EMS ride along or extra shift?

[tdod]

I have my first EM rotation coming up and we have an optional EMS ride along. Not sure what to expect, and I'm wondering if I should sign up for it or if my time would be better spent volunteering for an extra shift in the ED. I'm worried that the ride-along would consist of lots of waiting, and, when something does happen, having no involvement other than observation. Moreover, I imagine that if the ride-along experience is really valuable then I will have to do it during residency anyways.

Thoughts?

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[Stephanopolous]

My biased opinion (former medic) is to do the ems shift. I feel that a lot of em physicians don’t have a full understanding of what their pre hospital teammates see and experience in the field. You may see some crazy things. You may not. Treat it as a chance to learn something new and potentially make friends with the medics and emts that you’ll see later in the ED or maybe later in residency.


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[Apollyon]

So, I am an EP, and, a paramedic, formerly a street medic. Honestly, like every single other thing, ever, it depends. Is it in an urban area? Is it a paid or municipal service? Will you be on an ALS unit? If you are in a city, on an ALS bus, you're going to see action. However, a lot of it will still, likely, be quotidian. Chest pain, SOB (asthma vs COPD vs CHF), occasional MVCs, less other trauma, and violent psychs, but, as ALS, you won't get a lot of the BS, BLS stuff, like lacerations, back pain, cough, itch, general malaise, "I need a ride, and you gotta take me".

It will either be thrilling, or, you will say, "What a dud!".

 

[RustedFox]

So, I am an EP, and, a paramedic, formerly a street medic. Honestly, like every single other thing, ever, it depends. Is it in an urban area? Is it a paid or municipal service? Will you be on an ALS unit? If you are in a city, on an ALS bus, you're going to see action. However, a lot of it will still, likely, be quotidian. Chest pain, SOB (asthma vs COPD vs CHF), occasional MVCs, less other trauma, and violent psychs, but, as ALS, you won't get a lot of the BS, BLS stuff, like lacerations, back pain, cough, itch, general malaise, "I need a ride, and you gotta take me".

It will either be thrilling, or, you will say, "What a dud!".

Dude.
We know each other, and we're cool.
I mean absolutely zero animosity when I ask this, but "what's a street medic?"

I have zero EMS experience. Was never "me" prior to getting into EM.

Don't take this the wrong way.

 

[Apollyon]

Dude.
We know each other, and we're cool.
I mean absolutely zero animosity when I ask this, but "what's a street medic?"

I have zero EMS experience. Was never "me" prior to getting into EM.

Don't take this the wrong way.

I meant, in the past, I was working on the bus, regular working guy, whereas, now, I have my EMT-P card, but I'm not working on the ambulance. "Street medic" isn't bravado - it's akin to "pit doc". Absolute parallel.

 

[RustedFox]

I meant, in the past, I was working on the bus, regular working guy, whereas, now, I have my EMT-P card, but I'm not working on the ambulance. "Street medic" isn't bravado - it's akin to "pit doc". Absolute parallel.

So, you can work on the ambulances, but not be an EMT?
Again; asking out of ignorance.

 

[Cryc_to_the_point]

So, you can work on the ambulances, but not be an EMT?
Again; asking out of ignorance.

Paramedics technically aren't EMTs, but less pedantically many paramedics (and some EMTs) work in the ER or as techs elsewhere away from EMS. One is going to have to be some sort of EMT/Paramedic in most EMS systems. The exceptions are RNs and physicians working on specialized units.

 

[Apollyon]

So, you can work on the ambulances, but not be an EMT?
Again; asking out of ignorance.

You can, but that's a rather inefficient way to do it. If one is not certified, they can only drive the unit, or clean it, but not do any of the job specific parts of it (the back of the ambulance, where the action is). Most they could do is put on direct pressure, or do CPR (under direction of the EMT, as a prudent layperson).

Likewise, in fire departments that are fat with cash, there can be a firefighter driving, with two EMTs, Paramedics, or combination, doing all the patient care.

In NY, for example, there are, actually, 5 levels of EMS cert in NY (but one is sunsetting). When I started, in 1992, there was EMT, EMT-Intermediate, EMT-Critical Care, and EMT-Paramedic. Then, they transitioned the EMTs to EMT-Ds, and, later, added the "CFR" - "Certified First Responder". Now, the "Critical Care" is being sunset out (it's like a stripped down paramedic, and only existed in NY).

