Hi everyone,
Warning this is a long post. I am not going to apologize for it. I wanted to post because I feel the need to defend my profession.
I am a paramedic. I work 24 hour shifts with a hospital based ambulance service, who is the sole 911 provider in a 620 sq mile county with a year-round population of around 130,000. Add approx. 30,000+ college students to the mix during the fall and spring. We are also the sole non-emergency transport service in the county. The service has 4 24 hour trucks and a 12 hour truck. We average 40+ calls per day as a service. The particular truck I work on averages 10+ per day. Some days over 50% of those calls are non-emergency transfers. Other days less than 10% are non-emergency transfers.
I became certified as an EMT-Basic after attending a semester course during the summer while taking Physics I and II. For 2 years I worked part time as an EMT-Basic as medical coverage at special events at the school I attended. This was a completely different experience than working on an ambulance. I worked as an EMT-Basic for 2 more years full time at the ambulance service. The first year was while completing my bachelors of science degree in molecular biology as a university honors scholar in 3 years with a honors thesis.
I applied to medical school late in the summer/ early fall after graduating. I applied to approx 25 schools, finished secondaries to 15 and did not receive a single interview. Some of that was due to applying as a Georgia resident (my parents live there), and living/working/going to school in Alabama. Some of that was due to being late in the game. When calling admissions officer/directors to ask what I could do to improve, they stated I had a great application, they were not sure what to tell me except try again. One school from Georgia told me I was so close to being an Alabama resident to not apply again. An Alabama school told me that I was a Georgia resident, don't bother. I felt that I needed more life experience because until then my life had been school, school, school, and doing things to get into medical school. I, like many people around me, didn't do anything else. So I decided to take time off and just work full time.
I was tired of being just an "ambulance driver", as in our state this highest level provider is always in the back no matter the condition of the pt.
I finished my certification as a paramedic in August 2008 and immediately transitioned into working as a full time paramedic. I can now tell you the experiences I have gained as a paramedic in the past year can not be compared as the experiences as an EMT-Basic. (I am not trying to offend any EMT's out there. I would have argued to he** and back about this point before being a paramedic.) The same type of calls I went on as an EMT-Basic are totally different now that I am the one determining a differential diagnosis and treating the patient.
We have to remember, EMS is a relatively new field. While there have been things around, especially in the military that the roots of modern day EMS can be traced to, modern pre-hospital care really began in the 1960's. This is long after nursing and medicine became established. EMS has come a long way in the past 50 years, and is still developing and gaining respect.
Now for those who don't know the difference between the levels in EMS, it varies depending on the state where you live/work. We do more than O2 administration and rib breaking. The basic idea is that the EMT-Basic provides basic level of care/first aid, EMT-Intermediates provide a level of care that is between EMT-Basic and Paramedic, and Paramedics provide the most care with cardiac monitoring, drugs etc.
In my area, EMT-Basics are certified after passing National Registry exam requiring 1 semester of course work, Healthcare provider CPR/AED training, and approx 48 hours of clinicals between the ambulance and ER. They are allowed to do basic first aid, give oxygen, and assist the pt administer their own physician prescribed medications.
My area does not certify EMT-Intermediates. In the neighboring state, until the last 2 years, they did not certify EMT-Basics, only EMT-Intermediates. I believe EMT-Intermediate is another semester or two of course work depending on area. EMT-Intermediates start IV's, give fluids such as normal saline and D50, and in some areas are trained in endotracheal intubation.
Paramedic certification takes approx 2 years straight through including EMT-B and EMT-I coursework. Some areas require some amount of work experience as an EMT-B or EMT-I before training as paramedic. Other areas let people go straight through school. To be licensed as a paramedic in my state, you are required to be nationally registered. You are also required to have and maintain certifications in Healthcare provider CPR/AED, Advances Cardiac Life Support (ACLS), International Trauma Life Support (ITLS), and Pediatric Advanced Life Support (PALS).
Paramedics are physician extenders. They are acting under their medical director's license. Paramedics are trained in advanced skills such as endotracheal and nasotracheal intubation, cardiac monitoring/defibrillation/pacing, pharmacology (including training on multiple medications carried/administered), needle chest decompression, needle crichothyrotomy, surgical crich. They administer many medications including antidysrhythmics, anticonvulsants, sedatives and narcotics on what is called standing orders. Some places paramedics do pericardiocentesis and in extreme cases, chest tubes. They are trained to form a differential diagnosis and to treat that pt based on that diagnosis. They act on many standing orders and depending on the area of the country have to call online medical control for few, if any orders. There are many things that we could do, or not do, that would adversely effect the outcome of the pt.
