Ride Along

[letmesleep]

I do agree with most of what Ruff is saying as far as getting your medic right away, but with that I feel as though any basic getting a start while that is going on is better served. I don't think that any kind of time frame is necessary, but getting a feel for how those basic skills (assessment, VS, face to face contact) fit in to an ambulance (of any kind) is the true point I'm trying to make. If all that is going to happen in the OP's new job adventure is driving then, yes, do something more constructive with your time if medic is in your future. Obviously the more road time a medic student has under their belt, is going to better their school experience, but I also believe that an EMT that is planning to continue to medic school should focus on medic school FIRST. If they have an opportunity to work on the street at all, I say do it, but make it a hell of a learning tool.

Ruff wrote

"I've worked a transfer service, I know what it's like to run transfer after transfer day after day. Of the hundreds of transfers I did in my one year of transfer work I think I used my skills that I was taught in emt school 10-15 times. The rest of the time it was take one set of vitals, sit back and enjoy the ride to Grandma's nursing home. So to say you are going to get experience when doing transfers I don't buy it. Unless you are transferring really sick people from hospital to hospital which should require a medic anyway the only thing that an EMT is really going to be doing is driving. What kind of experience is that."

Ruff, heres what I don't buy, can you honestly say that a "brand new" EMT is not going to be able to hone their different skills by doing basic NH to hospital transfers? I know that you have precepted students before, yes? How many times have you had a medic student come ride with you who had no clue how to take a BP? count resp? any of those basic skills that we feel they should possess at that point in their education? It happens, how about those that can take a BP, but not going down the road? Don't take this wrong, I'm just asking you to think about how nice it would have been for that one student to have done some transfers, and practiced those skills.

[Just Plain Ruff]

Ruff, heres what I don't buy, can you honestly say that a "brand new" EMT is not going to be able to hone their different skills by doing basic NH to hospital transfers? I know that you have precepted students before, yes? How many times have you had a medic student come ride with you who had no clue how to take a BP? count resp? any of those basic skills that we feel they should possess at that point in their education? It happens, how about those that can take a BP, but not going down the road? Don't take this wrong, I'm just asking you to think about how nice it would have been for that one student to have done some transfers, and practiced those skills.

Quote from above

If you are not going to go on to medic school or you don't have the means right now then by all means go get the job as a transfer jockey and put in your time. I never said not to take the job, I just said that if you have the means, go get the medic rather than put in time as a transfer jockey. If you can do both at the same time then by all means do that but to use as your sole criteria to get experience and then go to medic school is in my opinion a waste of a year or so.

I have precepted many many students and teaching them is where I come in. If they don't have the foundation then I spent countless hours with them working on getting their skills up to par. But shouldn't they have gotten the basics down in emt school. I mean in my emt class it was expected that we were able to take vital signs in a dark room, in the noise of the garage, in the back of the ambulance, siren on and off, and vitals while trapped (simulated) in a car.

If they don't have the basics down, then they need remediation and their instructors need a good thrashing. Isn't emt school there to "get the basics"???

If they came to my truck as a medic student and couldn't take a vital sign to save their life then time was spent on how to get it right. Over time those students became more confident and adept at doing it right. Discussions were had with the teacher and the excuses I heard were legendary.

But I'll go back to my previous posts - if you have the means to go back and get your medic right out of EMT school why not take that opportunity and do that. It will save in the long run and it may help keep you from failing the medic portion of the national registry. You get someone who is so used to doing this type of assessment on their transfer patients that they revert back to what they do at work while in the practical portion of the testing.

If you do not have the means to get your medic right away, and many do not, then going to work as an EMT is the RIGHT thing to do. Just know that you are behind the eight ball in habits and those habits are hard to break. If you do your patient assessment on those nursing home patients like you did in your emt school to prepare for the registry then great but I know from experience, that never happens. All good intentions are there, it just sometimes doesn't happen that way.

[jsadin]

have precepted many many students and teaching them is where I come in. If they don't have the foundation then I spent countless hours with them working on getting their skills up to par. But shouldn't they have gotten the basics down in emt school. I mean in my emt class it was expected that we were able to take vital signs in a dark room, in the noise of the garage, in the back of the ambulance, siren on and off, and vitals while trapped (simulated) in a car.

If they don't have the basics down, then they need remediation and their instructors need a good thrashing. Isn't emt school there to "get the basics"???

