However what sort of experience leading to clinical judgment can really be gained by a provider who has essentially zero education in the scientific foundation of medicine and where the stock answer to almost any medical scenario is "non-rebreather, request paramedics, emergency transport." I might be able to get on board with the concept of a paramedic being an advanced provider (in the sense of a critical care paramedic being an advanced paramedic) where experience is a good thing if foundational education was required for EMTs, but it's not. It should take longer to go from lay provider to EMT than EMT to paramedic, but since the EMT education is watered down to "do this, this, this, and this, and if it requires any sort of judgment, pick the most drastic option first (e.g. the only "indication" for nasal cannula being the patient won't tolerate a NRB mask)," it doesn't require any actual critical thinking. This is, of course, ignoring that the education is watered down to what's pertinent in a 10-30 minute time frame. Don't believe me? Ask an EMT about reactive oxygen species (because oxygen is, contrary to EMT education, not harmless).This is something we should absolutely NOT be telling our students! I remember when I started that National Registry made us have six months street experience just to be able to sign REMT-A after our name. There was a reason for that. There is a reason that we should not put a kid right through school from EMT-B to EMT-P. It is called experience leading to better clinical judgement.
I just saw the post by Joe P. If there are any good PA schools taking students without prior health care experience of some sort I am not aware of them, nor are any of the many PAs that I work with in our training system. We just happened to have had this discussion last week.
We have PAs in our training system from CA, IL, NY, PA, WA, WI, and I think a few other places. We have PAs in our sub regional clinics, and at our hospital from a number of other states too.
Here's my question about this. Considering that the environment paramedics is about as close to independent practice as possible (after all, how often do providers have their medical director on scene, especially in areas that do not mandate base hospital contact?), why do we seem content with knowing that the clinical experience and scientific foundation is severely limited? I'll also put forth that, while, EMT experience can help with the clinical aspect (more supervised clinical time during paramedic school would also help. Also EMT experience can lead to developing bad habits), EMT experience does absolutely nothing at curing the issue about scientific foundation.PAs and RNs both have significant clinical rotational periods that are required for their licensure. MDs and DOs both have a 2 year rotational requirement for licensure and a minimum 4 (3 for pathology but 5 for surgery and more if specializing i.e. trauma surgery) year residency for any hospital to allow privileges. All of these professions also have a standard basic sciences: anatomy, physiology, pathology, biochem and clinical reasoning components...
Meanwhile Paramedics do not have significant basic science prerequisites for paramedic licensure. Additionally, after 200 hours of clinical hospital time and 480-720 hours of field experience, a paramedic can qualify to take the licensing exam from the NREMT.
My only concern was and is, should we as instructors be advising EMT-B students to go directly into EMT-Paramedic programs without any field experience?
Shouldn't EMT-B experience provide a buffer for the lack of substantial clinical time? What about providing the EMT-B student the opportunity to actually experience the job before they invest another year of time and money in a paramedic class? My fear is that economics are driving this decision to recommend these students to paramedic promotion prematurely.
Asked a different way, does working as an EMT-B provide no benefit prior to initiating paramedic study?
I think you should have to do some hours of hands on to gain experience of patient management before proceeding to the next level of care.