Nursing is a whole different field and can not be compared to being a paramedic. I have friends who went to nursing school after being a paramedic and had trouble because of a different mindset. I have a friend who was a paramedic, became a nurse. She recently got in trouble for going ahead and treating a pt without an order from a doctor. She consequently saved that pt by doing what she was trained to do as a paramedic. She was told she should not have acted on her own, but should have called a code since she could not get in touch with a doctor for orders.
Many of the nurses I know that have a poor attitude toward paramedics do not realize what we are trained to do. I have personally had nurses hand me paperwork to take with me on a transfer to a higher level of care, that have told me they sealed the envelope because it is confidential medical information and we are not part of their medical care. I have had a charge nurse tell me I never had a class on cardiac medications. I have been asked every day I have worked "why didn't you start an IV on this patient?" This is on patients that do not need an IV. I am not going to start an IV and draw blood on a patient that I am not going to give fluids to or give medications to just because it makes a nurses job easier. If something happened and God forbid the IV site become infected and in extreeme case the pt loses a limb, telling the court/judge that you "started the IV because the nurse wanted you to", is not going to cut it. (Sorry for the vent!)
I believe every ER nurse/doctor should be required to ride at least 72 hours a year with EMS in at least a moderately busy 911 setting; this should be in 24 hour shifts. Paramedics should also be required to do the same number of hours of rotations in the ER a year to see the ultimate diagnosis of patients.
I agree that pre-hospital education is completely different than other medical fields. It has to be. Our ultimate goal in life threatening emergencies is to keep the patient alive. We are not trained in long-term therapies. We are not trained about how our treatments affect the long-term case management of a patient. Unless you follow up on your own, you do not know the ultimate diagnosis and outcome of a patient.
That being said, I do feel that the education and attitude of many paramedics is subpar. Many are now taught to pass the test. Others are taught with the attitude, the protocol says to do A when B happens, not why they are doing it. Some people in this field give others the bad name/ stigma that we have. I agree there are definitely some bad apples.
All that being said, some comments on some posts in this forum. For those that say their co-workers lack professionalism. You are going to see this in every field. I have met nurses and doctors that have lacked professionalism. Some nurses I work with are notorious for having conversations with co-workers and purposefully ignoring their "annoying" pt's questions/requests. So it is not just paramedics acting unprofessional. For those people who are saddened by this fact, do something to change it. Do your best to act/look professional and to promote that standpoint. For those who stated examples of paramedics treating patients wrong (status asthmaticus treated as a panic attack), I agree there should be a system in place to let paramedics know the ultimate outcome of a patient and quality control.
To those who say paramedics do not provide pt education. A big part of my training was to do just that. We are taught to go out into the community to be visible and promote preventative education. We do presentations to schools, churches, daycares on injury prevention. We do CPR classes in the community. When caring for patients with a preventable condition we explain how they could have prevented getting into this situation (ie take your medication as directed, don't eat so much salt, no you can't take extra insulin just to eat that huge piece of chocolate cake or you can't take your insulin and eat cucumbers and tomatoes for dinner). Also I have been amazed by all the times I explained to a patient how their medication was supposed to work, and why they were feeling how they did (side effects), that they said they were never told. Who was supposed to provide that pt education? I have provided family education in explaining the condition of their loved one all while working to keep them alive.
In some cases (many more than not), ambulance transport is nothing but an expensive taxi ride. Sometimes for people in wheelchairs, sometimes for people who can walk. We are abused by all including other health care professionals. I have no desire to deny anyone the treatment they wish to have, but the person with the bug bite they got 3 days ago, that itches gets old. The person that calls multiple times a day, every day, and wants to be transported to every hospital we have (in various parts of the city) so that they can use their taxi cab voucher to go shopping gets old. The hospital calling for us to transfer a patient home that has no medical devices, and can walk, is ridiculous but happens all the time.
I have done multiple non-emergency transfers that I have learned a lot from. I make a point to research a medical condition if I have never seen it. These are the calls that you really have time to talk to a patient, unlike emergency situations. I feel that the more you learn during these calls, the better you are during the "real" calls.
