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JWeber

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[The following was posted at another forum, and went unanswered. I am in a similar situation and was wondering what this forum's members' thoughts were]:

...this question is more for EM residents. I am currently in a traditional rotating internship (PGY-1), and I recently found a strong interest in emergency medicine. I will be working for a few years in the military as a general medical officer as part of my scholarship committment before returning/applying to residency.

In the meantime, I'd like to pursue educational courses that may be beneficial to me down the road in training. I am considering certifications in EMT or Paramedic! Any thoughts from those who had prior experience in EMS? Would it make a tremendous difference to have gone through the course? or would I be over-qualified and that there will be adequate exposure to pre-hospital care while in EM residency training? Your comments much appreciated. Thanks.
 

iwakuni_doc

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JWeb:

I'm at the tail-end (56 days left!) of my flight surgeon tour in the Navy & heading back to do a civilian ER residency this summer. From my own personal experience, I'd say that you'll have plenty of opportunity to be involved with pre-hospital & operational medicine if you choose to do so. As a GMO, you'll be tasked with training your corpsmen/medics - I've taught several of the EMT classes, so it might seem a little strange if you were doing the same thing as they were.

Now if you were talking about moonlighting in a civilian job - you'll probably get some good exposure, but you'd be much better off financially to moonlight as a doc, not an EMT.
 

southerndoc

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I think an EMS fellowship would be the way to go, especially if you want to be involved with a large city EMS system.

You could probably obtain EMT-P certification during your fellowship.

A fellowship isn't necessary, but it would be useful for someone who doesn't have a background in pre-hospital medicine.
 
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DrQuinn

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I know at my hospital, Tampa General, we get a lot of the Special Forces paramedics come through and we teach them intubations, RSI, chest tubes, etc... if you could somehow get involved in teaching them or whatever, that woudl be beneficial.

Just so ya know, one of my fellow interns did a year internship, worked as a GMO for a few years, then did some disaster research for a few years and is now a PGY-1 at a 3 year MD EM residency...

Q< DO
 

beyond all hope

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If you are already an MD, you know 90% of what a paramedic knows. An EM MD knows 99% of what a paramedic knows, and with much greater depth.

A lot of paramedic training is basic physiology/pharmacology, physical exam and history skills, ACLS and ATLS, all of which you should know better than they do. Also, they aren't trained to make the same kind of diagnostic/theraputic decisions that you are.

I was an EMT before doing my EM residency and unfortunately EMT training didn't help much. I also know paramedics who did med school and work closely with medics and I doubt you'll get much out of the training that you wouldn't get in an EM residency.

Just do a couple of ride-alongs in your residency. Don't bother with the whole EMT/Medic course. You'll be bored.
 

basementbeastie

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what you will get from the medics: comradarie at the station, emergency response to the scene (always a blast), seeing the patient in their "native" environment, extrication and packaging challenges (which can get creative), voyeurism, procedures in less than controlled environment (IVs in a moving medic unit, blind intubation in a car that has rolled on its side, coding 600 pounders in a tight elevator, intubation in a ditch, etc). of course, your clinical knowledge, skills, and judgement will be at a higher level, but your resources will be at a lower level. it is a lot of fun and i think it heightens your clinical acumen. i do agree that sitting through an entire P course would suck. perhaps you could challenge the license/certification after getting up to speed on the equipment used (ie: "doctor, please set up the stair chair") and the systems aspects of whatever jurisdiction you would be in (radios, dispatch, etc).
 

edinOH

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You will be highly over-qualified in paramedic training. An ACLS, PALS, and ATLS course will shore up some of the finer points that you don't traditionally learn in medical school. Actually, you probably already know this info, it just packages it up nicely for you. ATLS will teach you about c-spine and use of splints and traction along with the initial assesment and mgmt of trauma. This course goes above and beyond what paramedic training entails.

I actually took the Navy version of ATLS while in the Navy myself. It is alittle heavier on the procedure stuff than the one I took in residency, since they are obviously preparing you for operational medicine.

