First Post - Just graduated and passed the NREMT!

[Just Plain Ruff]

Where would I get experience as an EMT that was not on a transfer truck or hospital setting without being a fireman? In my area, fire and rescue are the same. I don't want to do fire school (yet, at least) in Florida because I don't want to limit myself here.. There is one "county" EMS that does do 911 calls, but they are way booked up

honest question though, I don't see what else you can "do" as an EMT, and less so, a paramedic, unless you are a fireman also. (Again maybe that is just my location)

Jax, it is definately your location.

Where I work, EMS is not predominately fire based. There are fire departments in towns who run fire and ems but most places are still run as private or public EMS agencies.

These places you do not need to be a fireman.

There are plenty of places you can go to not have to be a fire man.

[uglyEMT]

Where would I get experience as an EMT that was not on a transfer truck or hospital setting without being a fireman? In my area, fire and rescue are the same. I don't want to do fire school (yet, at least) in Florida because I don't want to limit myself here.. There is one "county" EMS that does do 911 calls, but they are way booked up

honest question though, I don't see what else you can "do" as an EMT, and less so, a paramedic, unless you are a fireman also. (Again maybe that is just my location)

jmdjax in other locations fire and ems are seperate entities. So folks from these areas volly at squads or hospitals to get their "experience" before moving on.

I believe what your asking and I think has gotten a little lost in the shuffle is that you dont want to get your medic in Florida THEN get your Fire Cert while still in Florida. I think the more important question should be where you want to live and work first. Then find out that State's reciprocity requierments to transfer your Basic cert. Then go for your Medic. Then if you find you live in an area where you are in a combined service (fire/ems) then get your Fire Cert. But if you dont want to be in the fire dept (it kind of sounds like you really don't) then find an area that has seperate entities and just go for your Medic and start working.

Now that you have your basic and want "experience" why not try a hospital ED? I know some places let B's work in the ED, at least in my area, menial stuff at best but at least its something without just doing IFT.

[fiznat]

To make it sound like you will gain the needed experience to be a paramedic only after having spent time as a basic is disingenuous and demonstrates a pretty thorough ignorance of the educational preparation of paramedics.

Really? Because I am an experienced instructor at a well known and nationally accredited paramedic program. I don't think it is fair to say that my feelings about paramedic students derives from "ignorance" of this educational system. Far from it.

I believe that preparation at the EMT level is absolutely essential to the development of good paramedics. Paramedic training is extremely abbreviated for the amount of responsibility and accountability the job demands, and I think students need to be completely comfortable with "the basics" before they can attempt to focus on advanced medical care. By "basics," I mean proper scene control, patient interaction, equipment management, radio, scene, and hospital reports (written and oral), dealing with family, coordinating resources, and general comfort within the system. Graduates from paramedic programs are expected not only to be experts in their medical care, but leaders in the field. It is my firm opinion that you cannot be an effective leader without experience in how the system works, and if recent graduates have to focus their attention on that aspect then the medicine will suffer. I've seen it happen and it is ugly.

You can try and make the argument that nurses and doctors don't require this kind of preparatory training, but it just isn't a fair comparison. First of all, medical school starts with a four year undergraduate degree followed by four more years of medical school. Then there is residency training that lasts several more years. You simply cannot compare that to the 1600 hour class that paramedics get. As far as nurses, they work under the direct supervision and instruction of physicians inside a controlled and highly regulated environment. There is a safety net there that we don't get out in the field. Paramedics are expected to work independently in dynamic, uncontrolled, and often dangerous situations in first few minutes following an incident. Moreover, individual paramedics are expected to be leaders right out of the box, and serve as the absolute highest level of care on a given scene. This is NOT asked of new nurses. If you respect the work that we do, you must recognize that paramedics face difficulties and responsibilities that many other healthcare professionals just don't see. New graduates need to be thoroughly prepared for this job before they start shouldering the whole load on their own, and I believe that preparation starts with a sold BLS background.

...But you're not engaged in neurosurgery, either.

