Advice to students of EMS, from another point of view

[Ridryder 911]

After reading some posts and viewing the "chat room" I have seen a large percentage of non-EMT's and EMT's that are entering Paramedic school. I came across an article in JEMS, that I found very interesting and has very good ideas. The link is as posted, I did not copy due to possible copyright infractions.

http://www.jems.com/educationandtraining/articles/13369/

I hope that all students or future students will read this article. As an instructor and working medic I am concerned of the future of our career. Main points I found interesting in this article was common basic thinking, although I am finding this is getting harder & harder to find daily. Like the author I find very few students takes the course (s) seriously. I find talking to a lot of EMS students, that the routine of studying is less than 6 hrs a week. When asked about library research or reading, I get a puzzled look. Would a student not study chemistry more than a couple of hours a week, would one think a class on administering medical care should not be as in-depth ?

I am also concerned that we as instructors are not "challenging" our students. As some of the few medics on this forum site, will admit; although we may disagree with a response from another peer, we will respect their opinion. That is if they can properly explain or discuss it. The old saying there might be more than one way.... is never more true than in emergency medicine. However;I do not see majority of medic students recognizing this. The simplistic textbooks on the market appearantly are not providing enough challenge to the students.

I know while I was in medic school, we were issued texts with conflicting literature on purpose. This was to make us research and develop "our own educated rationale". Yes there are of course core standards, and basic scientific understanding for all material, but most scientific data can always be challenged in some form. Should we not encourage EMS personal to challenge the educational standards and protocols? Understanding why, and how we are performing treatment is just as appropriate as accurately treating our clients. Just reciting protocols without knowing why or if there is something better out there is detrimental not only to our patients, but our profession as well. I refer to such common statements as "o_{2 @ high flow.... etc.}

_{The other portion of the article even addressed dressing for class. Which I found interesting and in total agreement. I am not endorsing suit & ties, but dressing for success should be part of the curriculum as well. When attending EMS conventions I can almost always identify EMT' in the crowd of multiple medical personal. I wonder sometimes, if medics own any clothing without any EMS or Fire logo's on them. Of course there has to be as many baseball style caps as well. Yes, I too have several hundred articles clothing of various conferences and services I worked at, but these are reserved for leisure activity.}

_{Emphasizing professionalism should start at the career of the EMT. Emphasizing reading journals, CEU's, behavior (off and on-duty) as well professional appearance needs to be addressed as well.}

_{As we have had plenty of discussion of curriculum changes, some of these could be performed internally without a national forum.}

_{So to start a discussion or debate, what else would you recommend a new student of EMS?}

_{Be safe,}

_R/R

[Dustdevil]

So many EMT's, including paramedic students, that I talk to see being a paramedic as simply a collection of technical skills. They almost completely discount the mental portion of paramedic practice in their minds. Show them how to intubate and all they can say is, "that's easy! Why can't EMTs do that?" That's why we see all these people here asking what 8 hour course they can take to learn to do paramedic skills without actually going to paramedic school. Personally, I think those people should be banned from EMS for displaying such a frightening lack of understanding of their own profession. There is no cure for that kind of stupidity.

Ya know, after a week in L&D during nursing school, I was pretty confident that I could perform a c-section as good as any OB there. But I damn sure didn't think that I ought to be doing it! There is so much more to it than a few cuts and sutures. And the same thing applies to paramedic skills.

So, my recommendation is that students get a firm understanding of the theory of medical education and medical practice from the very beginning so that they understand priorities and what is important. This will help eliminate a lot of the attitude that dooms people to failure from the very beginning.

[Rezq304]

I'm currently a Paramedic Student...just started a few months ago acually and I can't agree more. One of the other students that was riding with me to class just up and dropped out. Now, while I can say I thought he would make a damn good medic, I'm glad that he quit when he did if his heart wasn't in the right place. I think I'm one of the few in the class that actually look forward to going to class and I've made it a point to try and at least one thing new EMS related every day. I'm thrilled with the class and I love the mental challenge put before us!

[jenniemt]

I'm with Rezq304. I start medic school in January and I can't wait because I can't wait to learn the whys and whens of the advanced skills. I know how to intubate and start IVs and I've done it on manikins (whoopdy-do!!) but now I get to learn when to do it and why I'm doing it and how it benefits the pt, not just "this is how you do it". I read JEMS, EMS mag, and of course this site. If there is something else you experienced medics would suggest I read in addition to or in place of any of those, please let me know.

I studied for my EMT class far more than I ever did for any other class I've ever taken. I'm already counting on seeing my friends in medic school more often than my family because of how much studying we will be doing. I agree that the books put everything so simply. It's up to the instructors to elaborate. Example: on my EMT final there were a bunch of questions where we had to determine what type of shock (if any) the pt described was in. After the test I was looking in my book to verify some of the answers I had picked and nothing even close to that complex was in my book. So last night I was looking at a paramedic textbook at a bookstore, and even it didn't go into the detail our exam did. Can we blame the publishers for just putting in the basics and relying on instructors to teach the real meat and potatoes? I don't know.

Oh, and no I'm not even an EMT yet. We don't have to be until we start the paramedic curriculum, which comes after a few months of A&P. I hope to test this month or next month though.

I read that article on JEMS the other day and thought it was great. I was never late or missed a class, always wore my uniform (required), and was always ready to learn.