Like previously mentioned, one of your responsibilities as a GMO will be training your corpsmen. No better way to learn than to teach. Make sure you have a copy of Tintenalli's text as well for reference.
 

southerndoc

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Originally posted by SMW83
EMS is the way to go if you want to do something:D

It's always great to hear from someone who isn't certified as an EMT/paramedic, who isn't in an EM residency, who hasn't been to medical school, or who isn't even enrolled in a pre-med program.

As usual, thanks for your input.
 

OSUdoc08

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I've been a paramedic for a few years, and I plan to be an EMS medical director and an ER physician. Is the 1-year EMS fellowship after 3-year ER residency the only way to go if you want to do this, or are the other options?
 

beyond all hope

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To be an EMS director you have to be an ER doc (in any major city), but you don't necessarily have to do a fellowship. However, as EM grads are multiplying, a fellowship will probably be necessary in the near future.

Basically, the answer is yes.
 

Midwest Medic

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I disagree with the above post. If you want to be a EMS director in a larger city (NY, LA, Detroit...) you most likely need to have the EMS fellowship training in order to do well. On the other hand, if you want to be a EMS director in a smaller city, the EMS fellowship would be nice, but a basic understanding of EMS would be all you HAD to have. Also, you do not have to be an ED doc in order to be a medical director. The hospital I did my 3rd year (St. Louis) at had a FP doctor who worked in the ED as a director of many EMS companies. Also, the EMS company that I worked for had a surgeon with no EM training who was the director of three companies. There is a medical director course that is sponsored by one of the EMS insurance groups (maybe even the nat registry) that is required by most EMS insurance groups in order to be the director though.
 

southerndoc

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I agree with Midwest Medic. It's probably not necessary that you complete an EMS fellowship if you want to be a medical director in a small town. This is especially true if you have previous EMS experience as an EMT or paramedic.

If you want to be a medical director in a larger city or academic setting, then a fellowship could be useful. The main reason for completing the fellowship is to get experience with research, grant funding, teaching, etc.
 
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vtach

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Well, I have to agree with some of the above. I have been an EMT-A/I/P since 1989, and worked full-time for 8 years at it prior to going back to Medical School. There used to be an advanced shortened paramedic course for nurses, which basicly included, the non medical stuff....extrication, immoblization, medicine outside of the hospital and then clinical(ride time). But I believe that was dropped with the new 2000 standards from the national registry. After completeing medical school, I think that you would find the paramedic classroom work alittle easy. As with Medical school you learm the most from the clinical ridealongs. I am sure you might be able to work out a deal with a local squad and medical director to do some ridealongs, which I think you would find much more educational than taking the whole class. Check out local paramedic training opportunities and see if you can get involved with teaching, and leave a spot in a paramedic class open for someone who wishes to actually practice as a paramedic.
 

flighterdoc

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If you want to sit through an EMT class (~120 hours of instruction), knock yourself out. However, except for the manual dexterity you might pick up by practicing putting people in C-collars, backboards, etc. you won't learn anything. In fact, you might detract from the learning experience of the others in the class, since YOU will be the resident subject matter expert on all things medical, not the instructor (typically, EMT instructors are Paramedics and Nurses).

Paramedic instruction is much longer - ~1400 hours in most jurisdictions. 1/3 didactic, 1/3 in practicals and 1/3 on ride-alongs. Now, I'm not sure you have at least 6 months free to take the training, but again you won't learn anything except some manual procedures.

If you want to learn about street EMS, go sign up for some ride-alongs.
 

OSUdoc08

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Well if you are already a doctor, I'm sure you won't learn alot of things, although I know I've taught some ER docs a few tricks myself. However, if you haven't started medical school yet, then I think EMS training is important, especially if you want to be an ER doc. It provides a great advantage for you when you get to your clinical skills. There is also classroom medical knowledge such as pharmacology, cardiology/ekg's, and other things that will be helpful. First & second year med students demonstrate an advantage in cardiology, pharmacology, and anatomy. Third & fourth year students have an advantage because not only do they have experience with IV's, intubation, cardioversion/defibrillation, cricothyrotomy, needle thoracostomy, ekg interpretation, and other various skills, but they have the confidence of knowing how to handle emergency situations that medical students do not yet possess. These advantages are voiced in current medical students and physicians alike.