Despite your attempt to buffer it, you are defending accelerated paramedic training by saying that the job we do isn't deserving of the time and effort. This can be an extremely demanding job, and our young need to be throughly prepared. Start with that.

Paramedic education, in an established and accredited program, will offer the foundation needed to produce an entry level paramedic. Just like nursing school will offer the academic foundation to produce an entry level RN. Just like medical school will provide the academic foundation to prepare entry level MDs (who are prepared for specialty training in a residency program).

See above. Entry level RNs and MDs don't work in our environment, and aren't expected to immediately perform as sole leaders with very little safety nets or assistance. Our jobs are NOT THE SAME.

There's a reason other educational programs don't require experience at a lower educational level first. It's a waste of time and does nothing to prepare students for the rigors of educational training at the level required for the profession.

Really? Because you have to have an undergraduate degree and solid MCAT score before you even think about medical school, and nursing training has prerequisites that take more time than the entirety of paramedic education. What do we require? A high school diploma and/or a pulse?

Just like everything else in EMS, why do we insist on thinking differently?

Ours is a unique and demanding job that takes place in dynamic and uncontrolled environments. I believe that respect for this work very much warrants some extra thought about how we train our candidates.

[paramedicmike]

Agreed. There are plenty of places out there where you can work as a paramedic without having to double as a firefighter.

What you're pointing out with Florida being such a fire centered system has been discussed here before, too. The concern is that with so many departments requiring their hires to be a paramedic prior to hire or as a condition of employment, people who don't really want to be paramedics are earning the certification simply to be a FF. Then, when it comes down to it, you've got people who don't want to do the job of a medic functioning as a medic because they're *forced* to... not because they *want* to.

Just out of curiosity, are you in a position to move away from Florida? Or do you prefer to stay there? No wrong answer... just wondering.

[chbare]

Really? Because I am an experienced instructor at a well known and nationally accredited paramedic program. I don't think it is fair to say that my feelings about paramedic students derives from "ignorance" of this educational system. Far from it.

I believe that preparation at the EMT level is absolutely essential to the development of good paramedics. Paramedic training is extremely abbreviated for the amount of responsibility and accountability the job demands, and I think students need to be completely comfortable with "the basics" before they can attempt to focus on advanced medical care. By "basics," I mean proper scene control, patient interaction, equipment management, radio, scene, and hospital reports (written and oral), dealing with family, coordinating resources, and general comfort within the system. Graduates from paramedic programs are expected not only to be experts in their medical care, but leaders in the field. It is my firm opinion that you cannot be an effective leader without experience in how the system works, and if recent graduates have to focus their attention on that aspect then the medicine will suffer. I've seen it happen and it is ugly.

You can try and make the argument that nurses and doctors don't require this kind of preparatory training, but it just isn't a fair comparison. First of all, medical school starts with a four year undergraduate degree followed by four more years of medical school. Then there is residency training that lasts several more years. You simply cannot compare that to the 1600 hour class that paramedics get. As far as nurses, they work under the direct supervision and instruction of physicians inside a controlled and highly regulated environment. Many nurses are not supervised nor istructed by physicians. Nurses often follow a set of orders, but most of the supervision and instruction comes from nursing. There is a safety net there that we don't get out in the field. Nurses are starting to proliferate into the field and are working in highly autonomous environments. They may or may not even have experience; however, this hospital safety net you speak of does not exist in this environment. Paramedics are expected to work independently in dynamic, uncontrolled, and often dangerous situations in first few minutes following an incident. Moreover, individual paramedics are expected to be leaders right out of the box, and serve as the absolute highest level of care on a given scene. This is NOT asked of new nurses. Again, nurses have pushed into these environments, some with limited experience. If you respect the work that we do, you must recognize that paramedics face difficulties and responsibilities that many other healthcare professionals just don't see. This is no longer unique as other providers such as respiratory therapists and nurses are working in the pre-hospital environment. In fact, I have to do a paramedic precepted ground EMS rotation during my respiratory clinical rotations next semester because transport is becoming such a popular area for respiratory therapy. New graduates need to be thoroughly prepared for this job before they start shouldering the whole load on their own, and I believe that preparation starts with a sold BLS background. This sounds like a paramedic school problem. We should be educating competent entry level providers and not relying on basic experience to fill this missing gap.

