UMSTUDENT

Yes, in Maryland the Maryland State Police Aviation Command is the only provider of emergency 9-1-1 air emergency medical services. 12 aircraft respond from eight strategic locations within the state. The expense is paid for almost entirely from a vehicle plate registration fee. Each aircraft is designated "Trooper 1-8." Each is staffed primarily by a civilian pilot and a sworn Trooper/Paramedic. Troopers complete a 26 week live-in state police academy and then enter into the aviation command for additional training. The aircraft also complete law enforcement and rescue (hoist, etc) missions. Go to http://www.mspaviation.org/frames.asp to learn more about the system. Its really the vision of the late R Adams Cowley, MD and something most Marylanders are very proud of. Yes, it does have its drawbacks and critics do abound, but the system is free. Its not hard for them to find people whose lives have been made better by the service. It comprises a significant part of our state EMS system. Private transfer air medical services are provided by several for-profit air medical entities such as STAT Medevac, Maryland Express Care (PHI), and DC MedSTAR.

How did you finish your prereqs for medical school? I'm about to finish my B.S., but still need to finish Organic Chemistry (8 credits) and Physics (8 Credits). I also may need to take another semester of English if I decide to pursue the DO route. When I finish school, I'll probably start working a bit. I've heard that finishing at a university or enrolling in a formal post-bac program is what medical schools would like to see, but the local community colleges (who offer everything I need to take) are VERY cheap. Whats your take on this? I'm a good student, but money is an issue. One of my professors, who is an MD, states that medical schools don't care where they were taken so long as you did well. However, he did mention that the need for a composite letter of recommendation from your school pre-health committee is hard to acquire from community colleges. Oh and thanks for the advice. It means a lot.

Thanks Rid. I especially appreciate exactly how you came to make the decisions you did. I love education, but I also want a career and family. I'm at a crossroads. There are so many things that I feel I would enjoy to do in life, but feel only prepared to continue in medicine. Some people have suggested I work for awhile, but I fear that I may never be capable (financially and family-wise) to return to make an extensive full-time commitment as student. A lot of people are like, "Be a paramedic for a while," but if my education has taught me anything it is that this field is hugely fragmented, mostly unstructured, and lacks little-if-any upward mobility. Plus the pay generally sucks.

I'm looking for some input from former paramedics who have continued their medical education at the graduate level. Specifically, I'd like to hear from paramedics who became nurse practitioners, physician assistants, or physicians. Individuals who sought other paths are welcome too. What influenced you to choose the profession? How long were you a paramedic before? You don't have to have been a paramedic, but I'd like to hear from people with prehospital experience.

If you don't mind a 18+ week academy in a fire-based system, Maryland and Northern Virginia has plenty of highly funded professional systems. Good pay and benefits.

No, EMT is not an "entire" semester. 120 hours of didactic classroom time is equivalent to approximately 4 credits. Full time at most community colleges and universities is 12 credits or more. Most students take around 15 credits a semester. The EMT-B curriculum does not require a degree of any sorts. Seriously, it is basically an upgraded first-aid. What does need to happen is the recognition that true EMS is provided by EMS professionals. In other words, paramedics educated at the collegiate level (AAS or BS).

Nope. EMT should be increased to something like at least the equivalent of a college semester. 120 hours is pitifully small.

Has anyone considered that the problem is that the curriculum for EMT-B is so easy that a 16 year old is able to pass it almost blindly...? I was licensed as an EMT when I was 17 years old. I completed the class with a stellar understanding and little effort. Looking back I thought I could handle it, but now some years later, I feel as if the state was and still is totally wrong for allowing it. It isn't the death that bothered me. I was placed in situations that, looking back on it, were not appropriate for a 17 year old to be in. I was in no place to make some of the decisions I had to make. Flat out EMS should be a field that is entered after extensive collegiate education....end of story.

Honestly, I wouldn't worry about a resume until you've successfully completed a paramedic program. In my opinion there is a huge step in the level of professionalism between the two job functions. A good paramedic program will boost your resume with a couple of key factors: A) A degree (AAS or BS). Clinical hours. Clerkship, Rotation, Internship, Externship...whatever your school calls it. C) Membership to a professional "registry" of equally qualified individuals. Add some volunteer hours in whatever you so choose and you're off to a good start. Remember, you'll be starting off new so don't expect to be gunning for an officer level position or time on a helicopter. Spend some time as a street paramedic and go from there. As I've started looking for possible careers I've kept a couple of things in mind: A) Competitive entry. If lots of people want to work for this employer, the package is probably fairly good. Benefits, benefits, benefits... C) Competitive Starting Salary. Look for bonuses for ALS qualifications in fire-based systems. This will depend on your area. I'd say 36,000+ is fairly decent in most of the country for a new paramedic. Where I'm at 45,000-50,000 is ideal. D) Clearly defined advancement structure. E) Respect for education and performance-based advancement. F) Union Representation. Go to your interviews in a suit, bring a copy of your resume, and be prepared to sell yourself...no not illegally.

