Thoughts - Halfway Through Paramedic Prep . . .

[NickD]

I've always used writing as a way to collect my own thoughts so if I get into paramedic school, like I hope, you'll be in for a lot more of this - so, I apologize in advance.

I have a cardiac exam first thing in the morning, but I feel my purkinje fibers short circuiting already so I'm taking a short break from the books. Just FYI so far I've had three exams, A&P, Pulmonology, and Neurology. Passing is 80% and so far I'm carrying a low 90s average.

But I had a light bulb moment the other day. This will seem naive, maybe even ridiculous, to some of you old hands, but it's something I missed at first.

It came about reading some of the paramedic blogs that are available. One in particular I enjoy is Street Watch, Notes of a Paramedic. Now before launching into this I need to say a few things. My time as an EMT has all been in Los Angeles County in California. The only paramedics I interact with are fire medics. We do have private medics working in LA County but they seem to be employed by private ambulance firms just so those firms can say they have a paramedic capability. The reality is they only seem to be trainers and/or supervisors while their medical skills rusts away to nothing. And you can't help but wonder why they would reside in a county where their tickets are basically meaningless. Or, why they didn't go fire in the first place. They'll mostly say, if asked, they didn't want to go fire for one reason or another, but then you can't help thinking they couldn't go fire for one reason or another. It's actually a sad situation to see them in. And so it goes without saying if deemed worthy of paramedic school and I work hard enough to be successful I'll be leaving LA County to find work.

Another thing is new EMTs should always (or hopefully always) worry about inadvertently doing harm in a profession where doing none is the core idea. And in my first months as an EMT I was glad my limited protocols made that unlikely unless I really did something galactically stupid. But now that I'm learning more about being a paramedic I can see the overall responsibility and the possible mistakes are so much greater. But that's not the light bulb moment.

When first exposed to something it's hard not to think what we see is the way it is. And like I mentioned I've only been exposed to fire medics. These medics ride as a pair in their ambulance, or pick-up type rescue vehicle, and there are usually several other medics, sometimes more, riding on the attending truck or engine. So it isn't too uncommon to have a half dozen paramedics on every scene. For the simpler ALS cases only one medic would jump into my ambulance with me or sometimes two would. When it was trauma related, or a very serious medical, I'd get two medics in the back with me, two more standing in the open fwd side door, and two more by the open back doors. And these guys all consulted and concurred with each other like a group of doctors making rounds. I didn't think anything about this being anything until I started reading the Paramedic blogs. And now here comes the light bulb moment.

I realized while reading this one blog, about a private medic with an EMT driver in another part of the country, that he's on scene, in the back, and transporting, completely and utterly alone. That struck me like a shovel to the side of the head. Even on the simplest ALS cases, in LA County, the fire medic has me, or another EMT, in the back as an extra pair of hands. See, I told you it would sound silly to most of you. But this lone private medic is handling it all, doing it well, and doing it (outside of having comm with medical control) all by himself. It made me realize I was striving for the wrong thing. I don't want to be a gang assessment medic. I want to be that guy all by himself.

Well, I better get back into the books. I've got an awful lot to learn . . .

[Kaisu]

Good insight. I lucked into my current job. I could have just as easily been doing ITF or as you say, a gurney jockey for fire. I have absolutely no interest in fire and do not misunderstand - as a middle aged woman, I make demographics look good and had several offers to go into fire.

I am that lone medic in the back of the rig on most of my calls, and believe me, with long stretches of I40 as well as 5 major state highways to cover, I get a lot of gnarly calls.

Check out the agency and more specifically, the actual station you would be running out of. Our station 60 miles away, same company, same management, are hewers of wood and carriers of water for fire. I love where I work. Good luck to you.

[Dustdevil]

I don't want to be a gang assessment medic. I want to be that guy all by himself.

Luckily for you, the solo gig is pretty much the norm outside of California and a few large cities. You certainly won't have any problem finding that kind of position.

I'd say the real lightbulb revelation here is the HUGE differences in EMS (and EMS education) across the nation. We often hear people cavalierly quipping about how "a paramedic is a paramedic, because we all take the same test". Bullshyte. The differences are vast, and sometimes insurmountable to the medic who relocates. You'll be in good shape, because you'll be relocating before you become too conditioned by the LA system. And, of course, you're not quite the typical impressionable young n00b who is eager to play the "Monkey See - Monkey Do" game to fit in with the cool kids either.

It is interesting that you make this observation, because it is actually one that has been lamented by us in academia for several years now. Now that the American Heart Association has tossed out MegaCodes, and is instead now testing students as a group effort, it only further encourages this mentality. Too few people are forced to put it all on the line and make decisions under stressful conditions, leaving them poorly prepared for responsible practice. I wondered just how long it would be before that spilled over into paramedic education on a larger scale.