Wish my basic class was like that. I think we spent one class on vital signs and that was taking them in a quiet classroom. We only saw one ambulance during our class and that was just the "ooooo....aaaaahhh" tour....no real learning expected.

I think a year of ride time (whether 911 or transfer) helps to get the potential medic some entry level "patient care" experience so they can decide whether taking care of the sick/injured is something they really want to do. How much does it suck to put 1500hrs of your life into something only to discover it really isn't for you?

[Arizonaffcep]

Here's the one thing that I find interesting about the whole EMT straight to Medic thing...EMS is the only profession that I can think of, where one can go straight from graduating a basic class to a Medic class. I'll give you a for instance...in the fire service, once you graduate the academy, you must "prove" yourself (that you can complete certain basic skills) before they (most departments, most specifically, big departments) will allow the "probie" to move on to advanced things. Same with human development...you need to crawl before you can walk and run. When I teach a medic class, the one thing that gets to me the most is having to re-teach students how to take BASIC VS. Going into a medic class, this should be known. It's a BASIC skill. A medic course only adds tools to the tool box.

[katbemeEMT-B]

The program that I am currently in requires a course on ambulance operations and an EMT-b internship. The difference is that you work mainly a 911 system to help hone those basic skills. These are just two of the required prerequisites. If you currently work on a service as a basic, you must have been the lead on a minimum of fifty calls to wave out of the internship. Personally, I think it's a great idea because there is very little if any patient contact during basic class.

[mobey]

When I teach a medic class, the one thing that gets to me the most is having to re-teach students how to take BASIC VS.

A medic course only adds tools to the tool box.

This statement is one I will respond too.

I have just been accepted into University of Alberta's full time Paramedic program, the instructor there told me (regarding experience), "I hope you have very little, the more BLS crap you are comfortable in, the harder it is for me to break you of old habits." He went on to tell me that one of his biggest problems is students always reverting back to bls because ALS is new to them and they are not comfortable in it.

What he was getting at is, ALS is a different entity, you don't even approach your patients with the same mentality as an advanced provider as you do as a basic. In a perfect world he would like to educate paramedics from the ground up, part of being a good Paramedic is being good at bls skills, but really how long does it take to get "good" at blood pressures? If you cannot do BP's or count resps after your practicum, you should be re-taking your clinicals. I mean really.... these schools are pumping out EMT's AND Paramedics who can't take a pulse rate? or use a BVM effectively?

Simple math, it takes 6 mos to be an EMT + 1 year to get good, then 2 years for P then a year to get good at als. Total time before the world sees a "good" medic, 4.5 yrs.

Option 2 (zero to hero) 2.5yrs to obtain ALS/BLS education, 1 year to get "good" = 3.5 years

Seems simple to me!

*Really.... if there was no such thing as an EMT-B, we would just have a bunch of really good als providers who can't take a BP or recognize a "load and go" situation?* :roll:

[JPINFV]

Here's the one thing that I find interesting about the whole EMT straight to Medic thing...EMS is the only profession that I can think of, where one can go straight from graduating a basic class to a Medic class. I'll give you a for instance...in the fire service, once you graduate the academy, you must "prove" yourself (that you can complete certain basic skills) before they (most departments, most specifically, big departments) will allow the "probie" to move on to advanced things. Same with human development...you need to crawl before you can walk and run. When I teach a medic class, the one thing that gets to me the most is having to re-teach students how to take BASIC VS. Going into a medic class, this should be known. It's a BASIC skill. A medic course only adds tools to the tool box.

Of course the basic counter to that is that EMS is the only career that I can think of where the main level (paramedic) requires providers to work at a lower level first. Doctors don't have to be PAs first. RNs don't have to be CNAs or LVNs first and EMS has a lot more in common with health care fields than with the fire service.

[Arizonaffcep]

Of course the basic counter to that is that EMS is the only career that I can think of where the main level (paramedic) requires providers to work at a lower level first. Doctors don't have to be PAs first. RNs don't have to be CNAs or LVNs first and EMS has a lot more in common with health care fields than with the fire service.

This is true. However, typically, new grad nurses need to work on the "floor" for awhile, before they can transfer to a higher acutity unit, such as the ICU or the ED, or specialize even further with NP or nurse anesthetist. Even for flight...they must have, at least in Arizona, typically 2-3 years ICU/ED experience before they will even look at their resume.

