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Tonight’s entry is a guest post from @MattTheMedic, an off-shore paramedic who has recently started his own blog.
He’s an incredibly intelligent and witty guy, so if you aren’t
following him on twitter you should check him out! After you’ve read,
please head over to his blog and say hi, and feel free to comment on
this post to let him know what you think!
To draw an objective conclusion about the flawed state of EMS
Education you first have to admit there is a problem. Unfortunately I
was unaware of the problem because I thrived in the earliest (and
easiest) stages of said training.
The EMT-Basic program is a class designed for the lowest common denominator.
Good at memorizing things? Great.
Have half an ounce of common sense? Even better.
Willing to unquestioningly accept that 2 + 2 = 5 (90% of the time)? Awesome.
Medical directors are gonna love you.
At this point we’ve stumbled upon …
Problem #0 *: The EMT-Basic program is a watered down
course that most 8th graders could pass with a little help. As long as
you’re capable of memorizing and making your hands do what you tell
them, you’re in. You’ve also just met the criteria to work in fast food.
I did not understand this problem due to the relative ease in which I
negotiated the class. And this is not to say that I’m a rocket surgeon,
by any means. I consider myself of average intelligence and had the
benefit of running for 6 months on my local volunteer ambulance prior to
ever stepping foot inside the EMS classroom. But, if you can remain
calm, remember a few simple mnemonics (SAMPLE, DCAP-BTLS, AVPU, etc.),
and memorize the practical sheets, you are the new Golden Child of EMS.
Please do not take this as a dig on my EMT-Basic Instructor. He was a
wonderful teacher with too many students, too little time and a long
list of things (mostly silly things) that the state required him to talk
about. He was, and still is, one of my EMS heroes, an awesome Paramedic
and a genuinely great person who I consider myself lucky to have had
the opportunity to work with.
Also, please do not read this and think that I’m taking anything away
from being an EMT-Basic. I was one for nearly 8 years. I bought into
the “BLS before ALS” concept with my whole heart. I believed “Paramedics
save lives; EMTs save Paramedics.” I was certain that I was better than
95% of any “Para-God” out there. I used to honestly believe I was the
greatest thing to happen to EMS since Johnny Gage and Roy DeSoto. I was a
genius and all you had to do was ask me. I’d tell you how badass I was.
I’d give you the contraindications for a traction split while doing a
keg stand. You could wake me up from a dead slumber and I’d rattle off
how many CCs of air the blue balloon took to be fully inflated on a
Combi-Tube. Need a pro Bag-Valve-Masker? I was your man. I was the
master of all that was the BLS Craft. Life was so much simpler back in
Then came working in an Emergency Room for 2 ½ years. At the same
time I was working for a private ambulance on a 911 ALS truck. Then,
ultimately, it came time for me to go to Paramedic School.
After about 2 days working in the ER, 2 weeks of working on an ALS
911 truck, and 2 months upon entering Medic School I had 3 minor
epiphanies that equaled one coherent though:
“What I don’t know is not only dangerous, it’s nearly criminal.”
It was the perfect storm.
It was like I was Jake Blues screaming “YES! YES! JESUS H. TAP-DANCING CHRIST… I HAVE SEEN THE LIGHT!”
But, it turns out; I’d only recognized there was a problem. Not a solution. Yet.
To be blunt; I didn’t know D.I.C.K.
Differential Diagnosis: I’d never
even heard of this until I entered Paramedic School. Hell, the only
thing I’d ever heard was “We don’t diagnose in the field.” And I
believed that. Thus, a systematic approach of figuring out what was the
matter with my patients never occurred to me. Sure I’d been taught to
get a SAMPLE history, but no one ever explained how to formulate a plan
of how to use said information.
Intravenous Access: Although I knew Medics could
start IVs, I had little idea of why they could do it. And I was mostly
unaware of the fact that ability to start an IV was not a treatment. It
was a means to an end. The act of starting an IV itself has never once
saved a person. All I knew was that it was damned cool and I wanted to
be able to do it. Many people want to be paramedics solely to “do cool
stuff like IVs and intubate.” And likely half of them couldn’t tell you
why they want to do those things.
Cardiology: I knew two things about the heart to be
true: If there is no pulse start CPR. If there is an AED available get
the patient naked and slap that puppy on. I was clueless as to the “Why”
and “How” of AEDs. Sure I picked up little pieces of the puzzle here
and there, but no one sat me down and explained V. Fib or V. Tach to me
in EMT class.
Ketoacidosis, Kalemia, Kussmal, K
(Potassium): Some of these words I’d heard of, some I had not.
Sometimes I just pretended to know what they meant so I didn’t appear
stupid. Regardless, I was not prepared to describe, in great detail, any
of the things above. In all honesty the only thing I knew about K
(Potassium) was that there was a cereal I liked called “Special K.” And
even at that, I still wasn’t sure if I was eating flakes of Potassium or
just some corn flakes with really awesome marketing by the Kelloggs
The solution to problem zero seems relatively easy:
Make the class harder, to better prep EMT-Basic’s for Paramedic School.
• Teach Differential Diagnosis early. Let’s stop pretending that our
students will remain EMT-Basics for the rest of their lives.
• Increase time spent on Anatomy and Physiology.
• Introduce Pharmacology earlier and more extensively (For starters,
focus on the drugs these EMTs will end up handing their Paramedic
• Teach them basic cardiac rhythms so they don’t feel overwhelmed later
on in life. Or, at minimum, explain the concept of a P, a QRS and T
• Give an intro to medical terminology (Or at the very least commonly seen EMS terms)
• Add more required Ambulance ride time and more ER clinical time.
• And lastly, institute an entrance exam to weed out the people you
don’t want in the back of an ambulance taking care of your loved one.
Why don’t we stop pandering to the lowest common denominator? Just
because you’re capable of passing a state mandated test does not prove
you are ready to hop in the back of an ambulance.
To rectify this problem would be to kill a large sub-section of EMS,
since many people are fine with staying Basics (especially in more
rural/volunteer areas). The EMT-Basic may not be the backbone of EMS in
the United States, but they most certainly are the legs. Sadly, making
the course harder would eventually just be a case of shooting ourselves
in the foot. I don’t have a perfect solution, but doing just a couple of
these things could certainly help. EOR. – MW
*Problem 0 due to it being a problem before you even get started in your EMS career.
** Side note: The first thing I tell anyone interested in going to
Paramedic School is to enroll in a medical terminology class at their
local community college.