Experience VS Paramedic

[mobey]

Thank you.

Gotta use the smiley's to show emotion, or else I don't know how to take you?

At first glance I thought that may be sarcasm, in which case I would further explain...

[tcripp]

Gotta use the smiley's to show emotion, or else I don't know how to take you?

At first glance I thought that may be sarcasm, in which case I would further explain...

My sarcasm is usually followed by a smiley. Not sure which smiley for sincerity. I was, am, being sincere.

But, I will explain why I thanked you for the statement. I have been working with EMTs who do have many years of experience who, on occasion, do as Ash did above by just doing what they think instead of conferring with the lead medic. What happened to a team approach? Why not ask your medic if he's not already thought about that or, maybe just maybe, blood sugar was at the bottom of his list of Hs and Ts.

The other day, we had a patient that had crapped out on us...hyperthermia. My ILS partner was starting an IV and I pulled the catheter that I wanted used. Low and behold, my partner grabbed a larger catheter and decided to use that instead completely disregarding my approach to the treatment plan. Not a huge ordeal with the exception that I'm the one who is ultimately responsible for the patient and will have to explain if anything goes wrong. A simple "are you sure this is what you want" would have been more appropriate, in my opinion.

[Dustdevil]

I guess the question I am getting at is does anyone wish they had changed the decision they made as far as training/experience?

Absolutely! Unfortunately, there weren't any better options back in the Stone Age, when I started. The 90 and 180-day wonder medic schools were all there was, as we were all still under the impression that Johnny and Roy knew wtf they were doing. Boy, were we wrong!

By the time I went to paramedic school, I had already been an EMT and military medic for 5 years. I thought I was hot shit. I could hit any tube or IV in my sleep, and recite protocols backwards and forewards. Life was good! Then I went to school for my biology and psychology degrees. Every day of class, I found myself learning something that made me think, "Wow! I can't believe they let us practise EMS without knowing this!" I started to realise just how inadequate EMS education really was for the procedures we were practising.

So, then I went to Respiratory Therapy school and quickly learned that what I had learned in medic school was not only dangerously inadequate, but much of it was just plain wrong. Again I found myself saying, "Wow! I can't believe they let us practise EMS without knowing this!"

Then I went to nursing school, and as you may guess, I each day caught myself saying, "Wow! I can't believe they let us practise EMS without knowing this!"

Now, again, I had at least five years of EMT practice before going advanced, yet I was still so dangerously ignorant of the physiological (and psychological) basis of our therapeutics that I am quite sure that it contributed to the death of many patients, even though I was technically -- by protocol -- doing everything right. So the question is, what did I gain in that five years of EMT practice? The answer is, very damn little.

Experience without a proper foundation to build upon is worse than useless. It is counterproductive, and it retards your educational progress.

When you get to paramedic school, you will notice that there exist a peculiar sub-species of student. S/he is the one who wastes everyone's time with frequent interruptions to either argue with the instructor, or to dazzle us all with war stories that are usually irrelevant and ninety-percent bullshyte. These students usually graduate (if at all) with much less knowledge than their unexperienced fellow students because they think their experience gave them such a "leg up" on education, that they cannot be convinced that they still have much more to learn. They spend a lot of time tuning out the instructor when he covers pathophysiology and other complicated topics that he is convinced you don't really have to know just to start an IV or hit a tube. To them, it's all about skills, because for the last few years, that is all he has seen of the medics' practice. He is SO wrong.

There is nothing of benefit to you or your patient that is learned from basic EMT practice that cannot be learned better and faster as a paramedic student, with the only exception being driving. But I for one didn't become a paramedic just to be an ambulance driver, did you?

Oh, and of course, if EMS turns out to not really be your cup of Joe, then of course there is some small chance that you might conclude that during EMT practice, which would certainly be nice to know before spending two years in college. But that rarely happens, because even unhappy EMTs usually just assume things get a lot better when you become a medic. They don't.

If you just have to make a living while attending paramedic school, and you are so without skills or attributes that being an EMT-B is the only job you can get to do so, then sure, do it. We all have to eat. Just don't put off paramedic school for any time under the mistaken belief that doing so will benefit you. It won't.

Edited April 14, 2011 by Dustdevil

[DwayneEMTP]

I went from basic to medic, not by choice but because of the inability to find any quality basic experience.

The only thing I believe that I would have gained by being a basic first is some first hand knowledge of the political climate of the EMS environment. I do ok, but I would likely have made a lot fewer people cry if I'd understood some things before embarking on my journey...

And Ash...you're off in the ditch Babe...not even in the ballpark.

