Archive for the Guest Posts Category

Guest Post: Flaws in EMS Education

Posted in EMS, Guest Posts on December 1, 2010 by medic61
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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!

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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 those days.

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 Corporation.**

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 partners)
• 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 waves.
• 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.