As for the 6 months of time, I took my paramedic class from January to August. It was 2 nights a week for a couple of hours.

I was in college earning my bachelor's degree at the same time in a different location, and made my best GPAs during those semesters.
 

flighterdoc

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Originally posted by OSUdoc08

As for the 6 months of time, I took my paramedic class from January to August. It was 2 nights a week for a couple of hours.

I was in college earning my bachelor's degree at the same time in a different location, and made my best GPAs during those semesters.

For a Paramedic course?

The DOT standard (the nominal minimum training sylabus for EMS workers) specifies
1000-1200 hours for average competence: http://www.nhtsa.dot.gov/people/injury/ems/EMT-P/disk_1[1]/Intro.pdf

8 months x 4.3 weeks x twice a week x a couple of hours =128 hours, or the standard (more or less) time for an EMT-Basic course.
 

12R34Y

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I was wondering about the "couple of night a week" paramedic course also.

My paramedic course was quite an intense experience (obviously seems easy now that i'm an MS2) and there is no way I could have attended undergrad at the same time.

paramedic training was a 9-5 m-f thing. 24 hour ride along shifts full time for 3 months, 3 months of clinicals etc... blah blah blah.


where did you go to school?

later
 

OSUdoc08

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Wow we have an EMS forum now? Well back to the medic school thing. To do the Paramedic course that is January-August, 2 nights a week, you have to already be an EMT-Intermediate. If you are just an EMT-Basic, it is August-August.

The class is on Tue & Thurs nights from 4pm-10pm. However, we only showed up for class from like 5-8 or so, depending on when the instructor wanted us to be there.

It met the DOT requirements, I promise, because it was approved. As I said before, my GPA was better the semesters I was doing EMS training than when I was not. (Don't ask me why.)
 

JWeber

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Everyone:

Thank you very much for all your comments. The above threads seem to indicate that as a physican, one would gain little in terms of overall knowledge from going through an EMS course.

Just one other minor detail - if I were to go on and try to match in EM, would having an EMT or paramedic certification in and of itself be advantageous?

I know that in addition to looking at numbers, AOA, research, etc, EM residencies often look favorably upon past EMS experience when evaluating potential cadidates. My numbers are average at best. Would just having that additional "merit badge" offer a leg up on the competition as far as securing interview slots? Or would a selection comittee look more carefully to make sure that that person had years of experience working in the EMS field?

Thanks again.
 

southerndoc

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It depends on what you do with it... I think many PD's and EM attendings who interview applicants do view pre-hospital experience favorably, especially if you were active in EMS.

If you did things such as clinical research, teaching, QA, protocol development, community work, etc., then yea, it will go a long way.

Being an EMT in and of itself doesn't give you any more advantage, especially if you haven't worked on an ambulance.

With your case, if you went to EMT school AFTER graduating medical school, then I'd think that would give you some negative points among PD's. Maybe I'm wrong, but I think many would question just why you went to EMT school after earning an MD.
 

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Ride alongs are the way to go in your position.
In fact you may want to up the challenge and specifically ride along with emergency Lear (jet) flights for highly critical patients (they pay real well if you have all the requirements for them, like AeorCare Based in Florida but located in many large cities), or the choppers at your local Trauma I. You will get the best use of your medical training as well as all the goodies. The teams of Docs RN's, Respiratory Tech's, as well as Paramedics are generally cohesive so they will be able to answer any of the higher questions you may have whereas the Paramedics will only be able to give you the tips and tricks of the equipment. (If you stick around on this thread long enough you will learn the tricks anyway :cool: )
Good luck in your decision just remember that your purpose should be to gain additional knowledge not simply be able to drive fast and through the red lights.
 
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