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Basic Before You Move To ALS?
I was wondering if you have to be a basic EMT before you move up to ALS if it was strictly on your own time Ex.) Volunteer?
Replies to This Discussion
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Permalink Reply by B.J. Jones on -
ABSOLUTELY! In my humble opinion - one should also get at least 2 years truck experience BEFORE starting Paramedic (ALS) school. There is no greater teacher than actual experience.
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Permalink Reply by Neil White on -
I can't comment on the US system of doing things, but the way I look at it an ambulance is an ambulance is an ambulance...
attempting ALS before BLS, its like running before you can walk, swim or fish...which ever takes your fancy. Gaining confidence/experience in the basic skills allows for an underpinning knowledge before applying advanced skills. for example its all very well knowing how to intubate but if you can't change a portable oxygen cylinder when it runs out you're in trouble fast. As we see from many BASICS or physician responders that are effectively very skilled in a hospital setting but in a responder role become very quickly out of their depth, attempting things that should be left until arrival at the ER.
Coming from a personal experience, My training consisted of 3 years at University, I'd never been in any caring role in the past....was a travel agent. The first year was a full time practical and theory do at the university with occasional placements in the field. The second and third years we were employed by the sponsoring service part time as EMT's putting the basic skills into practice whilst returning to uni for paramedic and advanced skills, undertaking clinical placements in hospital in-between. It was the working portion where most of the knowledge was actually learned. I'm sure everyone says this but in the classroom they teach how to longboard someone who is lying perfectly flat on nice soft carpet being very cooperative and it is on the road experience that teaches how to do it when the patient is drunk hanging upside down from his newly flattened sports car.
I look now against other colleagues who graduated from different institutions where the basic practice wasn't included and the spark is not there...By all means don't get me wrong they have the smarts to decide what is going on and what to do but there is no flow...they're always thinking about what's coming next. Where as 2 experience basic trained staff now paramedics can anticipate the comings next for example getting the chair or the stretcher when the colleague wants it without having asked for it.
Basically the experienced gained of coming to grips with the medical stuff, equipment communicating with patients ect without the burden of the additional skills, drugs and responsibility is as mastercard always says priceless...
Hope that helps?
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Permalink Reply by Joe P. on -
In general, you have to "have" a basic certification to go to paramedic school. Now I put "have" in quotes for a few reasons.
First, there are paramedic programs, colloquially called "zero to hero programs" where the first bit of time is essentially a basic course. So by the time students enter into the 'paramedic' portion of the program, they are certified as a basic.
Second, there are programs that require you to have a basic certification, but do not require any time spent working as a basic prior to entry.
Third, there are programs that not only require applicants to have a basic certification, but also require some time (either in terms of months/years or hours worked) as a basic (environment worked (911 vs any ambulance vs any place that uses an EMT-B cert such as emergency rooms) prior to enrollment.
Does this answer your question or were you looking for a more academic discussion on the merits of requiring students to be an EMT-B before they start taking EMT-P courses?
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Permalink Reply by Joe P. on
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For the people who want paramedics to have experience working as basics first, why do medical schools not require applicants to work as PAs first? Why don't a lot of PA schools require their students to work in health care? Why don't RN schools require work as a CNA or LVN first? Why don't RT schools require prior health care work first?
To me, the only two reasons why this aberration in health care education exists is because too many paramedic schools suck and use EMT-B training as a crutch or band aid or require it because of tradition.
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Permalink Reply by Royce Terry on -
Well it pretty much put it in place.
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Permalink Reply by Royce Terry on
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Well all of you pretty much hit the nail on the head. Great advice thanks guys.
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Permalink Reply by Neil White on
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I would suggest its all about the environment of working, Because the paramedic is effectively an autonomous practitioner. Okay he has his crew mate, who in fairness may be of lower qualification, its not like working in a controlled setting such as a hospital where you can turn to a senior colleague or call in a crash team when the brown stuff hits the whirly thing.
You can't say "hold fire on having your MI, mate while we fathom out how to inflate the reservoir bag on a non rebreather mask"
In other healthcare disciplines, such as nursing and medicine the supervision given to students is strong as professions students have been part of it since creation.