Despite your attempt to buffer it, you are defending accelerated paramedic training by saying that the job we do isn't deserving of the time and effort. This can be an extremely demanding job, and our young need to be throughly prepared. Start with that. I can only speak for myself, but I do not support any type of accelerated education. If it were up to me, the entry level paramedic programme would be at least three years long with a year of pre-requisites and two years of core paramedic courses and clinical rotations. Clearly, this is anecdotal as I am unaware pf any data that supports or refutes this mandate.

See above. Entry level RNs and MDs don't work in our environment, and aren't expected to immediately perform as sole leaders with very little safety nets or assistance. Our jobs are NOT THE SAME. Unfortunately, I wish this were the case; however, nursing in particular is branching out into every area they possibly can. Sometimes, highly inexperienced providers are taking the helm so to speak.

Really? Because you have to have an undergraduate degree and solid MCAT score before you even think about medical school, and nursing training has prerequisites that take more time than the entirety of paramedic education. What do we require? A high school diploma and/or a pulse? Again, change this. Requiring more basic experience prior to paramedic school is no answer IMHO. Improve paramedic education and mandate pre-requisite courses like many other professions.

Ours is a unique and demanding job that takes place in dynamic and uncontrolled environments. I believe that respect for this work very much warrants some extra thought about how we train our candidates. Agreed. I do see a trend toward improvement in some areas to fair however. I am faculty at a community college based programme and it is interesting to note that the number of clinical hours we require would be the entire curriculum for paramedic courses I saw during the 90's.

Take care,

chbare.

[paramedicmike]

Before we delve too deeply into this, you should remember many of the arguments I've presented in these very forums arguing for an increase in the educational requirements for EMS providers than what is currently mandated. I am a very pro-education person and believe that short changing anyone in the education process (including reduced acceptance requirements as well as reduced completion requirements) is a bad thing.

I believe that preparation at the EMT level is absolutely essential to the development of good paramedics. Paramedic training is extremely abbreviated for the amount of responsibility and accountability the job demands, and I think students need to be completely comfortable with "the basics" before they can attempt to focus on advanced medical care. By "basics," I mean proper scene control, patient interaction, equipment management, radio, scene, and hospital reports (written and oral), dealing with family, coordinating resources, and general comfort within the system.

The argument you're presenting appears very similar to the "BLS before ALS" argument that many EMTs try to present. All of the points you've just mentioned are part of providing appropriate patient care. It is dangerous for an educational program to assume proficiency at any part of the job for which they're providing education. It is also irresponsible to not start with the basics as the foundation of your educational program before moving on to more advanced issues. So unless I'm reading this incorrectly, and that you're assuming skill proficiency of your students, I have many questions as to the quality of the program for which you're teaching.

Graduates from paramedic programs are expected not only to be experts in their medical care, but leaders in the field. It is my firm opinion that you cannot be an effective leader without experience in how the system works, and if recent graduates have to focus their attention on that aspect then the medicine will suffer. I've seen it happen and it is ugly.

So why isn't your program providing adequate education in how the system works? Honest question. Because if you're not providing that type of education, in combination with the medicine, then you're doing a disservice to your students.

The leadership required of a brand new medic is not the same as one who's been on the street for ten years. There is a difference between entry level leadership at the level at which one is working and leadership developed over time. Paramedic leadership can't be gained as a basic. Nor does the inadequate training and job requirements of basic level providers provide adequate preparation to be leaders at the paramedic level.

You can try and make the argument that nurses and doctors don't require this kind of preparatory training, but it just isn't a fair comparison. First of all, medical school starts with a four year undergraduate degree followed by four more years of medical school. Then there is residency training that lasts several more years. You simply cannot compare that to the 1600 hour class that paramedics get.

If you want to compare it on an hour by hour basis, no. The comparison isn't there.

