Things "not taught" or "not taught adequately" in paramedic schools

At a conference recently I spoke with a group about things (knowledge, skills, abilities, attributes) needed by EMS providers but either not typically taught, or not adequately taught in paramedic schools (or EMT, or whathaveyou).  What do you think?  Are these accurate?  Are there others?



1.       Wellness/fitness (not just lecture, but active; PT etc.) - there is nothing in the typical paramedic program to develop an adequate level of fitness to perform essential job tasks.  "PT" is typically not part of the program (as it is in most fire and police training programs).

2.      Personal defensive tactics, situational awareness - most programs don't train their students how to respond if attacked, or how to recognize and avoid dangerous situations.

3.      Diffusing/negotiating skills - ties to above, but is actually much larger.  Managing a rowdy crowd without help.  "Verbal judo" skills and whathaveyou.

4.      Grief management (post-code, etc.) - are EMS people adequately trained to deal with families, particularly as we pronounce more and more people in the field.  I'd expand this even further - how well are we equipped, mentally, physically, and equipment-wise, to deal with the wide spectrum of mental illness?

5.      Driving/vehicle management - this seems to be taking a powder in many EMT and paramedic schools, being "left to the employer."  Same with "patient handling" such as stair chair, stretcher, bariatrics, etc.  Funny how the two things we don on every call (driving and patient handling) seem to be low priority.....

6.      Patient care during access and extrication (working in hazardous environments).  Do we teach our new EMTs and medics how to safely operate in the "rescue" environments?  Can they provide patient care while the patient is being removed from a crumbled auto, while stuck in a confined space, etc.?  Last week seven fire-EMS folk were overcome by CO when they kept walking in to a scene - do we lack sufficient awareness?


There's got to be more --- chime in please!

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I wonder if the driving and vehicle management is left because of the sheer volume of differing equipment that each service has... Newer vehicles will have newer models of carry chair ect.. whilst the principles are the same. We couldn't expect an education provider to house all the models on the market...

I know this has been discussed before but Law, Ethics and dare I say Professionalism is something that is not well underpinned as it should.

Areas of team leadership and supervision of junior colleagues was certainly not covered on our minute your a student the next your in charge of 4 EMT's at a road traffic incident, responsible for patient care and liasion with other agencies....Not just general team leadership skills but also one to one supervision, coaching if you like...
Thanks, Neil.

Add to the list:

7. Law, ethics, professionalism (more than the cursory single lecture that is given now).

8. Incident management and command (functional capabilities). Team leadership experience.

And I'll throw in a couple of more:

9. The economics and finance of EMS.

10. History, culture, and traditions of EMS.

11. Poltiics and culture of EMS.
Research methods and technical writing. Paramedic students should critically analyze studies and write papers about them.
Having thought about this some more. I wonder if there is any room for diversity...

How the paramedic responds to and troubleshoots cultural differences, religious, society, language ect... Committing a faux par sets the tone for the rest of the job...

Whilst on some occasions its an emergency and things just need to happen but I always enjoy reading Thom Dick's article in jems and how the little things such as a your welcome after a thank you makes such a big difference...
What a great (or maybe accurate is a better work, its not great that we aren't teaching these) list! I don't have anything to add right now but will think about it some more.

Keep up the good work!
I like your list. I just want to point out that there are a many many things that need to be included that arent. The problem is that it would make a Paramedic program much longer and not many people who have power want that!
Something like this? I think most parts of Canada do EMS better than most parts of the US.
Patient handling, lifting, and moving in a variety of real-world situations...including stairs, vehicles, single-wide trailer bedrooms, small front stoops, and the dreaded couch-to-cot move.
I very, very, very strongly agree with this.

Robert Sullivan said:
Research methods and technical writing. Paramedic students should critically analyze studies and write papers about them.
Basic research, maybe, but entry-level clinical education and things related to the core provision of EMS services are more important. Research is important, but street medics aren't generally the people doing it.

Justin Sleffel said:
I very, very, very strongly agree with this.

Robert Sullivan said:
Research methods and technical writing. Paramedic students should critically analyze studies and write papers about them.
Skip, I generally like your list, and most of the suggestions under it. Some of the things, I feel, (working in hazardous environments, e.g.) are really refinements of the basics, and would be best done after the basics, i.e. after paramedic school. But that's just me.

I would also add that very, very few schools teach you anything about calls other than emergencies--leaving out (depending on where you work) 30-70%+ of your call volume, and also totally leaving out any mention of non-911-ambulance roles for medics. I didn't know a thing about medical transportation until my first job for Transcare, and the skills and knowledge (and mindset, even) for that sort of job are totally different from what you need on an emergency ambulance vs being an ED paramedic.
The discussion before this discussion (that set me down this path) was a group musing about how people could graduate paramedic school, get licensed, get a job, and never have seen or heard about the following:

nursing home
homeless person
chronic inebriate
foley bag

I fear that there is a lot more......


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