The advantage of an all paramedic system is that the EMT-P can take any call, including the BLS calls, whereas, the EMT can only take BLS calls. "All New Yorkers are American, but not all Americans are New Yorkers."

So, yes, you can work on the bus without being certified (CFR or EMT), but that is quite economically inefficient.

 

[Apollyon]

Paramedics technically aren't EMTs, but less pedantically many paramedics (and some EMTs) work in the ER or as techs elsewhere away from EMS. One is going to have to be some sort of EMT/Paramedic in most EMS systems. The exceptions are RNs and physicians working on specialized units.

Where are paramedics not EMTs? Again, from my state, my cert and recert exams have a BLS and an ALS score. And, where can you get paramedic without being a prior EMT? Please clarify!

 

[Porfirio]

Flip a coin - let fate decide. It does not matter either way.

 

[Apollyon]

Flip a coin - let fate decide. It does not matter either way.

Well, it's a little unbalanced - if the OP chooses EM, they'll be in the ED forever, just like the extra shift. The chance to ride the bus might be a once or twice in a career thing. And, hey the OP might be motivated into doing an EMS fellowship!

 

[MediMike]

Where are paramedics not EMTs? Again, from my state, my cert and recert exams have a BLS and an ALS score. And, where can you get paramedic without being a prior EMT? Please clarify!

I'm guessing they were referencing the fact that the National Registry phases out the EMT-P title in exchange for NRP (Nat Reg Paramedic) back in 2013.

Transition Policy +

The NREMT Board of Directors is committed to implementation of the EMS Education Agenda for the Future: A Systems Approach.

www.nremt.org

And unfortunately more programs are going away from requiring field experience as an EMT prior to paramedic schooling, although you are correct in that the EMT cert must be obtained first.

 

[Apollyon]

I haven't thought about it, but, I wonder what the "Neonatal Resuscitation Program" (NRP) of the AAP thinks about that?

 

[MediMike]

It's funny how few people equate the neonatal resuscitation program with "NRP", if I refer to it as an acronym they are always confused, once it's explained they go "Oh! Nurp! I've taken the nurp class"

 

[24GaugeEJ]

Agree with all of the above. I was a street medic and also worked in the ED where I essentially functioned as an additional nurse (except more doing and less charting). More physicians should be aware of what goes on in the prehospital setting. It might give you a more complete perspective on continuity of care, the living conditions and struggles of a large percentage of your future patient population, and a unique view of exactly how “real” things can get outside of the hospital setting. I am currently a student like yourself, but helped out on many units at different points in time while I was a medic - the prehospital setting is to the ED what the ED is to the rest of the hospital in terms of potential for wackiness. At least if you end up on a busier truck. I say take the experience, you might not have a similar opportunity in the future.

 

[24GaugeEJ]

As far as the EMT/medic thing...when most people say EMT they are referring to The EMT-Basic level of training, which is most similar to a certified nursing assistant if you’re looking for a hospital analogy. Paramedics require more rigorous, lengthy training, and typically must have been an EMT-Basic, first. Paramedics are closer to ED nurses than anything else. A lot of protocol driven treatment and quick, quasi-diagnosis in the field. Typically start IVs, intubate, give certain medications, etc. This is a bit of an oversimplification, but you probably get the gist.

 

[deleted859535]

I have my first EM rotation coming up and we have an optional EMS ride along. Not sure what to expect, and I'm wondering if I should sign up for it or if my time would be better spent volunteering for an extra shift in the ED. I'm worried that the ride-along would consist of lots of waiting, and, when something does happen, having no involvement other than observation. Moreover, I imagine that if the ride-along experience is really valuable then I will have to do it during residency anyways.

Thoughts?

Big picture: won't matter. May as well just do it. Might get some neat experience(s), might not. Your EMS exposure or lack thereof will vary somewhat depending on residency.

 

[deleted109597]

Ask other people who have done the rotation. Did they all ride along? If yes, then you probably should too. If not, then don't.
Don't volunteer for another shift. Please. Do the required amount, and don't have the appearance of trying too hard. It doesn't work well in our field.