Dwayne

[Just Plain Ruff]

Alright I have to give my opinion on this one. I think people need to get experience as an EMT before they go to paramedic... Most calls are 90% BLS skills and medics seem to often forget that. Ive noticed that most medics that go straight for medic tend to rely mostly on their ALS skills only. Perfect example is a code we ran a few weeks back. The paramedic started yelling that he has CHF and his heart must be filled with fluid and we needed to fly him and blah blah blah.... I start yelling back that hes diabetic and his sugar needed to be checked... well I had a basic take over compressions and against the medics wishes I checked the sugar and guess what.... the reading just said LOW... well we pushed d50... shocked him... and oh look got a heartbeat... it took a basic and an enhanced to tell the medic what was wrong because he only has 6 months experience as a medic and never was a basic.... so just saying... bls before als

Ash, I think you've told this story before.

If you went against my wishes on a call that would be the last time we worked together.

It sounds like in your description that you both were out of control on this scene and both of you were yelling.

So how did he get to be a medic if he had "never" been a basic???

I do not believe that the sugar was the cause of the arrest, I check sugars on all my arrests not to determine a first line treatment because in an arrest, sugar aint nowhere near first line but to have a baseline for treatment post arrest.

I have have in the past 5 years about 40 codes and of those 40 about half showed LOW on the meter. Only had two or three that got a rhythm back and those 2 we gave an amp of D50 to but after the maintenance drips of amiodarone or lido were hung.

Maybe you cured him? maybe you didn't.

[DwayneEMTP]

I'm curious how you diagnosed the hypoglycemia so quickly in a dead patient?

Or for that matter what caused him to take the time to diagnose CHF in a dead patient? What steps did he take to do so?

My last partner was a rockstar, yet he would never, ever, ever had done anything outside of his scope without my permission. Now, there were a couple of times when I wasn't paying as close of attention as I maybe should have been that he said, "Dwayne, did you want me to go ahead and push THAT NARCAN?" trying to make it sound to anyone listening that he was doing it at my direction. Had I continued to ignore him at some point, quite a ways down the road I can see him saying, "Hey! I need it quiet in here for a second! Dwayne! Would you like this Narcan pushed!?!" I miss him a ton...

I get exhausted from just this one story from ignorant basics (Those that are ignorant, not all basics are ignorant), not ones like it, but THIS one, "So I put in an OPA and I'm bagging him, getting good chest rise, and then the ParaaaaGoooood comes running in, yanks it out and intubates! I tell him, "Shithead! We were doing just fine the other way!!"

Sheesh.

Dwayne

[Richard B the EMT]

I currently work 40 hours a week and attend classes part time, in addition to being a mom who decided to never get married. (I hate the "single mom" moniker as too many use it as an excuse or a pity ploy).

Perhaps overly "Politically Correct" but what about "Working Single Mom"?

[MetalMedic]

Perhaps overly "Politically Correct" but what about "Working Single Mom"?

LOL Possible, but I personally hate the words single and mom together when describing myself. It makes me feel like I am trying to invoke pity or the poor me attitude based on my life circumstances. No one owes me a damn thing because I go it alone. I don't deserve a hand out from the goverment or pity from anyone because I'm tough enough to raise a child alone, work and go to school. Single mother IMHO to me means single woman with kids who complains about her situation. And I strongly believe that a woman who is divorced and the father is active in the life of the child is NOT a single mother, she's a co-parent. So yeah, I'm sure I'll get crucified over my opinion, but that's cool.

I prefer a single working woman with child.

-MetalMedic

[Dustdevil]

Cardiac arrest victims are almost always hypoglycaemic, regardless of the cause of arrest. Anyone who has taken A&P knows that, as well as why.

Giving the victim dextrose was almost certainly a good idea, diabetic or not. But again, you would learn that in any good paramedic programme whether you ever worked a single day as a medic or not, so the story is not particularly relevant to this discussion. It only suggests that you work with poor medics. And the solution to poor medics is not better EMTs. It's better medics.

[DwayneEMTP]

...It makes me feel like I am trying to invoke pity or the poor me attitude based on my life circumstances....

No pity here. You seem smart, and funny, and kind...I have every confidence that you will someday find a strong, stable man to take care of you...

Nod Dust..Hopefully you know I wasn't really curious if an arrest was hypoglycemic but as to the criteria that the poster may have used to determine that, 'cause I'm confident that it wasn't anchored in A&P.

Dwayne

Also, MetalMedic, though I'm confident that you would see the humor in my comment as being grounded in irony, thus in no way my true opinion of you or your actual capabilities where it concerns taking care of you and your babe...I'm making it clear here, just in case I've over assumed so that you don't kill me in my sleep...just sayin'...