My post on Tuesday generated quite a number of comments centering around the issue of EMTs going right from EMT class to medic school. Here are my thoughts on it:
When I started you had to have at least a year of field experience before they would even consider you for admission to medic school. I had been an EMT for a number of years when I went to medic school(as a volunteer and in a small commercial emergency, but non-paramedic service), and even at that I had a hard time. Medic school isn't easy. I envied some of the people in my class who were working as EMTs with paramedic partners during class. That gave them a big advantage in understanding what we were learning. I did my 120 hours of field time and then did an extra internship where I rode with a commercial service a couple nights a week for months. When I started at a commercial service, I precepted right away and was cut loose after six weeks. Then I was on my own. I was terrified not of the common call, but of the unknown (some of that terror never goes away, it recedes, but the unknown will always be out there). In my case because my experience while more than some coming out of medic school, still wasn't as much as many, so the unknown was in fact fairly common. I encountered the unknown every day, where now I encounter it infrequently.
One of the differences between a paramedic and a nurse or a doctor in their early days on the job is that the medic is alone with no one to call upon for help, no veteran to say this is not what you think it is -- this person is not really seizing, this person is not really unresponsive, this person is not really having difficulty breathing or to say, while this person might not look it, they really are sick and you better get moving. You will learn the lessons eventually, but without extensive field or hospital experience with emergency patients, as a medic, you have the ability to do a lot of harm. Harm with your drugs and harm with your inability to recognize the severity of a situation or how to deal with the scene.
(One of the commentors made a comparison of a new medic without experience to a new Lieutenant in war without experience -- you are in charge, but if you don't know what is going on, and you don't have a street smart veteran partner, someone may get hurt.)
Now I am used to a one-medic system. And when I started it was a one-medic system with basically no first responders. (As a condition of my medical control, I had to be assigned an experienced EMT as a partner.) If you are working in a two-medic system (one with a junior and senior medic) or in a fire system where there are other medics on the engine with you, then a new medic is going to have it much easier. In this case, I see no problem with a new EMT going right into medic school and then going out on the street -- as long as they are operating under someone else who is in charge of them, and can guide them. No problem here at all.
We all hear the refrain "they don't make medics like they used too." Or "these medics nowadays, don't know..." They were saying that before I started as a medic, when I became a medic and they are still saying it today and they will be saying it in the future. In many ways the medics I see coming out today, at least around here are better trained than I was. At that same time, it seems nowadays anyone who wants to become a medic can become one. Again when I started, 15 of of 85 people who applied to medic school got in. A couple years later they were calling up people who had been rejected previously and asking them to apply. With a proliferation of medic program, they need bodies coming through the door.
Many years ago we had very few medics. I was often one of only two medics on duty covering the whole city, and there were never more than six of us. Today, there are times when every car has a medic in it. Reimbursement practices have made it financially advisable to have a medic in every car to get the paramedic billing when the paramedic does "a paramedic assessment." A problem with so many medics is it becomes harder for new medics to gain the experience they need. Instead of every call being a real emergency or an intercept with a basic car screaming for help, the day can be filled with routine emergencies and transfers. What took a new medic a year to see now may take several.
I was talking with a teacher from a paramedic program recently about the issue of the new EMT going right to medic school and she said that one of the benefits of it is that the educational institution can keep an eye on them all through their training and keep them from developing bad habits, can more completely form them in the model they are aiming for. Maybe. Hopefully they are at least riding with a service after they get their EMT so they have a context in which to place what they are learning in medic school.
I have trained many ER nurses who were going through paramedic school. Instead of doing their ER clinical time in an ER, they get sent to ride with me. They do very well -- in some cases exceptionally well -- on the medical part of the job, but need a lot of guidance when it comes to the scene management. I have also had some very smart students who are going the EMT right to medic school route ride with me, and despite their book smarts, I have seen them struggle mightily with the field.
I am sure that many EMTs going right to paramedic school will eventually become fine paramedics, just as some EMTs with years of street experience will turn out to be poor paramedics. As some commentors have pointed out its what's in the person that counts. Going straight to medic school is just a harder route.
Good luck to all of you who have chosen to become paramedics. It is a difficult job, but if you care about it, no matter the obstacles, you can become good at it. It is a noble thing to do with your life.
You deserve thanks and please, stay safe.
