A new type of Paramedic Internship (For AnthonyM83)

[Dustdevil]

As well, preceptorship started with the paramedic saying “I don't like the way you've chosen to become a paramedic, it shouldn't be legal, and I'll tell you up front that I won't pass someone like you through on their first attempt.”

As if her 10 month tech school was a much better approach.

Fired.

My preceptor was giving me a scenario that required me to run through my ACLS protocols...She thought the new standards were pretty stupid, and said “The protocols, OK, maybe are written by Dr.s and such, but they haven't seen a patient in 20 years! On the street we ignore them and do what works!”

Riiight... as if she has had SO many full-arrest saves in her career that she can quantitatively tell us what always "works." What she was really trying to say was, "It's a lot easier to just keep on doing what I've always done than to lose any television time learning new protocols."

Fired.

I came into EMS with high standards, believing I would enjoy spending my days with others that shared these standards, yet at nearly every junction there are educators, preceptors, employers, demanding that you drop those expectations in order to proceed...

Am I cut out for professional EMS? I am, I just can't find any.....

I just wish I ran that service so I could fire her and hire you. A little bit of that, and you will see standards and expectations change real quick.

[AnthonyM83]

YOU Have to take charge sometime of your own destiny and that includes asking for a different resource to get you acclimated to the company. If you do not take charge of your career then you have no one but yourself to blame if it doesn't work out.

Amen.

[Just Plain Ruff]

I won't quote Dwaynes entire post but I'd want this "brilliant medic" to explain the ACLS protocols and her deviating from them by doing what works to her supervisors.

Let's see what she has to say.

I can tell you what I'd say to that statement if it got to me and I was in any level of authority in that organization

There is the door, don't let it hit you in the ass as you walk out of it.

She's irresponsible.

please tell me you have a new preceptor, one who has more than a clue????? If you don't Please don't fall in that pitfall that she is in where she seems so lazy that patients suffer.

Remind me to ask for a different paramedic when I get injured in your city.

[becksdad]

Dwayne, I can't help but feel for the situation you find yourself in. But DO NOT, under any circumstance, diminish your standards and expectations! The vision you hold for EMS is what can help us progress.

I can't help but think that Medics who offer smart-aleck responses to serious questions either don't know what they're talking about anyway, and/or they are afraid of someone else excelling and making them look bad. Hang in there, my man. I know you will find good Medics that will be good mentors, and knowing your judgement, I know you will choose your mentors well.

As for your "preceptor" stating that no one should become a Medic the way you are doing it, I assume she means going straight from Basic to Paramedic. That's pure bullsh!t! I wish that I had done things the way you are doing it. Several years of experience as a Basic has done absolutely nothing to further my ability to be a good Medic. I could have gotten those same years of experience with the education you are gaining now. As it stands, I'm still a Basic.

I'm with Dust on the idea of hiring you if it were an agency I was responsible for. Only I wouldn't fire your current preceptor right away. I would let you precept her and give her a chance to remedially train for excellence. With the attitude you describe, though, I doubt she would make it.

[vs-eh?]

The only real challenge I've found so far in relating to patients is the time aspect. It's difficult to get the information I want, apply the monitor, get a BGL, and start an IV (the requirements my preceptor has for me for me for about 85% of our patients.) with the 5-12 minute average transport time that we have..(This is my observation phase)

Dwayne, EMS is not a game of rushing around and trying to get procedures done within a finite amount of time, generally speaking. Your clinical/hospital time would have prepared you for the physical aspects the job. Your preceptor time should be where you start to hone your approach to the patient, assessment style and priorities and focused questioning as needed. Critical aspects include recognizing the "sick or not sick" patient. I'm not talking simple query ischemia CP patients or what not, I'm talking truly emergent, can-really-benefit-from-ALS-intervention-five-minutes-ago patients.

Take the 5-10 minutes (which 95-99% of patients can handle) and get the basic information YOU need based on what YOU want to do to aid in your pre-hsopital diagnosis or adding to your differentials. It made me cringe, and feel that you are rushing through assessments (and possibly scaring/confusing patients), because you probably are. Basic procedures can be done by others during this time, oxygen (if YOU want it), monitor (if YOU want it), etc... DELEGATION IS AN EXTREMELY IMPORTANT "SKILL" TO LEARN! The IV thing, to me is meh... In all honesty, IV's are probably started on about 20% of the patients I carry. The fact of the matter is that the actual/potential need for IV intervention (fluid or medications) for EMS patients is pretty low. A lot of people get stuck on this point, but whatever. You don't need to start a line on that patient that may need something in hospital 3 hours from now, but opinions will vary by system, and there is a fine line between laziness and practical application I suppose. I've gone off on a tangent...

If 85% of your patients truly need an IV, monitor, and blood sugar than kudos. You either must work in a system that sees many times more "sick or treatable" patients than me or you are following (your preceptor is telling you) a cook book approach that, again, is not needed in EMS. Get the information you want, develop your assessment. Tell your preceptor that you are feeling rushed. There should be no real need to feel that way. Delegate basic procedures as you see fit, develop a treatment plan (if needed) and proceed from there.

