About to start EMT-B Training

[Selenolycus]

I'll start off telling a bit about myself:

I'm about to start an EMT-B class that is 9:00-16:00 Tues/Thurs from 2/14 - 5/22. I'm a 22y/o male in Central Oklahoma, and have wanted to get into the program since I got out of HS, but financial restraints at the time and youthful indecisiveness delayed my pursuit of a particular educational goal.

I'm not sure what I'll do after I get my EMT-B Cert., I want to work ASAP after getting certified. I think I will enjoy it. I know I want to be in a field where I am helping to save and preserve life. I have 34h college credit atm - so I'll either be getting an associate's as a paramedic, possibly an RN - it just depends how much I like the setting.

Anyway, enough background. I have a couple of questions:

1) How difficult is it to find a job as an EMT-B fresh out of school? I tend to perform well academically, so you could assume I'll be a good performing student.

2) If working on an ambulance will a large part of my job be merely driving around the EMT-P and the patient?

4) In addition to taking the course itself, what else could I be doing to help myself? I need to start lifting some weights, I think - my arms are rather scrawny and effeminate, and I know lifting people will be part of the job. But, what text resources should I be consuming? I want to focus largely on course material, obviously, to perform well, but I do have a little over a month before the course starts. Would merely getting the course textbook and reading it before the class begins to give myself an edge be a good idea?

My apologies for the almost childishness of the questions, I'm just a bit excited and want to perform well in the coming months.

Thanks.

[JPINFV]

Anyway, enough background. I have a couple of questions:

1) How difficult is it to find a job as an EMT-B fresh out of school? I tend to perform well academically, so you could assume I'll be a good performing student.

That really depends. While I don't know about the job situation specific to Oklahoma, there are generally jobs to be had in interfacility transport. These jobs tend to be high in mundane "taxi" work where you will be dealing with nursing homes (system wide neglect at its finest). Normally these companies run "emergency" calls from nursing homes (I've had these range from "we're useless RNs who can't even place a foley cath in the patient" to "patient has a BP of 60/20). The emergency calls are generally more medical than trauma and EMT-B programs rather poorly prepares basic level providers for medical calls. Thus, many basics hate these jobs because even the emergency calls lack the adrenaline raising factor that traumas have.

2) If working on an ambulance will a large part of my job be merely driving around the EMT-P and the patient?

That will depend on how the system where you work is set up. If it's a basic/paramedic set up, then yes, your job will be assisting the paramedic and driving the unit on all of the critical calls. The decision on who is allowed to take the call is either based on the system (some systems require the highest level provider to take care of the patient all the way to the emergency department) or the paramedic's decision.

4) In addition to taking the course itself, what else could I be doing to help myself? I need to start lifting some weights, I think - my arms are rather scrawny and effeminate, and I know lifting people will be part of the job. But, what text resources should I be consuming? I want to focus largely on course material, obviously, to perform well, but I do have a little over a month before the course starts. Would merely getting the course textbook and reading it before the class begins to give myself an edge be a good idea?

Without knowing your other educational background, I'm going to suggest the generic "take a general chemistry, physiology, anatomy, and writing (technical/scientific writing. Being able to write even a decent narrative seems to elude a lot of basics). These are all courses that are essential to working as a medical provider (even as an EMT-Basic provider) that is not covered in nearly the amount of depth as is needed in EMT-Basic courses. Granted, it does appear that your EMT-B course is already scheduled and it is better to build a solid educational foundation before taking applied courses, but what done is done and there are plenty of people who are able to pass the course without a strong educational base.

My apologies for the almost childishness of the questions, I'm just a bit excited and want to perform well in the coming months.

Thanks.

No reason to apologize. It's better to look before you leap, no matter how close the cliff may be.

[note: The same question was posed on another EMS forum, which is fine since there are different populations on both boards with a handful of people that post on both. Due to that, I just copied my reply from both, so I'm not 100% sure if my quotes match completely.]

[medic511]

First, welcome to the EMS world. I think you have made a great choice. The single thing that I have most appreciated in EMS is the willingness of virtually everyone in the profession to "mentor" and assist newcomers with the ongoing improvement of their skills. That does not mean that everyone is always your best friend or that no one will ever say something that is mean or hurts your feelings but, at the worst just a little below the surface, I think you will find almost everyone willing and eager to help you as you help yourself -- especially if you ask. Being willing to do all the grunt stuff, especially when you are really new, helps a lot too -- kind of makes up for the extra time that it takes to explain things and show a better way or whatever.

Speaking "better way," if you try really hard to remind yourself that "better way" is a very subjective thing and that the person showing you their better way is probably just trying to help. Keep an open mind and give it a try. I learned a great deal just that way and now find that some of what I was shown really was better after all!

Your strong academics will make it easier for you to progress and, ultimately, become one of the best paramedics. I too have always had both a real interest in learning how things work and learning new facts, theories, numbers etc. But, I have never been a natural athlete and have always had to work a bit harder on training my hands to do what I wanted. And, although I like people, I was not the most socially comfortable person on the block. The physical eye-hand coordination skills and the "people" skills are just as important to your overall skill as an EMS provider as the academics.