In paramedics, the majority of guys started of as basics and climbed the ladder, it is only recently that we see direct entrance university programmes, quick fix short cuts and very soon here distance and e learning paramedicine training. The basic training for tradition was instilled from day one, the universities are very much addressing the science but not the day to day ambulance skills. They rely on field placements and paramedic mentors to take care of this mainly because of equipment/technical difficulties (not being able to have front line ambulances to play with readily. The paramedic mentors, mostly if not all are tradition trained paramedics and expect the university to have taken care of the basic skills. Its the proverbial catch 22.
I would say that in most programmes the interview processes are very robust in selecting students who have the interpersonal skills necessary to adapt to a caring role. I'm not advocating that you are not allowed to apply for paramedic without having been an EMT for 100 years. I am advocating that choosing a programme that incorporates the basic training/experience is the wisest decision to make. Not only do you notice it in the way you practice but also in the respect afforded to you by colleagues
Joe P. said:For the people who want paramedics to have experience working as basics first, why do medical schools not require applicants to work as PAs first? Why don't a lot of PA schools require their students to work in health care? Why don't RN schools require work as a CNA or LVN first? Why don't RT schools require prior health care work first?
To me, the only two reasons why this aberration in health care education exists is because too many paramedic schools suck and use EMT-B training as a crutch or band aid or require it because of tradition.
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Permalink Reply by Joe P. on
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Neil White said:
You mean if you take someone and put in an environment that they aren't trained for, that they tend to make mistakes? Now, I'm all for physicians with additional training on issues related to field work responding to some scene calls. However, with out the additional training, I would expect it to work out about as well as putting a paramedic with just paramedic training in the emergency room and in charge of multiple patients for any significant amount of time.physician responders that are effectively very skilled in a hospital setting but in a responder role become very quickly out of their depth, attempting things that should be left until arrival at the ER.
Coming from a personal experience, My training consisted of 3 years at University, I'd never been in any caring role in the past....was a travel agent. The first year was a full time practical and theory do at the university with occasional placements in the field. The second and third years we were employed by the sponsoring service part time as EMT's putting the basic skills into practice whilst returning to uni for paramedic and advanced skills, undertaking clinical placements in hospital in-between. It was the working portion where most of the knowledge was actually learned. I'm sure everyone says this but in the classroom they teach how to longboard someone who is lying perfectly flat on nice soft carpet being very cooperative and it is on the road experience that teaches how to do it when the patient is drunk hanging upside down from his newly flattened sports car.
So your program didn't require any experience working as a basic prior to enrolling into the paramedic program? Having an appropriate amount of clinicals, including clinicals that focus on "BLS" care (note: there is no such thing as "BLS" level care or "ALS" level care. It's just patient care) hardly analogous to requiring work and experience as a basic prior to applying for a program.
Basically the experienced gained of coming to grips with the medical stuff, equipment communicating with patients ect without the burden of the additional skills, drugs and responsibility is as mastercard always says priceless...
So essentially you're advocating sensible education, not additional prereqs. I'll use my current school as an example of what I mean that ties into what you're talking about. Starting during the first semester of the first year of school (OMS1*) we start seeing standardized patients (SP) in Essentials of Clinical Medicine. Now the SP experiences are designed and structured to get us use to communicating with patients as well as conducting a history and physical. For example, our first experience (and the only group experience to date) was 5 minute rapport building drills where we had to come in, introduce ourselves, and build a connection with our SP while the SPs portrayed different emotional states (the SPs rotated after each 5 minute session). For example, one older female SP was in absolute shambles and tears because 'her husband of 30 years left her for another man.' Others were more normal patients. Some were downright hostile or frustrated. A separate female SP portrayed a naively innocent 20 something who was concerned that using a tampon would affect her virginity. The point to take home was that the school wasn't expecting us to be able to show perfect compassion ("showing" and "having" are two different verbs) and communication skills prior to enrollment. They expected and planned to teach us those communication skills. Just like they aren't expecting us to be able to take a history and physical prior to enrollment either.