[DwayneEMTP]

It made me cringe, and feel that you are rushing through assessments (and possibly scaring/confusing patients), because you probably are. .

I was rushing...and not doing anything correctly. The thing that worried me most was that she seems focused on mechanical interventions. I'm much more focused on, or wish to be focused on, assessments and proper medical interventions.

My line of thinking went something like this...

First shift: I really don't know anything that isn't theoretical, other than 300 hrs of hospital clinicals, so I'm focused on doing what I'm told, prepared that much of it might not make sense at first.

Ass chewing after ass chewing for not getting history, vitals, and IV. My assessment was approximately 50% complete on most patients, but I often had an IV.

Second shift: In my pea brain I say "Ok, I've now started 10 IVs that I didn't think were necessary and haven't managed a single complete assessment, which I do think is necessary. This doesn't seem to be a well thought out plan. To medic "It seems like I'm trying to do too much at once, and not doing anything correctly" Medic "Well, it takes experience, and you don't have any do you?!"

Then it occures to me, there are three of us here, but only one of us that will have to live with the results of this time...so...

Shift three: I decide my preceptorship is not designed with logical, intelligent steps for progression and success, so I'm going to design my own...and she can be damned if I can't get, or choose not to get her wondrous IV. (only have two Life Flight transferes the whole shift)

Fourth shift, first call: Bumped ahead of medic to patient, started my own history and assessment, started packaging her with the basic to move her to the ambulance, asked the medic to set up the monitor and spike a bag of NS. The lady was difficult to waken after possibly taking an additional vicodin for back pain. (Medic is way pissed, but I've decided that if she won't define the parameters of my preceptorship then I'll force her to define them, or kick me off of her truck, we need to stop wasting each others time. I've got shit to do, I'm unwilling wait for her to decide if she likes me or not)

Get to the hospital, Sats are up, fluid is running, full assessment and history completed. I'm feeling pretty peachy...Of course, the ca ca hit the fan, starting with

Medic "You have no business stepping in front of me! I will not allow you to make me look bad!!"

Me "Did I make you look bad?"

Medic "No."

Me "Then what are you so mad about?

Medic, "I don't like you getting all cocky, thinking that you can run things!"

Me, "Then explain what it is you do want, up front, instead of sniping me for something different at the end of each call. And why (honest to God) do you have to explain everything at the top of your voice?"

She said (quietly)"Well, you did ok...what did you like about that call...?" (wait! Didn't she kind of sound like a teacher for a sec...?)

I thought we'd had a break through, but my instructor called today saying that it is probably best if I leave that truck and take one that "won't be so tough on me." 8)

I think I'll stay where I am for now...Maybe this preceptor will actually give the next medic student an education...

Have a great day all...

Dwayne

[vs-eh?]

Second shift: In my pea brain I say "Ok, I've now started 10 IVs that I didn't think were necessary and haven't managed a single complete assessment, which I do think is necessary. This doesn't seem to be a well thought out plan. To medic "It seems like I'm trying to do too much at once, and not doing anything correctly" Medic "Well, it takes experience, and you don't have any do you?!"

Tell your preceptor this...

"I am not going to be touching the patient, outside of my assessment (i.e. ausculation, palpation), unless there is a procedure that I want to do".

There is no reason (other than mentioned) for you to be touching your patient or doing a procedure on your patient on any average EMS call. Your partner can do an IV, start oxygen, monitor, draw up medications, etc... You don't HAVE TO do these things. Proper assessment equals proper treatment, anything else uneducated cookbookedness (patent pending). Delegation and "stepping back" is as important as anything else in advanced assessment and treatment. Watch an ER doctor for reference...

Now I'm not saying don't do anything. Start an IV if you want from time to time (especially on difficult patients), obviously do critical ALS interventions (intubation, med administration, thoracostomy, etc...), draw up medications if you want, etc... But your assessment is your treatment. Don't be rushed, stand firm on this, and tell people what to do (that is your job, as long as it is within their scope). You're not a dick for telling people what to do.

[CBEMT]

As well, preceptorship started with the paramedic saying “I don't like the way you've chosen to become a paramedic, it shouldn't be legal, and I'll tell you up front that I won't pass someone like you through on their first attempt.” (Well...alrighty then...)

What the hell? Didn't you go to a degree program? What crawled up her ass?

[Scaramedic]

By the way here is my post from the thread that started this...

Hey Anthony, sorry your post got lost in all the stupidity. The answer could be a program like some hospitals are doing with Nurses. In Portland some hospitals hire Nursing students in their Senior year. They get paid and practice at a level where they get a lot of hands on experience. This preps them to become RN's once they graduate and pass the NCLEX. This is above and beyond the training they are getting in their rotations and gives them experience in their focus of Nursing.

The same concept could be applied to EMS in some fashion.

Peace,

Marty

[BushyFromOz]

What the hell? Didn't you go to a degree program? What crawled up her ass?

Actually CB, i would bet money that the degree is the exact reaosn this bonehead came out with this statement, and it is deffinately the kind of reactions i have recieved as a uni student here in Oz with some of the less informed members of the profesion.