FDNY EMS - Basic to Medic and More...

[RatPack]

Ok I need to jump in here. I have been a professional EMT for nearly fifteen years, I work in a tiered 911 system, I am also educated, if I remember correctly spelling wasn't offered at my university. You should have mastered that by the six grade. I have two doctors in my family, neither of them have mastered spelling, punctuation or penmanship and they would be highly offended if we as EMTs and paramedics believed that we practice any form of medicine. We are technicians, born for a purpose.

We as EMT's are not impersonating anyone, from my medical director down to my shift supervisor they are well informed of my training and limitations as an EMT. I work in a system that was provided for me. I didn't falsify documents so I could ride on a ambulance with red flashing lights. I chose this profession. If you have a problem with me tending to my duties as outlined by my medical director, then make a phone call, other then that I cant help you.

I am in no way against education for all levels up to a point, however until someone requires it stomping around and telling people they should be doing something else because they're useless is your opinion, also remember that when they require a college education, you will not be grandfathered in and I would advise against any bridge programs. I would guess that ninety percent of EMS personnel are trained versus educated. There is a huge difference, Barry who took a two week paramedic program back in Nam is not educating you, and running his EMT or medic class in the back of his firehouse will never be confused with true education.

You speak of me(EMTs) as if we are doing something under the cover of darkness, playing a cruel joke on the general public. I would argue that no provider EMT or paramedic does much in the way of saving lives we are an important link in the chain but only one link. I do not consider the very few treatments at the ALS or BLS level anything more then band aids, until true medical professionals(MD's) have intervened. You dont practice medicine with an associates or bachelors degree, you never have and you never will. If you would like to do that I suggest medical school, nothing else will substitute. By the way the United Stated educational sytem up to about the Masters level is a joke and can be completed by just about anybody with a pulse and a alarm clock.

These argument are becoming old. Only in EMS would a person with 8 months of training argue with a person with 4 months of training about who is more capable. Its a joke. Grow up.

[Donavan]

...but some how working on 110 hours of training and being able to administer 5 or so drugs, including patient assist medications, of which only 1 gets any serious use, is supposed to make up for medic schools apparently not having a long enough field internship?

It has nothing to do with the training or the meds you can give, it has everything to do with the most important aspects of our job: speaking to people, scene control, and patience. Without these vital skills, which I might mention a lot of physicians I have met lack, all your vaunted paramedic skill are for naught.

I have met a few paramedics who were never EMTs first, either because of a RN-medic bridge course, or because they got their medic at a medic mill that included EMT-B, and they are usually poor paramedics. They tend to lose their heads, get tunnel vision, and other ailments that get medics (and EMTs) killed.

[tskstorm]

It has nothing to do with the training or the meds you can give, it has everything to do with the most important aspects of our job: speaking to people, scene control, and patience. Without these vital skills, which I might mention a lot of physicians I have met lack, all your vaunted paramedic skill are for naught.

Shouldn't speaking to peoples and patience be skills you are taught from the time you are age 5 and older? Why must one be an EMT to learn these skills ?

Scene control can and probably should be delegated to LEO's. If you're talking about controlling the LEO's and CFR's who have lost their heads on a job such as an MCI your control should be limited to what effects patient care, or by assigning them simple mundane tasks that wont interfere with patient care. No EMT class teaches such things.

[fiznat]

Shouldn't speaking to peoples and patience be skills you are taught from the time you are age 5 and older? Why must one be an EMT to learn these skills ?

Scene control can and probably should be delegated to LEO's. If you're talking about controlling the LEO's and CFR's who have lost their heads on a job such as an MCI your control should be limited to what effects patient care, or by assigning them simple mundane tasks that wont interfere with patient care. No EMT class teaches such things.

I think what Donavan is saying is that there aspects of what we do that go beyond "medicine." The logistical operations of balancing medical care with managing a scene is something that takes skill and practice to learn how to do well. Experienced EMS people (both medics and EMTs) know how to move patients with efficiency and due regard for injuries, know how to take command of a scene and calm bystanders down so that we can do our work. Good providers can illicit a complete history and physical exam in a compressed amount of time under stress, and get five other things done at the same time so that the patient is properly packaged, treated, and presented to the hospital. You might learn about "speaking to people and patience" when you are younger, but good bedside manner is a professional skill that is learned by experience. The same goes for our other skills in the field. This isn't everyday experience- you need to have been there.

Paramedics are tasked with all of the above responsibilities in addition to their advanced scope of (medical) care. A good paramedic needs to be comfortable handling the scene so that he/she can focus on the medicine. Setting up a plan of care for a really sick patient in your mind, while extricating, exposing, coordinating, and dealing with family members is not an easy task. This is why EMTs need experience in the field before they think about going back to school. You don't learn how to do this stuff well in a few months internship, and it is inappropriate to assume that other agencies (PD or FD) should handle our work for us.