It is the true emergency calls that everyone enjoys. This is not because you want anyone to be hurt or sick, but because you get to do what you are trained to do. Some people enjoy trauma the most. You may have heard those people refered to as trauma junkies or adrenaline junkies. Trauma is relatively easy. Personally I enjoy complex medical calls or even the more complex trauma/medical call. The COPD patient with acute CHF and hypoglycemia. You don't see these much, but I like the challenge. Many with chronic conditions wait until the absolute last minute to seek medical attention. The patient that had a seizure or a stroke and wrecked their car. The patient that overdosed and then shot himself in the chest. The challenging calls are the most rewarding to me.
I do not see how anyone could say that being a paramedic is not clinical experience. I went to undergrad with students who studied their butt off, took the MCAT and made in the 95% rage who had shadowed doctors and got into medical school only to quit and go to law school the first time they saw someone die.
I do not see how the clinicals we did as paramedic students do not count for clinical experience. I did well over 300 hours of clinicals in various departments including the ER, ICU, CVICU, OR, cath lab, peds, psych, medical floors etc and on the ambulance. The point of many of the clinicals outside the ER was continuity of care and to see the clinical outcome of the patient, administer medications, assess patients in a more controlled environment etc. The OR was not only to see surgeries, but gain experience in monitoring patients and airway control including intubation. I did clinicals in an ER that has interns and residents. While the new interns were standing back watching and twiddling their thumbs complaining about how they didn't get to do anything, they had the paramedic students in the trauma room starting IV's, helping to splint/bandage an injury, intubate and helping to take care of the patient.
I do not see how work experience does not count as clinical experience. I volunteered (and did not just sit and watch like many) the entire time I was in middle school, high school, and undergrad in hospitals and doctor's offices. I shadowed doctors in various fields most of the time I was in undergrad. That experience pales in comparison to my work experience. Shadowing a doctor that is telling someone their loved one died is totally different than telling them yourself. Determining in someones home that a 4 lb fully developed newborn is stillborn when the person didn't even know they were pregnant is different. Watching a doctor intubate is totally different than doing it yourself. Listening to a doctor tell how he determines what is wrong with a patient is totally different than doing it yourself. Making the decision on which medication a patient needs is different. I have seen and done a lot that I never would have experienced first hand without having been a paramedic.
As much as I have mentioned the bad, I can truly say I have saved a person's life. There is a little boy walking around today that would not be alive without all the paramedics did getting him to the helicopter and the paramedic and nurse on the helicopter, and the doctor's and nurses at the hospital. There is a man that was in cardiac arrest, that walked out of the hospital a week later. Calls like that I will remember forever.
Critical care transfers I have been involved with have made me more aware of all the different specialties in medicine. I have found a great enjoyment from working with critically injured/ ill children, especially infants. I never would have dreamed of wanting to do something like that before. I find many diseases and disease processes fascinating and want to learn more and more about them.
I have many times been told by patients, pharmacists, nurses, and doctors that I should be a doctor. This is coming from complete strangers who have no idea I want to be a physician. While my ultimate goal is to go to medical school and become a physician, the comment sometimes comes across as insulting. Why do paramedics have to be seen as unintelligent, or a stepping stone profession? Why can't paramedics be intelligent professionals, know more about their job, and know why they are providing treatments, not just that their protcol says to do that. All the good paramedics know this information. Some of it comes through experience. Many paramedics strive to further their education through continuing education classes and more certifications such as CCEMT-P. Others return to nursing school to come back and work on a critical care ambulance or helicopter as advancement is not available in my area as "just a paramedic".
It is frustrating, but I do not feel that I will see, in my lifetime, the advancement of the paramedic to what it needs (and I would like) it to be. I love my job, I love what I do. I love working directly with patients, seeing the entire picture of not only their illness, but the environment where they are living. I love being the one to make the decisions. I am not doing my job because it will look good on applications. I feel that I would let my self down if I did not go to medical school. I feel that I could have more impact on EMS as a physician. I also feel that I can do more specialty care as a physician than a paramedic.
After reading everyone's comments, I hope that being a paramedic does not hurt my chances of being a physician when I reapply in the near future. I hope that the people who truly want to be a paramedic (even if just for a little bit before medical school) pursue that field. I hope that you too can have an impact on the improvement of EMS in the future. And a tip, don't wait til August/September to turn in your primary application!
Thank you to all who took the time to read this. Good luck in all your future endeavors!
Medicechic