*OMS1=Osteopathic Medical School (student), year 1
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Permalink Reply by Joe P. on
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Neil White said:
...but not all physicians are working in environments where they are surrounded by other physicians. A rural ER might only have single physician coverage. Similarly, a primary care physician working in a private practice might have to hold the line while waiting for an EMS crew to respond when a patient walks in with an emergency (and we all know how EMS crews love to moan about fluster clucks in at doctor's offices). Prehospital care isn't the only field in health care that operates without an immediate safety net. Additionally, I do agree that paramedics operate essentially autonomous. For that very reason, they should be highly educated and glaring errors in education and training programs, like the lack of clinical and patient experiences, should be fixed by more than a band aid.I would suggest its all about the environment of working, Because the paramedic is effectively an autonomous practitioner. Okay he has his crew mate, who in fairness may be of lower qualification, its not like working in a controlled setting such as a hospital where you can turn to a senior colleague or call in a crash team when the brown stuff hits the whirly thing.
You can't say "hold fire on having your MI, mate while we fathom out how to inflate the reservoir bag on a non rebreather mask"
...but that's not how it's done on TRAUMA! (sorry, couldn't avoid the double reference on this one).In other healthcare disciplines, such as nursing and medicine the supervision given to students is strong as professions students have been part of it since creation.
...but again, it's the fault of programs not adequately developing their resources to provide meaningful education experiences. Paramedic programs should have relationships built up with local ambulance services and hospitals so that their students have these experiences. Not all medical schools own their own hospitals to play with, but they still find hospitals to place their students for meaningful clerkship experiences. Similarly, there are ways to simulate a lot of patient care (the aforementioned standardized patients) or patient care environments without waiting for official clinicals to start. Clinical locations shouldn't just be someplace that students go in the eyes of the program. The clinical locations should be education partners with the program.
In paramedics, the majority of guys started of as basics and climbed the ladder, it is only recently that we see direct entrance university programmes, quick fix short cuts and very soon here distance and e learning paramedicine training. The basic training for tradition was instilled from day one, the universities are very much addressing the science but not the day to day ambulance skills. They rely on field placements and paramedic mentors to take care of this mainly because of equipment/technical difficulties (not being able to have front line ambulances to play with readily. The paramedic mentors, mostly if not all are tradition trained paramedics and expect the university to have taken care of the basic skills. Its the proverbial catch 22.
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Permalink Reply by dr-exmedic on -
Side thought: aren't there still a couple of states left where there is indeed a regulatory mandate for some EMT experience before going to paramedic school? Individual schools may have their own mandates.
Thank you, Joe P, for already taking care of the notion that not every physician gets to call in backup when bad stuff happens--there are plenty of "controlled environments" where that ED doc is working as autonomously as the medic (and maybe more so, seeing as how if the medic doesn't know what else to do, there's always the diesel bolus to deposit said pt into that ED doc's lap). The other difference is that caring for multiple pts at once is the norm in the ED, but not in the field.
The biggest problem with extensive EMT experience before paramedic school is all the bad habits people have to unlearn. Skipping EMT class would make that less of a problem (although the current course structure really only allows you to go straight from one to the other instead of skipping, which is very nearly as good). I feel that most current requirements for experience are a vain attempt to remedy deficiencies in the paramedic curriculum.
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Permalink Reply by Neil White on
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I didn't realise that in depth analysis of each post takes place, i was expecting interactive graphics a special logo, some kind of theme music and panel of people for and against. Then there's part of me that says at least the quote feature is working well.
Of course if you remove part of the sentence structure in order to make it fit your point then it works well too...In the UK it is not mandatory to undertake any familiarisation training before taking on the role as a physician responder so my point about knowing basic ambulance skills was not directed at people making mistakes or paramedics being invincible just an example of how a lack of experience with basic skills can make for a difficult situation.
I don't feel it relevant to justify the who's why's and wherefore's of clinical experience before becoming a paramedic. Is it right to set a total, i don't think so....But in my programme, we had 1500 hours of field placements mentored by a paramedic covering BLS and ALS skills, 2500 hours of employed practice as an EMT plus 750 hours of hospital placements A&E, CCU, ICU, Paeds, Maternity, Primary Care.
The initial question asked whether experience at basic level was required before moving to ALS and I answered you do. How that experience is gained either through working as an EMT or as part of a programme is neither here nor there. I do however feel that this notion that there isn't 2 levels of care is false, because thats not true at all. A patient complaining of chest pain, which on investigation appears of cardiac nature will receive a very different assessment and management protocol depending on which EMS provider walks through the door.