Edited April 27, 2009 by fiznat

[Diazepam618]

To the OP get your medic cert and quick, even if you go through one of those 8 month programs and move out to southern cali there real $$$$$ to be made out here.

[tskstorm]

but good bedside manner is a professional skill that is learned by experience. The same goes for our other skills in the field. This isn't everyday experience- you need to have been there.

You're absolutely right, but you need to have been there at the level of care you want to ultimately provide, an EMT and a Paramedic will 90% of the time look at the patient differently. EMT see's an MI a Paramedic see's a Inferior wall MI... You can't learn the needed bedside manners of a paramedic by working as an EMT

I also feel it must be said, Just because one is in school to be a paramedic for a year doesn't mean you stop working as an EMT. You should be working as an EMT until the Paramedic class starts and during it, plus internship/clinical time you should have seen a significant amount of patients to develop some bedside manner.

and it is inappropriate to assume that other agencies (PD or FD) should handle our work for us.

When there is a patient involved and PD or FD is around they are resources to me, I use my resources to suit me best. I try to keep the big picture in mind, If my partner and I aren't tasked with the menial tasks we can focus more on patient care. What good is a CFR FF or CFR LEO on a cardiac arrest unless you delegate them to assist you?

Edited April 28, 2009 by tskstorm

[fiznat]

an EMT and a Paramedic will 90% of the time look at the patient differently. EMT see's an MI a Paramedic see's a Inferior wall MI... You can't learn the needed bedside manners of a paramedic by working as an EMT

If we're talking about bedside manner, I think this is absolutely something you can learn as an EMT. Learning how to talk to patients, illicit a history, and offer just the right amount of reassurance is something that any level of provider can learn to do well. Becoming a paramedic just means that you ask different questions, not alter how you ask them.

I also feel it must be said, Just because one is in school to be a paramedic for a year doesn't mean you stop working as an EMT. You should be working as an EMT until the Paramedic class starts and during it, plus internship/clinical time you should have seen a significant amount of patients to develop some bedside manner.

I don't think this is a long enough time. ...But hey if you are interested in abbreviating our already tragically short education and training time then that may be your prerogative. I'm completely against it. If you don't mind me asking, whats the big rush anyways? People new to this field need to be at the top within a year? Tell me, what other respectable medical career allows such a practice?

When there is a patient involved and PD or FD is around they are resources to me, I use my resources to suit me best

There is a difference between utilizing your resources (which we all must learn to do well), and using those resources as an excuse to abbreviate our training. You suggested in your last post that "scene control" was unimportant for EMS providers to practice because other services should be doing that job. I disagree. I think scene control is an absolutely critical portion of our job and it is something that we need to learn how to do well on our own, without subcontracting that work out to a FD or PD.

[tskstorm]

If we're talking about bedside manner, I think this is absolutely something you can learn as an EMT. Learning how to talk to patients, illicit a history, and offer just the right amount of reassurance is something that any level of provider can learn to do well. Becoming a paramedic just means that you ask different questions, not alter how you ask them.

Being a Paramedic vs EMT changes how you think and what you ask, if you're asking different questions how can you have had practice asking them

I don't think this is a long enough time. ...But hey if you are interested in abbreviating our already tragically short education and training time then that may be your prerogative. I'm completely against it. If you don't mind me asking, whats the big rush anyways? People new to this field need to be at the top within a year? Tell me, what other respectable medical career allows such a practice?

Better education leads to better patient care I'm sure we can all agree to that right? That's why I think people who intend to be Paramedics should just go straight through it and start offering the best care they can give right away. PA school's around here are only 18 month to 2 year programs, and the only reason it takes them that long is they don't do clinicals while the didactic sessions are still going on. I see that as being similar although I'm completely aware you need a bachelors and a lot of pre-reqs to get into the program itself.

There is a difference between utilizing your resources (which we all must learn to do well), and using those resources as an excuse to abbreviate our training. You suggested in your last post that "scene control" was unimportant for EMS providers to practice because other services should be doing that job. I disagree. I think scene control is an absolutely critical portion of our job and it is something that we need to learn how to do well on our own, without subcontracting that work out to a FD or PD.

FD or PD are on at least half of our calls without us asking for them, so I don't see it as subcontracting I see it as using your resources.

Edited April 29, 2009 by tskstorm

[Richard B the EMT]

If there are no PD or FD folks to help with crowd control, ask members of the crowd. I have many times asked crowd members (the curious type, not the angry type, which is an entirely different story) if I could "deputize" them to hold back the rest of the group. Many of them actually feel that they are truly helping, which is exactly what they are doing.

[tskstorm]

If there are no PD or FD folks to help with crowd control, ask members of the crowd. I have many times asked crowd members (the curious type, not the angry type, which is an entirely different story) if I could "deputize" them to hold back the rest of the group. Many of them actually feel that they are truly helping, which is exactly what they are doing.

Makes perfect sense ... anything available is a resource