If, however, you want to compare the two in terms of preparation for the requirements of the job, then you have a more solid comparison. Medical students are taught the basics from the very beginning. Their knowledge and experience is built from there. Through both their didactic and clinical preparation they are taught how the system works. They're also, through the same process, taught how to effectively lead and function within their role.

Paramedic programs should prepare their students the same way. Between didactic and clinical aspects of the program students should be taught how the system works while, at the same time, be taught both how to function effectively and lead from their position.

The field training an employer (should) offers should take care of the specialized training specific to the organization. It should also hone the leadership skills required of that provider within that organization to better prepare him/her for the leadership requirements that will come with gained street time.

If a paramedic training/educational program isn't offering their students sufficient didactic and clinical time to adequately grasp and apply at least the basic concepts of the role of a paramedic then they're falling woefully short of their obligation and responsibility to their students.

As far as nurses, they work under the direct supervision and instruction of physicians inside a controlled and highly regulated environment. There is a safety net there that we don't get out in the field. Paramedics are expected to work independently in dynamic, uncontrolled, and often dangerous situations in first few minutes following an incident.

Which is exactly why paramedic programs need to be all encompassing and teach everything they can from the very beginning including material that would be covered in an EMT class. Failing to include this material does not reflect well on the program.

Moreover, individual paramedics are expected to be leaders right out of the box, and serve as the absolute highest level of care on a given scene. This is NOT asked of new nurses. If you respect the work that we do, you must recognize that paramedics face difficulties and responsibilities that many other healthcare professionals just don't see. New graduates need to be thoroughly prepared for this job before they start shouldering the whole load on their own, and I believe that preparation starts with a sold BLS background.

This takes us back to the "BLS before ALS" argument. It also takes us back to the "provision of adequate and responsible patient care" response. It also raises the question, again, that if you're not preparing your students for this from the very beginning then just what, exactly, are you teaching?

Despite your attempt to buffer it, you are defending accelerated paramedic training by saying that the job we do isn't deserving of the time and effort. This can be an extremely demanding job, and our young need to be throughly prepared. Start with that.

On the contrary. I'll refer you to how I opened this very response. I have never argued for shorter or more streamlined training of paramedics. Nor will I ever argue for shorter or more streamlined training. In fact, many times here in these very forums (and elsewhere) I've argued that the minimum requirements for EMS providers should be drastically increased from their current and inadequate minimums.

That being said, however, doesn't negate the fact that while there are many things to consider while doing the job, it's not rocket science. A student who applies him/her-self can and will succeed.

See above. Entry level RNs and MDs don't work in our environment, and aren't expected to immediately perform as sole leaders with very little safety nets or assistance. Our jobs are NOT THE SAME.

I never argued that the jobs were the same. My argument deals solely with educational preparation. Education *must* start with the very basics and build from there. Medical students are educated in this manner. Nursing students are educated in this manner. Physician assistant students are educated in this manner. Radiology students are educated in this manner. Physical therapy students are educated in this manner. Social workers are educated in this manner. The list goes on. Starting with the basics does not require prior experience before moving up to the next level. It should be all encompassing in the education program.

Really? Because you have to have an undergraduate degree and solid MCAT score before you even think about medical school, and nursing training has prerequisites that take more time than the entirety of paramedic education. What do we require? A high school diploma and/or a pulse?

You missed the point I was trying to make. Perhaps I could've worded it a little better, too. My point was, as Ruff previously argued, was that candidates for medical school don't need to have worked as medics or nurses prior to admission. Nurses don't need to have been CNAs or LPNs prior to acceptance to nursing school.

Medical school may required an educational foundation prior to admission. But it does not require work experience. Many nursing programs don't require more than a high school degree, either... especially bachelor's programs. (Coincidentally, a BSN is increasingly becoming the standard for entry level nurses. This isn't being seen everywhere yet. But it's coming.)

Ours is a unique and demanding job that takes place in dynamic and uncontrolled environments. I believe that respect for this work very much warrants some extra thought about how we train our candidates.