[Kaisu]

Dust, as usual, you are so darn correct. I received a great education in a progressive part of the country, to come and work in a regressive state. I bang my head against the gaps in education with my co-workers on every darn shift. It is very difficult to get effective feedback. I am continually frustrated because although some of these medics have been running for a decade or more, just cause that's what they've always done it don't make it right.

Unlike most here that run their challenging calls by their fellow medics and instructors, I resort to personal research, including this site. I am very grateful that it wasn't the other way around. Students graduating here would have a heck of a time working up there.

[AnthonyM83]

But this lone private medic is handling it all, doing it well, and doing it (outside of having comm with medical control) all by himself. It made me realize I was striving for the wrong thing. I don't want to be a gang assessment medic. I want to be that guy all by himself.

Dude, the LA medics can't even rip their own tape for IV's. They literally get upset if the EMT doesn't have tapes pre-ripped for him and handed to him, even if EMT is trying to do something else like putting on O2 or hooking the monitor up. I can't imagine what would happen if majority of our medics were translocated to a real EMS system.

BTW, did you start medic school yet?

[JPINFV]

Dude, the LA medics can't even rip their own tape for IV's. They literally get upset if the EMT doesn't have tapes pre-ripped for him and handed to him, even if EMT is trying to do something else like putting on O2 or hooking the monitor up. I can't imagine what would happen if majority of our medics were translocated to a real EMS system.

Now imagine the chaos if they didn't have online medical control directing almost every action and protocols that read like a cook book?

[akflightmedic]

First, congrats on your light bulb moment. You have received some excellent responses so there is no need for me to parrot them other than saying I agree with them. It is an entirely different world outside of the big state.

What I do wish to address is the statement quoted below. This is a very irritating thought you still posses and it is nothing but full of inaccurate preconceived notions.

And you can't help but wonder why they would reside in a county where their tickets are basically meaningless. Or, why they didn't go fire in the first place. They'll mostly say, if asked, they didn't want to go fire for one reason or another, but then you can't help thinking they couldn't go fire for one reason or another. It's actually a sad situation to see them in.

Sentence #1: Maybe they like the county they live in and do not mind having a "meaningless ticket" for the sole satisfaction of being gainfully employed in the area they choose. Furthermore, maybe they do not crave the adrenaline rushes, like the non rushed pace of day to day work interacting with people on non emergent inter facility calls or the occasional emergency when one decompensates in their presence.

There is a lot to be said for job satisfaction and just because you prefer a different element does not mean they do.

Some one has to do the job and believe it or not, there are bus drivers, janitors, fast food workers who truly enjoy their job and perform it because they like it not because they have to.

So my point is you may want to do some inner reflection, open your mind a bit and realize everyone is different and not everyone has same goals or aspirations as you and that is ok.

Sentence #2 and #3: Partly covered above, but why do you automatically assume that they COULDN'T go fire? Why do you even bother asking them why they are not fire? Why not say, "good for you, you seem happy". When you go in the dentist office, do you ask the techs why they are not dentists? Do you ask medical techs why they are not doctors? No, because you realize they have chosen their career, their profession and they are happy with it. So why do you assume a paramedic is not happy or is not up to the challenge of being fire. It really is as simple as they did not WANT to.

Sentence #4: Why is it sad? They are employed and doing what they like. Where is the sad part? Again this is your perception of what they should be doing which is totally unfair, closed minded and immature.

I wish you well, you seem to be on the right path but please give some thought to what I have stated and see if there are any tweaks in your thought process that can change the way you think about non fire medics.

[Kiwiology]

I can't imagine what would happen if majority of our medics were translocated to a real EMS system.

They would spend the entire shift searching for some way to contact medical control

[NickD]

>>BTW, did you start medic school yet?<<

No, not yet.

Right after I finished the prep course my Dad unexpectedly passed away.

So I had to go back east for awhile and take care of things and it put a real dent in the tuition money I had saved up.

Looks like another few months of pushing gurneys and eating Top Ramen noddles for me, LOL . . .

[Dustdevil]

I'm glad someone bumped this thread to lure you back for an update!

Very sorry to year about your misfortune. I sincerely hope that things get back on track for you soon.

Discussions with you -- and others like you -- are frustrating for me. On the one hand, I know the dismal realities of EMS as a career field. I know the shitty life it most often leads to. I don't wish that on anyone I like. But on the other hand, I also love EMS. And I know that the only way it will ever become what we want it to be is for serious minded professionals like yourself to become involved and help drag it, kicking and screaming, into the twenty-first century. I hate to sacrifice good men like you for the future generation, but if that is what you want to do, then you have my unending support.