You can't expect universities that provide training to 20 or 30 clinicians to fund a front line ambulance in a profit making environment is not possible nor is it easy to remove a front line ambulance from service in order to undertake training (We don't have a lot of spare vehicles floating around here) So at times, it is only the realistic option to allow the clinical practicals to achieve these basic care skills.
I am advocating sensible education and i'm sure that was a sentence i already typed earlier guessed that missed the quote cut...I agree that the schools are not looking for experienced communicators prior to enrolment but look for those that have the promise that will respond well to training and be able to work as a team to promote good learning.
However it works, its always going to come with the retention of bad habits, i find it difficult to think of a way around that?
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Permalink Reply by Joe P. on
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Neil White said:I didn't realise that in depth analysis of each post takes place, i was expecting interactive graphics a special logo, some kind of theme music and panel of people for and against. Then there's part of me that says at least the quote feature is working well.
LOL. Sorry. I tend to enjoy online message boards a little too much. That said, the program that JEMS Connect is using for their forum is painfully bad with how formatting codes are used. Feel free to dissect my posts.
Of course if you remove part of the sentence structure in order to make it fit your point then it works well too...In the UK it is not mandatory to undertake any familiarisation training before taking on the role as a physician responder so my point about knowing basic ambulance skills was not directed at people making mistakes or paramedics being invincible just an example of how a lack of experience with basic skills can make for a difficult situation.
Sorry. It wasn't my intent to edit it to fit my own needs. I just see that EMT-B training and emergency physician training as targeting different fields. An EMT-B who is having issues with scene management in the field is a training issue that could very likely be due to poor initial education/training. An emergency physician having similar scene management issues is completely different since emergency medicine training (at least in the US) is focused primarily on the hospital environment. Sure, there might be a handful of ride alongs during residency, but any physician completing residency nowadays with a serious interest in EMS should trying to land an EMS fellowship. Similarly, I wasn't trying to blast you and make it seem like you were degrading physicians. It's just important to note that the training is difference, in part, due to the environment that each profession (paramedic and physician) is geared for. Hence why I tried to clarify with a similar situation with throwing a paramedic into an emergency room where the paramedic is expected to care for multiple patients for an extended period of time. It's not that a paramedic who can't meet that expectation is bad, it's just that isn't what paramedic training and education is geared towards.
The initial question asked whether experience at basic level was required before moving to ALS and I answered you do. How that experience is gained either through working as an EMT or as part of a programme is neither here nor there. I do however feel that this notion that there isn't 2 levels of care is false, because thats not true at all. A patient complaining of chest pain, which on investigation appears of cardiac nature will receive a very different assessment and management protocol depending on which EMS provider walks through the door.
To me, it is very pertinent whether the education is expected prior to starting school or during school for several reasons. First off, if the paramedic program is teaching the "BLS skills," then they can monitor the quality of the instruction and implementation. Second, it continues the artificial divide of "BLS" and "ALS" level interventions. To me, a paramedic who is failing to ensure that the patient is properly oxygenated during an intubation is not failing the "BLS" skill of using a BVM. The paramedic is failing the skill of intubation in addition to failing at patient care. Similarly, a paramedic who is focusing on "ALS" interventions to the detriment of "BLS" intervnetions isn't failing to "put BLS before ALS," S/he is failing at basic patient care. I seriously wonder how much of this BLS/ALS nonsense would go away if interventions were taught as just patient care and not in terms of levels.
You can't expect universities that provide training to 20 or 30 clinicians to fund a front line ambulance in a profit making environment is not possible nor is it easy to remove a front line ambulance from service in order to undertake training (We don't have a lot of spare vehicles floating around here) So at times, it is only the realistic option to allow the clinical practicals to achieve these basic care skills.
As far as the level of assessment, the basics of the assessment should still largely be the same. The depth might be different (especially when it comes to the use of diagnostic tools such as ECGs), but both should still be looking for similar signs, doing a history and review of systems using similar questions, doing a similar assessment. To say that because an EMT-B and an EMT-P do a different assessment, therefore there is BLS and ALS would be like calling a nurse BLS and a physician ALS since the depth of the assessments and the interventions provided are going to be different.
Additionally, who is saying that the program has to run their own ambulances? Even at medical schools that own their own hospital, they still maintain clinical sites at other hospitals and practices that they don't own. It is possible to use resources that aren't owned by the school.
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