"Capabilities of ALS operators have rested on this misconception. What the MICA experience has revealed is that it is not enough to just learn about skills or drugs. It is also not enough to learn the A&P."
Yeah, I totally agree. I have a now ex friend, who is a biologist, who used to look down on me because he'd see my course work and a couple of dot points about drug side affects or something and have a go at me for doing a soft course, completely missing the complexities of real world application of the skills, thinking that that was all there was to know. I think a lot of other people doing my degree (I don't want to spread aspersions, they're almost universally lovely people) don't really get the differences between the two which I'll touch on in a moment. I do get that there's a difference and I'm not at all saying, reading the CWI twice means u can do the thing. I had just heard a paramedic say that a MICA paramedic had once killed someone by making the wrong drug calculation because she was tired and the ALS medic couldn't back up the calculation. It just seemed to me that u could, as the ALS assitant, just spend 5 mins wrote learning a few dosages and, while you're not going to understand the subtlties of the practice, if you're MICA partner is about to poor sux down a persons throat with a shovel, cos he's so deliriously tired (which I understand is essentially what happened in that case I mentioned) then the ALS partner could stop that. That's just what I was getting at. But I take you point.
I think as far as policy goes, it seems from the outside, that what they're doing would work. Even with a bit of knowledge about the system. As usual though, their lack of consultation of the people on the ground has caused problems. "There are political, bureaucratic, organisational, OH&S, industrial, cultural and behavioural forces at work in ambulance and always have been. Students need to ask about the reality of the situation from ambos themselves, not those with vested interests." Hence my dialogue with people like you. The amount of bull:censored::censored::censored::censored: they feed us at uni about the ambulance service, the realities of working and about the application of clinical skills is obvious to some of us, so sorting through whats crap and what good is a difficult process. I could sit here and write you an essay on the reasons why our curriculum is bull:censored::censored::censored::censored:.
I'm not shocked to hear so many grad paramedics are poor, I am shocked though to see that they got passed through. The degree is getting better, but it still has some fundamental problems. I don't disagree with recruiting young people, nor having the course as a degree course. My problem is that they have just said, 'oh so we're making a degree, what do degrees have,...lectures...tutes...essays...okay lets have them" Without thinking that these things, in the same form as they take in other degrees, might be inappropriate for teaching paramedics. Medicine degrees take on quite different forms to other degrees. Science (which I started first) has extensive labs for every subject. Yet even for the particularly practical subjects (concepts of clinical practice, or A&P labs) we barely have any time to really practice the skills. We also have almost no 'class time' in which we could sit and work on intellectual problems like ECG interpretation with a teacher and ask questions when we come up against a problem or have a question. An academic degree is focused on weeding people out onto a spectrum between people who wanna learn and people who don't, and they are marked accordingly. Our degree should be focussed on training everyone up to the same level. So far all that has happened as far as that is that they make the course work pitifully easy so no one fails (which sounds similar to the problem you were having). When someone argues that point, all they do is make exams with tricky multiple choice questions that bear little resemblance to real life knowledge or application, just like the academic degree. Also you only need to know 50% of the course material to pass. Maybe I don't turn up the the lectures on shock, AMI, giving set calculations. I can still pass the exam with an alright mark of maybe 65-70% and go out on the road not even knowing what shock is let alone how to deal with it. Anyway, sorry, I get really angry at uni.
"12 days of on road training? - in 3yrs" The ammount of clinical experience in undergrad is improving. The buzz word at the moment is "education-not training" but we clearly need both, as I was saying above. I asked the director of the Queensland Ambulance Service about the risk of "overdoing the education at the expense or training in real world clinical applications" and he gave me the most convoluted politicians answer I've ever heard from a person, but I didn't have the guts to call him out on it in front of every pre-hospital luminary in Australia (this was at a conference on professionalism). I'm still not sure that he actually spent that 5 mins saying anything at all, which was odd because up until then he'd been a straight shooter. My degree has about 13 weeks of clinical experience. Although what this actually involves may differ greatly from student to student, depending on how nice your paramedics are, and what cases you get. I have uncanny luck. Three separate medics have had a go at me for being a case magnet
. But I also make use of my time by asking questions, using the gear in the down time and making the most of cases with nothing in them (helping granny up off the floor is a good time to practice reassuring and building rapore with patients I reckon, its a good one for us undergrads). I'm sure some of my paramedics get sick of my enthusiasm and questions, but that's their problem, I need to learn. Other students have gone on three of four shifts and not had a single case, or did one grazed knee, and then sit there and watch TV the whole time with a monitor, oxysaver and drug bag sitting there ready for practicing on (I don't get that. They just don't seem to care about learning their craft). My aunt is a grad paramedic in SA and in 2 years on the road has never seen a trauma arrest like the one I did in my 5 shift of placements. It's a lottery, but you also have to make an effort.
Mostly, we need more placements, but its a nightmare trying to get uni admin to get off their arses and organise them for us. But we can hardly just walk up to an ambulance station, in our gherkin uniform, and say hey can I ride along today, I'm a student and I need more experience (although I've considered it:wacko
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"you can see why the "ALS" backup cars for the 20 or more MICA SRU's to be implemented is a disaster waiting to happen let alone the resourcing problems, especially on weekends, I mentioned." --Good god its a sorry state of affairs. I get what you mean about the ALS back up. And I'm shocked but also not entirely suprised at the younger medics doing all that business.
"Add to this the mentality amongst some, not all, ALS operators that if MICA is coming they need to do little other than the basics as MICA will do it for them" -- To be clear, I agree that the ALS operators are largely not capable of doing what I was saying. I've heard some terrible stories lately about ALS ineptitude (The worst being a case where ALS response to an elderly diabetic having had a seizure, they gave the Glucose paste and Glucagon IM, no response, called MICA, 30 mins after the seizure, when MICA arrives just as they're putting a monitor on-asystole. They didn't even think to check the womans pulse or even breathing while waiting for the glucose or before it, she'd been in cardiac arrest all that time and they just say there waiting for some sugar to work). I was saying that they should be. That its their responsibility to be able to back MICA up, that its not necessarily the fault of a SRU system. That maybe its okay to SRU. maybe the problem is that to many ALS medics aren't up to scratch. I suppose I was saying that the fault may not lie in the theory of a SRU system. But I take your point. Even if the SRU system works in theory, you can't force the issue if it doesn't work in practice.
Thanks for explaining it all in such detail and with such patience. It really is helpful to have paramedics who will teach rather than scorn.
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