On this point you and I agree completely. Unfortunately, it seems we disagree on how that goal of adequately training candidates should be completed. I still maintain that a complete and thorough paramedic educational program will provide everything needed for a paramedic candidate to function adequately as an entry level hire.

There is no reason why an academic program can't take a motivated individual with no prior experience and completely and thoroughly prepare him/her to function effectively as a paramedic. As a result of this belief, I have to seriously question the programs that don't appear to do this.

[fiznat]

If it were up to me, the entry level paramedic programme would be at least three years long with a year of pre-requisites and two years of core paramedic courses and clinical rotations.

Fine, I agree with this. IF our paramedic programs included 3 years of study and a host of prerequisites (which I support!), I could maybe see reducing a portion of the EMT experience requirement. As you well know however, this is not today's reality. The NREMT currently requires 1600 hours, and in my opinion schools cannot reasonably train students "from zero to hero" in that amount of time.

however, nursing in particular is branching out into every area they possibly can. Sometimes, highly inexperienced providers are taking the helm so to speak.

The purpose of comparing nursing training to paramedic training was to identify differences in established modalities. What "some nurses" are "starting to do" in "some places" with "sometimes" inexperienced providers is an exception, not a rule. The point stands. Inexperienced providers should not be expected to serve in leadership roles for dynamic situations at some distance from their support structures. Currently, this applies much more to paramedics than nurses.

I am faculty at a community college based programme and it is interesting to note that the number of clinical hours we require would be the entire curriculum for paramedic courses I saw during the 90's.

Interesting, yes, but I get the feeling that neither your nor I are satisfied with it.

The argument you're presenting appears very similar to the "BLS before ALS" argument that many EMTs try to present.

I don't know if this is meant as a slight or what, but both EMTs and paramedics talk about how BLS should come before ALS. That is because it is true.

It is also irresponsible to not start with the basics as the foundation... ...I have many questions as to the quality of the program for which you're teaching....

....So why isn't your program providing adequate education... ...doing a disservice to your students....

...If a paramedic training/educational program isn't offering their students sufficient... ...then they're falling woefully short...

...why paramedic programs need to be all encompassing and teach everything... ...failing to include this material does not reflect well on the program...

...if you're not preparing your students for this from the very beginning then just what, exactly, are you teaching....

Paramedic schools don't have time to teach EMTs to be EMTs before they can become paramedics. If you want to argue that 1600 hours (the NREMT standard) is not enough time then I am all for that, but don't tell me that my school is deficient because it is not cramming in the EMT curriculum as well. The school where I teach does do some targeted BLS refresher stuff, but this is in no way is expected to replace EMT training and experience.

The leadership required of a brand new medic is not the same as one who's been on the street for ten years. There is a difference between entry level leadership at the level at which one is working and leadership developed over time.

Maybe this is true where you work, but not here. An ambulance around here includes one EMT and one paramedic. When that ambulance arrives on scene, that paramedic (and nobody else) is in charge. There is no "reduced leadership" role. My school is aware of this, and has a responsibility to graduate paramedics who are prepared to handle that reality.

Medical students are taught the basics from the very beginning. Their knowledge and experience is built from there. Through both their didactic and clinical preparation they are taught how the system works. They're also, through the same process, taught how to effectively lead and function within their role.

Paramedic programs should prepare their students the same way. Between didactic and clinical aspects of the program students should be taught how the system works while, at the same time, be taught both how to function effectively and lead from their position.

You can't just ignore the time spent. Physician training takes six years at an absolute minimum (not even counting undergraduate). Of that time, at least four of those years are spent in the clinical environment (and usually even more than that). If paramedic schools want to model their system that way, then the length is going to have to dramatically increase. As it stands today (which is the frame from which we should be talking), paramedic schools cannot hope to achieve such a complete "start to finish" product in the amount of time they have.

IEducation *must* start with the very basics and build from there. Medical students are educated in this manner. Nursing students are educated in this manner. Physician assistant students are educated in this manner. Radiology students are educated in this manner. Physical therapy students are educated in this manner. Social workers are educated in this manner. The list goes on. Starting with the basics does not require prior experience before moving up to the next level. It should be all encompassing in the education program.

