating patient Anthony mentioned is a prime (but one of many) example.

2) Dealing with family/general public

3) Dealing with doctors/ER/the general system

4) Driving!

5) Dealing with partners and other emergency services

You gain this core experience by simply attending calls, regardless of their acuity. Now people will disagree (looking at you Dust), but when I see the average preceptor road time of most American ALS programs being 300-400 hours (plus 12-24 BLS) the above cannot happen.

My transition from BLS to ALS (and I am considered to have fast tracked by 99% of Ontario standards) was simple. Why? My assessment and the way I handle scenes that I honed from my 2ish years experience did not change. The only change was the procedures and interventions I can perform. That is it.

I think fast tracking an already grossly fast tracked and undereducated system is a silly and reckless idea. I'm sure if you look at my Australian and European peeps on this forum, they would agree.

[spenac]

In good 2 year Paramedic program a person could get EMT-B after 6 months, then EMT-I after 1 year. With that they could get field experience while they complete the Paramedic program. No need to stop your education get experience, then restart education. I really wish I would have gone straight to paramedic. The education would have made things less stressful for me and much better for my patients. It also would have been easier for me as I have had to get my mindset regeared to school as I take my paramedic course after all these years.

In a perfect world, EMT-B and EMT-I would only be short term certifications that would expire immediately if you withdraw from paramedic course.

[vs-eh?]

In good 2 year Paramedic program a person could get EMT-B after 6 months, then EMT-I after 1 year. With that they could get field experience while they complete the Paramedic program. No need to stop your education get experience, then restart education.

I disagree, you need autonomous experience under your belt for the reasons I listed. Don't encompass it within your 2 year paramedic program. Learn the attributes that I listed in my initial post, attempt to hone them, and then proceed with advanced scope. You don't need to necessarily stop your education, just work on your certain aspects needed on any call prior to adding in ALS procedures and interventions.

Also, from what I understand, EMT-I is generally a mish-mash of advanced ALS procedures without adequate education for them. You don't need that. Do your BLS, strengthen those procedures and know how to do a call, talk to patients, assess patients to your skill level, and work the system. Then move on when you are comfortable. You are NOT comfortable with even the most basic scene calls until you have unobserved experience.

And before the arguement comes up (because it has and will)...

Yes, I know that physicians don't do PA or RN or paramedic prior to them becoming a doctor. I know that their isn't a mandated chain of progression from a "lower" medical profession to doctor. And I agree that you don't need it. However...

It is safe to say that medical school, residency, undergrad, etc...provides you with a substantially greater "well" of education to pull from, regardless of the years and years of "time in" you have over your average or top paramedic education. As a doctor/resident you also have (generally) at your disposal several, if not many people who have the skills (RN, RT. etc) and/or knowledge (attending physician/other MD's, etc) that are able to assist in your cerebral assessment or physically do procedures that you may need assistance with or cannot do. You have years of "guidance" with these things. Those who work in EMS (unfortunately), do not. Generally speaking ALS paramedics work alone or with another paramedic who can do said procedure or wax medically on treatment modality. They also (at absolute maximum) have 2 years education and experience to draw upon, not the years and years that physicians generally have during their education.

I won't waver from this position on the need for "real road" experience that is needed at the BLS level in EMS prior to entering ALS. This is even if you aren't doing 911 (though hopefully you are) and are simply doing stable interfacility transfers. You can still assess patients and learn the system...

[CBEMT]

*beeeeeeeeep*

Attention Dead Horse. Dead Horse, respond to "A new type of Paramedic Internship." This will be for a re-hashing of EMT-B experience prior to Paramedic school. That'll be Dead Horse, respond to "A new type of Paramedic Internship," for the EMT-B before EMT-P. Time out 21:11.

[spenac]

*beeeeeeeeep*

Attention Dead Horse. Dead Horse, respond to "A new type of Paramedic Internship." This will be for a re-hashing of EMT-B experience prior to Paramedic school. That'll be Dead Horse, respond to "A new type of Paramedic Internship," for the EMT-B before EMT-P. Time out 21:11.

My response was a suggestion that would solve the experience prior to entering field as a Paramedic. For 6 months you would strictly be working BLS skills. Then you would be slowly building more skills while working as an EMT-I. You would get plenty of patient contact and have a good idea of how to treat patients once you receive your Paramedic. My suggestion would work within the Quoted statement of OP.

[AZCEP]

The EMT-I could very easily be done away with, as it has outlived it's usefulness. Many EMT-B programs are introducing more and more advanced skills all the time. Holding on to the intermediate wastes resources.

I will agree with vs-eh's suggestion of allowing the entry level provider to gain some autonomous experience, with the caveat that it is unusual for EMT-Bs to be used in systems where they will gain useful experience in a reasonable amount of time. Having the experience prior to enrolling in a paramedic class can be useful, but it can make advancing more difficult as well.

[Dustdevil]

I will agree with vs-eh's suggestion of allowing the entry level provider to gain some autonomous experience, with the caveat that it is unusual for EMT-Bs to be used in systems where they will gain useful experience in a reasonable amount of time.

I would agree to that only if those entry level providers have a substantial and significant educational foundation behind them, as occurs in Ontario. Ontario medics have the education necessary to develop intelligent practice during their time in the field. EMTs do not. That is why my opinion on getting experience before going to Paramedic school varies greatly between the U.S. and Canadia.

That said, I don't feel it is necessary in either location. It is beneficial in Canadia, but certainly not necessary. The only reason either place really does it is so they can get warm bodies in the field faster. The same reason we still allow two-year nursing degrees in the U.S. Not because it is beneficial to patient care. Only because it is expedient. I do not support expedience when it is simply not necessary.

Back to the topic at hand, I really have no comment other than that there should be no EMTs in EMS, and therefore, I have no opinion on EMT internships. Once they reach professional EMS, I'll worry about their internships.

[AnthonyM83]

Back to the topic at hand, I really have no comment other than that there should be no EMTs in EMS, and therefore, I have no opinion on EMT internships. Once they reach professional EMS, I'll worry about their internships.

So, what about my original scenario of the EMT who failed out of his medic internship?

I know my year as an EMT has helped tremendously. Key lessons are: multi-tasking under stress, patient interaction, exposure to chaotic scenes, delegation, ambulance operations. Taking the medic prep class, then going on scenes also greatly changed the depth at which I viewed and interacted in each call.

I don't see how this can't benefit me during medic internship. I can't strongly advocate it, because I'm not a medic yet and haven't seen the results, but I really feel I'd be worrying too much about scene stuff rather than the medical practice during my internship otherwise.

I'm not saying you need years of BLS experience. I'd say anything more than a year without a reason is too much. 6 - 12 months seems useful...as soon as your learning/comfort curve starts to level off, that's when you're ready to move on.

[akroeze]

vs-eh?:

Where in Ontario do you practice?