I originally had Ron Paul listed, along with several other individuals like Dennis Kucinich and Mike Huckabee. It wouldn't allow me to include more than so many poll options, so I made a quick guess of candidates I felt people would be most familiar with (popularity, media attention, etc). Elaborate a bit on Ron Paul Dust. He's one of the candidates that interest me.

So, the Iowa Caucus is about t-minus thirty days away. Most of the candidates have released their form of a plan for heath care, but I've yet to see anything extremely specific for public safety. Which candidate do you feel would best support the interest of EMS? I don't care about the fire service or public safety in general...I want to know about EMS and the issues that face our profession.

See, this whole mess isn't a problem in my state. We don't have nurses flying on our 'copters. One paramedic, one pilot. And you don't lip off to the paramedic because he carries a gun and handcuffs. Maryland State Police Aviation Division. Eight helicopters geographically deployed throughout the state. Maybe not the best model, but it works here...for the most part... Millions of dollars? Yes. Overly used? Yes. Paid for? Tag and license fees. We also have the GO team, which is basically a way of grabbing anesthesiologist and trauma surgeons from Shock Trauma to fly into the field for amputations, etc.

Sorry, but the conservative administration that currently controls most of our country's wounded poltical system is not the same as the conservatives Reagan was running around with in the 80's. It is a totally appropriate term, although I will agree that it is a term thrown around by the 24-hour news networks far too often. To make you happy, I'll just call them "evil." Not quite as silly a term. As far as Dust..., ugh whatever. Your from Texas, it makes sense. I'm not going to try and convince you otherwise.

Actually, credible scientist still call it global warming. "Global climate change" is a euphinism that the republican, neoconservative oil think-tanks developed to desensitize the American people into believing that New York City will still be above water in 80 years... I'm sorry, I used to think global warming was a total bunch of junk. I was a big fan of the belief that these temperature increases were just normal variations in otherwise historical deviations of temperature and ocean levels. I've seen too much literature from too many respected, skeptical scientist saying otherwise. 7 billion people are producing billions of tons of carbon emissions..

My understanding is that you're a former disciple... ??

My old roommate works for a private consulting/lobbying firm in DC. I'd say he's making in the range of 55,000-65,000 grand right now as a first year graduate. He acquired the job before he finished his Master's. I'll leave out details in the interest of discretion for his job and company. Remember, MOST first-year college graduates make crap. I think a lot of EMS professionals forget this. Many young adults live for years on the poverty line. The fundamental difference is that most careers have a defined upward mobility based on experience that, given proper marketing, will produce a livable career. We're spoiled as paramedics because you can make 60,000-70,000 a year with OT. We forget two things: 1. This never goes up. 2. We're working horrendous overtime to accomplish it. Seriously, just stay away from the northeast. Period. Look at the South and Midwest if you're looking for a fiscally responsible, performance oriented EMS organizations who will need your education. I work per diem at a local EMS organization to make some beer money. I was quickly assigned administrative duties/hours as part of my job. The #1 remark I get is that I can: 1) Spell words correctly. 2) Utilize proper grammar and punctuation. 3) Use a word processor. 4) Use Excel. Things I've learned in college have helped to some extent. I know fundamental research techniques and can read and interpret a peer-reviewed study. I can speak, intelligently, with professionals . I can write a technical memo. I know basic managerial skills, aka conflict resolution stuff... Still, the first four have been seen as far more useful to my organization. Sad but true.

By the sound of the curriculum, I'd say you're at Pittsburgh. I informally interviewed there, but ended up choosing Maryland over it for a couple personal and academic reasons. There is absolutely, IMHO, no market for Bachelor's prepared paramedics. None. In fact, depending on the department, it may disqualify you for a job. Fortunately, I've only found this in the northeast mostly. Systems like Wake County, NC embrace education. I read recently that all of the upper administration there has at least a bachelor's degree and many have upper-level graduate degrees. I've done a good bit of research with our graduates and have found the following: 1. Most end up being absorbed into fire/EMS systems as would any other paramedic. There is about a 50/50 split from graduates. Some say the degree has helped them advance tremendously while others attribute any upper mobility to shear hard work. The good news is that most are supervisors/administration fairly quickly. 2. Many choose to progress to higher medicine. Nursing and Physician Assistant programs eat up a lot of these people. Nursing is a quick bridge in some areas. Depending on your program's prerequisite curriculum, you're practically set-up for admission to a PA program. Our program’s high # of clinical hours meets most of the "documented" clinical experience needed for admission. 3. Emergency Management. We've had a couple of guys/gals go into emergency management. One of my roommates works for a private consulting firm in DC making boatloads of cash. Another works for a local state emergency management agency. 4. Medical School. In the early 90s the degree was a ticket to an MD or DO. I think medical schools have been saturated with these kinds of applicants now. A lot of pre-med/paramedic students encounter the same difficulties as other students now with admission. Granted, the clinical experience still speaks wonders of the individual, but it’s still a difficult process. Plus, these programs seem to be extremely credit intensive. Most paramedic-track majors don't have enough available (manageable) credit hours to fit in the full year of organic chemistry and semester of physics/calculus. Unless you stay an extra year (too expensive), community college or a formal post-bac is your only route later in life. I think a lot of prospective medical school applicants get lost in the "real world." I’m finishing my senior year now. I’m currently deciding on option 2 or 4.