I'm glad you listed these.

Physicians - 6 years (minimum) graduate level

Nurses - 2 or 4 years undergraduate or associates level

Physician Assistants - 2 years graduate level

Radiology - (?? radiology is a physician specialty. Do you mean rad-tech? That's 2 years undergraduate level)

Physical Therapists - 2 or 3 years graduate level

Social Workers - 4 years undergraduate level, most have graduate degrees

Paramedic training is MUCH, MUCH shorter than all of the professions you listed. Different worlds, really. Not only that, but with the sole exception of physicians (who's training is the longest), not a single graduate from any of these systems will be expected to perform as an independent leader and provider for the sickest, most critical patients.

A paramedic is unique in that he/she has the least amount of training among his/her "peers" in healthcare, but one of the highest levels of responsibility. I see that as a dangerous situation, and I want my students to be as experienced and prepared as possible. The ultimate answer to that problem, yes, is to increase the time we spend training paramedics. Until then (and I might argue even then, really), I would much prefer that paramedic students have some experience in the field before they apply.

Edited December 22, 2010 by fiznat

[chbare]

Where are you getting the 1,600 hours from? The NREMT does not set this standard, the NREMT will only let you test if you complete an approved programme per DOT NSC guidelines.

I am not aware of the NSC mandating a "minimum" number of hours for paramedic education. Even the coaemsp interpretation of national standards does not address a specific number of hours.

Take care,

chbare.

[fiznat]

Where are you getting the 1,600 hours from? The NREMT does not set this standard, the NREMT will only let you test if you complete an approved programme per DOT NSC guidelines.

I am not aware of the NSC mandating a "minimum" number of hours for paramedic education. Even the coaemsp interpretation of national standards does not address a specific number of hours.

Take care,

chbare.

Well jeez, you're going to make me cite references huh? There is no "mandated minimum" hours, but there is an expected course length as described by the DOT.

http://www.nhtsa.gov/people/injury/ems/EMT-P/

The US DOT National Standard Curriculum for Paramedic Training, which is as you say the NREMT's guideline for course approval. Page 17. They say that the course can be reasonably completed within 1000-1200 hours of instruction. Add 400 hours of clinical time (which is what my school does) and you get 1600. That works out to about a year, which is the average medic school length.

[jmdjax]

Agreed. There are plenty of places out there where you can work as a paramedic without having to double as a firefighter.

What you're pointing out with Florida being such a fire centered system has been discussed here before, too. The concern is that with so many departments requiring their hires to be a paramedic prior to hire or as a condition of employment, people who don't really want to be paramedics are earning the certification simply to be a FF. Then, when it comes down to it, you've got people who don't want to do the job of a medic functioning as a medic because they're *forced* to... not because they *want* to.

Just out of curiosity, are you in a position to move away from Florida? Or do you prefer to stay there? No wrong answer... just wondering.

I have seen most major cities seem to be fire/ems integrated, with the exception to (mostly very) rural areas. This may not be true nationwide, but at least it is as far as I have seen. But to answer your question, I have a lease agreement for the next 6 months and I am open to the idea of moving elsewhere after that. I would stay if I can get into a paramedic program, but I am just unsure of which route to go as of yet.

As a side note, I am not opposed to fire academy, however I do not have the same "desire" to complete it as I do with EMS in this stage of my life. I feel I should move around a little bit (maybe even international once I have a good amount of experience?) before I decide to settle in government position like a fire station, if I ever decided to do that. I guess my point is that options are great, and I would rather do paramedic, which can be transferred to other states much easier than minimum standards, and seems to offer a broader range of opportunity.

Again, feel free to correct me if my interpretation of anything in this field is wrong. I am very serious about starting a career in this field, but I am a "newbie." As some have said, however, most people end their careers in this field, unwillingly, and as another poster mentioned, I do need a backup plan as always (another reason why the RN bridge program was appealing).

"Unwillingly" may not be the correct term, as I for one plan to continue my education for as long as I live in anything I can.

Thanks guys!

Edited December 22, 2010 by jmdjax