Particularly if you are working for an EMS provider rather than a fire department, strength alone is not what I mean by physical eye-hand skills. Sure, patients tend to be heavy, and being in reasonably good shape helps in numerous ways, but what I am talking about is just being comfortable handling the stretcher (even single-handed in the dark wearing gloves!) or threading all those darn straps on the KED, or getting the nasal canula on the patient correctly, the first time, from the head, from the foot, from either side etc.

Learning to get detailed, personal information from strangers under the worst conditions is a really challenging task, even for the best, but it's critical to sizing up the patient's actual condition (we try not to say "diagnosing" but that's kind of the idea). For me, the key here was/is self-confidence. With solid academics and knowledge plus having mastered (not perfected!) the physical skills allows you to let your mind run the checklists and think of the important questions as you assess the patient. Your self-confidence also makes the patient feel better, trust you more, relax (at least a bit), and convey much more information to you.

Throughout your career, try to keep in mind the essential and critical difference between self-confidence and cockiness. The former is great, a definite and maybe essential skill; the second is counter-productive, dangerous, and very annoying. Medics have a well deserved reputation for being cocky ("paragods"). You will be working with some of them, so try to see through that and find the benefits of their confidence and filter out the annoying crap.

I think the single best thing you can do while in school and afterwards is to have as much patient contact as you possibly can get. In class, work with your classmates and take their BPs, find and time their pulse, palpate their jugular vein, hold c-spine on them, all as many times each class as you can. I know, you, like everyone else in that class, are going to feel "weird" about touching someone else. It's awkward with a person of the opposite gender and it can be even weirder with a person of the same gender. BUT IT IS CRITICAL. You cannot spot an abnormal pulse, irregular heart sound, adventitous breath sound, or JVD if you don't know what normal ones sound like, feel like, look like, etc. Pedal pulses (on the top of the foot) are really hard to find on a healthy person; determining if a trauma victim is without a pedal pulse is impossible unless you have thoroughly learned to consistently find the darned little critters on healthy people.

Take advantage of every clinical opportunity to listen, touch, and talk with as many people as you can. Ask your instructor about additional opportunities and about volunteering opportunities. It is really comfortable to stand and watch (and you MAY learn something) but you will learn a heck of a lot more by doing whatever the preceptor/host will let you.

As someone else said, what you "get" to do as a Basic will vary depending on how your system operates (a good thing to ask during job interviews!) but also how well you get along with and how much you are trusted and respected by your partner. If you express your interest to your partner, and have shown her/him that you keep your cool and do what you are asked, it may well be possible on some of the more interesting (usually more critical) calls to have another agency, often the FD, provide a driver so you can ride in the back and assist.

When you are driving, be the best damn driver out there. Plan in advance with your partner whether speed or smoothness is the more important. Many partners work out a code of sorts in advance to avoid saying things in front of family or patient that would be best not heard. Like, "I think we should just run her on in" meaning I want this patient at the ER ASAP but don't kill us on the way, while "let's make it nice and smooth" means lights and sirens but that a reasonably comfortable ride in back to allow ongoing treatment (or reduce patient discomfort) is more important than saving a few minutes. The latter is what usually works best, even with life-threatening cases because no one treats well while having to hold on for dear life. Remember, ALL rigs ride far worse in back than up front. The key skill is no sudden changes of speed or direction. Avoid hard or repetitive braking and seesawing on turns. Think of an egg setting on a formica table in back. You job is to get to the ER without the egg rolling off the table. You know that someone WILL do something really stupid in front of you; it'syour job to try to avoid having to make sudden adjustments to your course of travel. Of course, safety is always first. Sudden braking is far better than sudden crashes.

If you have not driven, parked, and backed up a very similar vehicle, ask to do so when waiting around for calls. The middle of the night, on a dark and stormy night with a very pregnant mother of four in the back, is NOT the time to practice your backing skills.

If you have a choice, get a job with a 911 service rather than doing intrafacility transfers. You will drive more miles with the "slings" but your patient assessment and care skills will not have as much chance to develop. If you have to do transfers, try to be in the back, talk to the patient even if they don't make much sense, take vitals again and again (the patients will love the care and your skills will get great training). Read the patient's medical records, noting what their diagnosis is, what their signs and symptoms were reported to be and what was normal versus abnormal. Read the meds and see what the side effects were. As a basic, these are probably not your immediate concern, but this time will be well rewarded when you go on to paramedic or RN classes.

Finally, your questions are by no means childish. Rather, I think they show that you have really thought about your career choice and have spotted many of the issues and potential issues.

Others will tell you different things than I have I am sure. Listen to them all. The one exception is, and I really mean this, don't let anyone tell you you are "only a basic" or that all real care is provided by medics or some such nonesense. I have worked with poor medics and great EMTs; I would MUCH rather have a good EMT than a poor (or unmotivated) medic as my partner or my caregiver. Always remember, most care is BLS not ALS; the ABCs are always THE most critical and they are BLS skills.

Take care and speak up if you have more questions.

[Dustdevil]

You should have worked "Oklahoma" into your topic title, to assure that those who can actually answer your question notice and read your post. We have two or three regulars here from OKC, so hopefully they will give you the straight scoop.

What are your college hours in? Do you have all the nursing school prerequisites completed?

[firedoc5]

Good luck, have fun.