As far as doctors are concerned, once they graduate med school, they go into a residency program. Typically, the medical doctor has at least a 3 year residency, while the surgical doctor typically has a 5 year, plus a 1-2 year fellowship for their specialty. So...In essence they start out as interns (lowest on the ladder) and eventually become "attendings" after they graduate their residency and fellowship. How does that translate into paramedicine? As medics, once we graduate, our employer has us ride 3rd person for...how long? A week? A month? 6 months? Where as doctors are "3rd person" so to speak for at least 3 years, honing their craft, whereas by comparison, we are "thrown to the wolves."

What I am getting at is not just being able to take a basic set of vitals. That's relatively easy. But it is a key part of being a basic AND a medic. This is also where you get to practice assessment skills and learn to build on them. Also, you get a chance to build up not only your confidence but also your interview skills to at least a basic understanding of how to do it. There are a couple of little "tricks" taught in medic class, but mostly it's a learning WHAT to ask, and when you get that new information, how to interpret it and WHAT it means to best treat the patient.

It's always good (in my opinion) to go into a medic class with a certain amount of "tools" in your "toolbox." The class should enlarge the toolbox and expand on what is "carried" in it.

On a similar strand of thought, this is why I always recommend that new basics and medics work interfacility for a little while, if given the choice, before going to 911. No, there isn't a lot of "action" on those calls. No there isn't usually a lot to do, because typically most of the work has been done. So, what does it give? An amazing learning expereince. For instance...how many different medical problems do you see on those patients? Besides, usually they are fairly compliant and usually patient people (no pun intended). How can an emt of any level benifit from this? First, start with assessment skills. Doesn't matter what or why they are being transported, if they will let you...do a WHOLE assessment on them! Look at everything. Touch everything (well...ok almost everything...don't get arrested ), ask everything. What's nice about this is that this gives the new basic/medic time to assciate different findings with the medical conditions. It also gives a chance to hone assessment skills, which is really the backbone of what we do. Without a good assessment skill base, you can't have a good basic/medic.

[Arizonaffcep]

This statement is one I will respond too.

I have just been accepted into University of Alberta's full time Paramedic program, the instructor there told me (regarding experience), "I hope you have very little, the more BLS crap you are comfortable in, the harder it is for me to break you of old habits." He went on to tell me that one of his biggest problems is students always reverting back to bls because ALS is new to them and they are not comfortable in it.

What he was getting at is, ALS is a different entity, you don't even approach your patients with the same mentality as an advanced provider as you do as a basic. In a perfect world he would like to educate paramedics from the ground up, part of being a good Paramedic is being good at bls skills, but really how long does it take to get "good" at blood pressures? If you cannot do BP's or count resps after your practicum, you should be re-taking your clinicals. I mean really.... these schools are pumping out EMT's AND Paramedics who can't take a pulse rate? or use a BVM effectively?

Simple math, it takes 6 mos to be an EMT + 1 year to get good, then 2 years for P then a year to get good at als. Total time before the world sees a "good" medic, 4.5 yrs.

Option 2 (zero to hero) 2.5yrs to obtain ALS/BLS education, 1 year to get "good" = 3.5 years

Seems simple to me!

*Really.... if there was no such thing as an EMT-B, we would just have a bunch of really good als providers who can't take a BP or recognize a "load and go" situation?* :roll:

I once was on a medic truck at my old fire department and we were dual medic, with a medic student. The joke of the day was, "the patient'll have 6 large bore IVs and no vitals taken!" I would not say ALS is a different entity, but rather same sport, different levels. Kind of like minor leagues vs. majors...or American Soccer vs anyone else (hope that's not too offensive ). What is wrong with being able to do a good bls assessment as a bls provider? Why is it a bad thing? (as perceived by the above post) It's the foundation for a good ALS assessment. This is not to say it's impossible for a new basic to go straight to medic class and come out good. It's just been my experience that those that have a "better grasp" of the job and how to do it, have a higher chance of coming out "good."

[reaper]

I never knew that there was a "BLS assessment". There is a Pt assessment, that should be done by an EMT or a Paramedic. If your Medic students do not understand how to preform a good assessment, then it is your job to teach them!

If someone was never taught how to preform an assessment correctly, working for a year on the street is not going to help. It is more likely that they will even get worse. That in turn now makes your job even harder.