 

[carbonizedeyesockets]

Do the ride along. It may be fairly boring. But even so, you need to have an idea of the environment EMS functions in and how it may affect care. Few jobs where you won't have to ever provide online medical command or otherwise interact with EMS. I've only been practicing EM for 6 years, but was a paramedic for 9. To this day, some of the wildest stuff I've ever seen or done was as a paramedic. Some of the best stories I have are from those 9 years. And to this day, there are some doctors whose necks I'd still like to wring because of their crappy orders over the phone and complete lack of appreciation of the constraints, dangers, etc. that EMS faces.

 

[cyanide12345678]

Do the ride along, you will do plenty of ER shifts otherwise through residency.

 

[Tenk]

A single ride along is a great way to see all the complete BS medics have to deal with outside the ED. Puts a lot into perspective.

 

[Cryc_to_the_point]

Where are paramedics not EMTs? Again, from my state, my cert and recert exams have a BLS and an ALS score. And, where can you get paramedic without being a prior EMT? Please clarify!

Most states actually. I didn't say you didn't have to become an EMT first, but Paramedics are not a form of EMT. Nationally Registered Paramedic, not Nationally Registered EMT-Paramedic. That's been the case now for years.

 

[Apollyon]

Most states actually. I didn't say you didn't have to become an EMT first, but Paramedics are not a form of EMT. Nationally Registered Paramedic, not Nationally Registered EMT-Paramedic. That's been the case now for years.

I don't want to belabor this, but, what you say sounds like you're "in the weeds" a bit. I went to the NREMT site, and, from what I can see, if one become NRP, I don't see that one has t to maintain their state cert. But, it's right on the gold patch - NREMT, and, just below that, paramedic. So, at least, you are muddling things. And, BLS is a rock solid part of ALS. So, I don't get your point, especially because the same agency that certifies NRPs also certifies NREMTs.

 

[southerndoc]

Varies by state for requirements. In Georgia, you must be certified to staff an ambulance. So you can't just have a driver, but some states may allow it. Not familiar with all state laws. Georgia requires you to at least be an EMT-B to staff an ambulance.

"Street medic" is an ambulance paramedic. Paramedics also work on movie sets (union requirement), industrial places, oil rigs, etc.

To the OP, I would highly recommend a ridealong. So many of EP's don't understand what it's like in an ambulance. One person in the back instead of 6 security guards holding down a combative patient -- if the doc was alone with a combative patient, they'd be more favorable giving ketamine. Likewise, not everything is a perfect condition. Intubating in the floor, pulling people out of a car with bilateral femur fractures... there are things that go on in the field that many EP's don't appreciate.

 

[carbonizedeyesockets]

Varies by state for requirements. In Georgia, you must be certified to staff an ambulance. So you can't just have a driver, but some states may allow it. Not familiar with all state laws. Georgia requires you to at least be an EMT-B to staff an ambulance.

"Street medic" is an ambulance paramedic. Paramedics also work on movie sets (union requirement), industrial places, oil rigs, etc.

In the Country of New Jersey, due to the stranglehold that the First Aid Council has on EMS, if the ambulance service is 100% volunteer, there is NO requirement that the crew have any training whatsoever (First Aid Council does make recommendations, but there is no state regulation unless the service is paid at least part time, then they are required to have 2 EMTs for a BLS ambulance). I remember working a cardiac arrest, and when all was said and done, the "EMTs" told me they came to the call from their EMT class. Neither of them were EMTs. Maybe had their CPR certs, but that was it. That was circa 2005 or 2006.

 

[Cryc_to_the_point]

I don't want to belabor this, but, what you say sounds like you're "in the weeds" a bit. I went to the NREMT site, and, from what I can see, if one become NRP, I don't see that one has t to maintain their state cert. But, it's right on the gold patch - NREMT, and, just below that, paramedic. So, at least, you are muddling things. And, BLS is a rock solid part of ALS. So, I don't get your point, especially because the same agency that certifies NRPs also certifies NREMTs.

My point is that EMT-P is nationally, not a thing dude. Geez.