[Dustdevil]

Of course, it is not just the student that has to be on board with this concept. If the school is run by wanker firemonkeys who think that combat boots, BDU pants, a navy blue t-shirt and a ballcap is a good image for a paramedic students, then professionalism is doomed from the start. :roll:

[AnthonyM83]

I like the overall principles that argument is pushing.

I think something that would help promote these things is making EMTB classes a bit more challenging, in some places.

My class did not have any homework (except for write-ups of our clinical rotations) or extra assignments.

No presentations or outside research. Very lax. Didn't go very in-depth on most medical topics.

I don't know about dressing up for class, though...not even medical students do that (it's mainly casualwear & PJs).

Most people in my class would be completely fascinated by class in whatever they were wearing...though it could be argued dressing up would increase importance even more?

Something else inhibiting total immersion in the subject is the outside commitments people have. Out of my class, some were in high school (so they're schedule was packed with homework), others were in jobs with rough schedules (more than a 9-5, flying for business, studying for MCATS), many weren't immediatley going to practice EMT (prepping for anothe career). In fact, I think there were 3 or less (out of 15) who was planning to go right into working as an actual EMT (on an ambulance).

Just throwing some thoughts out there...

[jenniemt]

Oh dust I really think you'd like my school. None of our fulltime instructors are FFs. I'll PM you a link to our website so you can see our uniform that is required at each and every class.

[Dustdevil]

I don't know about dressing up for class, though...not even medical students do that (it's mainly casualwear & PJs).

Most people in my class would be completely fascinated by class in whatever they were wearing...though it could be argued dressing up would increase importance even more?

I agree. Even paramedic school is just a part-time night school in most places. The campus is empty except for the students. They're there three nights a week for maybe 4 hours, and most of them drove straight from work. In those cases, a serious dress code is more harassment than anything else. On the other hand, there are certainly common sense guidelines that could/should be implemented to maintain at least a casually professional atmosphere.

As for the medical school comparison, you have to remember that our student base is very, very different. With very rare exception, medical students are responsible adults over 21 who have sowed their wild oats. Conversely, the majority of those in EMT school are teenaged wankers who are into challenging authority and expressing their individuality. Their number one goal in life is to be just like the guy on Turd Watch. Therefore, it is not really surprising that they need more guidelines than a medical student. If we are in the business of preparing these people for a life in a very structured professional world where they are expected to meet rigid standards, then are we not doing them a disservice by not running our programs in that model?

[Cookie]

When we started our Emt B classes as part of the cost was the issuance of two grey polo shirts with the staff of life on it and lettering from the college and Emt B etc. We were to wear those to class along with black pants, black shoes and black socks. Not only that we had to wear said same outfit to our clinicals, we could also purchase a heavy sweatshirt for the ride times. We looked pretty spiffy and professional looking.

We had class twice a week, I studied on the average of 3 to 4 hours daily, that was after work, days off at least eight hours. I also aked questions and challenged some questions etc. I was there to learn, however we had some students the instructor constantly had to remind them to shut up and pay attention. Some were more concerned about gossiping than learning. Those students had to take the practicals more than once and the test more than once, one girl has never passed her test at all.

I think its all in your commitment and how you want to succeed or if you want to succeed. If your there for the glory you will do just what it takes to get buy, (my opinion). But if you truly want to succeed you will do what ever it takes, research, chemistry whatever to make the grade and dress the part, dress for success.

My humble opinions.

[vs-eh?]

It is actually quite disheartening that articles like this even have to be written. Most of this is common sense.

Again (for the millionth time I know) will reference the program that I took for PCP (BLS).

http://postsecondary.humber.ca/07651.htm

Multiple research papers...

Several presentations...

In depth A&P, pharm, advanced assessment, etc...

People are weeded out...

Breadth education...

This is all to practice at the most minimum level in Ontario in the 911 environment. I dare say that I am thinking that a lot people currently thinking/doing their EMT-B education (for lack of a better comparison) would be hard pressed at doing this kind of education. The sad thing is that there is a fair percentage of these EMT-B's have a higher procedure set than I do as a PCP. That is sad.

I read about EMT-B's going to EMT-P with little to no road experience. I wholly disagree with this. Basic's from what I have read for the most part do not function in the 911 environment and work somewhat exclusively in the "transfer" area. How can you expect to move into ALS medicine without practicing BLS on real patients on real scene calls. I don't get it.

I think another problem is with the medical directors that EMS services have, because in the end they dictate your scope. I have talked to and read about EMT-P's who didn't do an in hospital OR field intubation prior to being "signed off" as an EMT-P. The drug lists that some of these same paramedics have which include some ridiculous drugs like flumazenil or being able to do RSI and have never heard of "BURP". Come on. Are your medical directors aware of some of the education that people are getting? They are comfortable with this? I tend to wonder if this influences the litigious nature of the public toward aspects of American EMS.

When I did my ACP education I did not really learn anything new. PCP education encompasses so much of ACP that there could be an argument to the move to the "zero to hero" in Ontario. I would disagree, but I could see a year being added and well....I haven't changed my patient assessment since doing my ACP.

I just get the feeling that EMT-B's have the "well I can do this, no problem" attitude, without having proper education and clinical/field experience. Listen to Rid, listen to others, listen to Dust (yes, yes, I said Dust, he has his moments - damn you on that niacin flush ).

Get educated, get experience. The opportunity to "save a life" will always be there...Although few and far between.