I agree with your assessment on the R,R' in V1. Good point that I failed to think through. I guess the next thing to do would be to look at the R-wave progression, which...ugh...I guess is fine. This is the problem with the 12-Lead ECG. So much of it may be irrelevant to your treatment of the patient. Physiologic finger prints... Nothing substitutes a set of labs. 12-Lead is a good tool for early recognition of STEMI. It has also helped me make some other treatment decisions in the past, but in the end it is one diagnostic tool among many.

As a Maryland resident: All of the community colleges are good options. Most of them should let you integrate into their second year of classes given you've completed their listed prerequisites. UMBC is not a good option unless you're willing to start from scratch and complete a four-year degree. Montgomery County and Washington County both offer an I-P bridge for their volunteer/career employees. Note: You must be certified as an NREMT-I'99. The I'85 curriculum is not accepted in MD.

I would say that one thing indicates right-ventricular involvement: 1. R-wave equal to or greater in size than the S-wave in V1. R/O Right Ventricular Hypertrophy. Bundle Branch Block too... Pathologic Left Axis Deviation. Did your patient have a history of Digoxin use?

Your answers are very good; however, they may be a little misguided depending on the university. My experience has been that universities are EXTREMELY political machines with little interest in hearing you complain. Professors who act unprofessional are usually one of two things: 1. Part-time staff that were dragged or begged to teach in the first place. They aren't there because they want to teach, so much as because of beer money. This is especially true of professionals with terminal degrees only because it is required of their profession. Ex: My roommates have had continuous problems with their accounting classes being taught by uncaring dicks. They're all CPAs. 2. Tenured professors. Tenure= untouchable. In most instances, outside of sexual harassment or flat murdering someone, these professors are not getting fired anytime soon. It takes a fairly large majority, or in some cases unanimous approval, from a group of peers within their respective college. There are formal procedures within each school for dealing with unprofessional conduct, but be prepared to fight adults as an adult. You need to represent yourself as an adult, paying for an education. Also be willing to go above someone’s head if necessary. Again, this is totally dependent on the university. I think it has a lot to do with why so very few students ever make formal complaints.

Read past the first paragraph...I wrote it for a reason. Thanks.

I can offer a fairly educated opinion about an alternative way of conducting field internships since our school takes a fairly different approach to the clinical process. I'm currently engaged in about 33-40 hours a week of clinical time. Our system operates by requiring a minimum hour requirement, minimal level of documented competencies, and required evaluations by EVERY preceptor we come in contact with. Our total clinical time, if done properly, amounts to approximately 1,000 hours over the course of our education. Clinical time occurs in a variety of settings with exposure to many types of patient demographics. Clinical time is split roughly 40/60 hospital-to-field. Time is spent on a variety of hospital services and with physicians. Field time is organized across multiple EMS delivery types and geographic areas. Urban, suburban, rural, and sky. Our clinical evaluation is HEAVILY based on number of hours completed and is VERY patient assessment based. The idea is to expose students to types of patients rather than just skills and drills. For instance, NICU time is arranged specifically so that students may be exposed to a variety of neonatal problems. I prefer this type of learning; however, I feel that EMS still suffers from skills obtainment issues. For instance, significant competition exist among classmates to obtain certain types of skills. I feel that FISDAP is actually a big cause of this. The idea of simple competency through a magic "number" is somehow silly to me, although I understand the need to measure statistical markers. Problems: Some clinical sites serve better as educational opportunities, rather than opportunities to practice. It can be frustrating spending 12 hours at a clinical site and having never done any type of skill. While often mentally exercising, there are certain skills that must be maintained.

Agreed, but unfortunately what you talk about does still exist within our state in many of the county academies. I have a friend who is currently taking his EMT-I this way. The program spends about 2-4 weeks on anatomy and then goes straight into the intermediate curriculum. Later, these students will "bridge" over to paramedic by completing a couple more months of 2 day-a-week classes, complete the minimum clinical time for registry standard, and test for their Registry Paramedic. They're called cook-book programs around here. Most of these classes are filled with career firefighters striving for the extra 3-4 grand a year that comes with holding a paramedic card.

Dust, In Maryland, many of the community colleges and UMBC require that you obtain your I-'99 prior to testing for paramedic. At UMBC most of our paramedic education occurs during our junior year. One full academic year of medical didactic curriculum, 6-8 hours a day. During the second semester students complete ~180 hours of clinical time before testing for their I-'99. During the senior year students complete approximately 900 hours of clinical time while completing classes in EMS management and seminars designed to refresh complex skills or knowledge. Depends on the area.