Hard Decision

[EmergencyMedicalSike]

So far, I’ve been an emt for an IFT company in LA County for 7+ months and I’m at a crossroads here. I either have the choice to go with a 911 company for 911 experience or skip that and go straight to medic school preferrably UCLA paramedic school. Essentially my main question is, is it a wise choice to go straight for medic school with only IFT emt experience?

 

[NightHealer865]

If your end goal is to be a medic, go straight to medic school. PA’s don’t have to be nurses before going to PA school, and nurses don’t have to be CNAs. 911 experience as an emt is gonna be mostly limited when you’re on an ALS truck. I had 2 emts in my medic class that were fresh out of emt school and both turned out to be good Paramedics in the end.

 

[mgr22]

I agree with NightHealer about going to medic school. Don't underestimate the value of working as an EMT -- even in IFT. Just dealing with patients, families, facilities and bosses is an education in itself.

 

[hometownmedic5]

I object to any calender based criteria for entering medic school, for a number of reasons. One, I don’t think it takes very long to become a competent basic, and i think the 14-18 months of medic school, presuming of course that you’ll have to work while in school, should be more than sufficient to learn the basics of the job. Two, some people pick things up faster than others and some will never reach minimum competency regardless of how long you give them, how much personal direction they get, or the quality of the instruction provided to them. Essentially, you’re either going to get it or you aren’t, and i don’t think it takes all that long to do it.

So with that being said, here is my speech for deciding whether to go to medic school or not. Are you committed? Do you want to be a paramedic long term, or are you using EMS as a time filler until you become a (insert profession unrelated to, or unable to be profoundly helped by experience as a medic)? Medic school is long, hard, and expensive. The joke(?) about medic school is that if you didn’t have a drinking problem going in, you will coming out. While some people struggle more than others, I don’t know any paramedics who stated they enjoyed medic school while they were in it or shortly thereafter. As time passes and wounds heal, some people profess that “it wasn’t that bad”, but it has been my experience that these are the people that struggled the most during medic school and are now downplaying their own negative experience.

So if you want to be a medic long term and you’ve mastered or at least made a start on mastering the basics of the job, now is the time to go to medic school because someday you’re going to wake up with the spouse and the kids and the mortgage and the schnauzer and you may find yourself in a position where essentially taking a second job(without pay) just isnt possible. That, beyond anything else, is how you end up with 30 year basics. Nothing against the old salts, but EMT was never supposed to be a career. It’s an entry level cert, unless you get trapped, or have no ambition whatsoever.

Medic school poorly prepares you for nursing school, PA school, and med school. We, generally, take a very a rudimentary walk through many clinical topics, which when pursuing higher medical education, appears to be laughable in comparison. True, there’s patient care experience, but the same is true for being an EMT; but medic school isn’t an efficient leg up on higher medical education.

As far as IFT experience v. 911 experience, there may be places where a basic gets real high acuity 911 experience on a regular basis, enough that it significantly influences their abilities as a provider, I feel pretty confident in saying that in most BLS 911 systems, the job isnt much different than being a transfer EMT. Drive to the call location, assess the patient, package for transport, transport, write a chart. Drunks, psychs, minor injuries and illnesses are what you’ll primarily be tasked with as a 911 basic(and as a 911 medic for that matter). 911 experience teaches you to pay more attention to scene safety, emergent driving, rapid assessment and some clinical decision making, but I dont think its worth putting off medic school to get. If you were in a situation where you couldn’t go to medic school for a year, lets say money reasons for the sake of argument, I would say it would be a valuable experience for you to take the 911 job, but if the choice today is you can go to medic school tomorrow or delay matriculation and take a 911 job, my vote is for go to medic school.

If you have to be a medic to get a fire job, then I guess you do you. This is a system I disagree with at my very basic core, but its a way of life for a lot of people in a lot of places and no amount of caterwauling about it here is going to change it.

 

[E tank]

If the choice is between advancing your education (in a relevant way) and not, default is to advancing education. If you were going to be able to do the 911 bls gig and go to nursing school or get some other BS/BA to go to graduate work, I'd say do that.

 

[DrParasite]

If your end goal is to be a medic, go straight to medic school. PA’s don’t have to be nurses before going to PA school, and nurses don’t have to be CNAs.

many RN programs I was looking at required CNA certification, and PAs and nurses do very different roles. Not really a good comparison.

911 experience as an emt is gonna be mostly limited when you’re on an ALS truck. I had 2 emts in my medic class that were fresh out of emt school and both turned out to be good Paramedics in the end.

and I had two experienced emts in my medic class who didn't even finish the class. what's your point? you can say 0 to hero medics are awesome, others might disagree. it all depends on the person, and what your personal experience it.

I will say the EMTs who had more experience or who were working on 911 trucks were able to pick up new things faster, apply basic EMS stuff (like documentation and patient assessments) better than the zero to hero ones.

As far as IFT experience v. 911 experience, there may be places where a basic gets real high acuity 911 experience on a regular basis, enough that it significantly influences their abilities as a provider, I feel pretty confident in saying that in most BLS 911 systems, the job isnt much different than being a transfer EMT. Drive to the call location, assess the patient, package for transport, transport, write a chart. Drunks, psychs, minor injuries and illnesses are what you’ll primarily be tasked with as a 911 basic(and as a 911 medic for that matter). 911 experience teaches you to pay more attention to scene safety, emergent driving, rapid assessment and some clinical decision making, but I dont think its worth putting off medic school to get. If you were in a situation where you couldn’t go to medic school for a year, lets say money reasons for the sake of argument, I would say it would be a valuable experience for you to take the 911 job, but if the choice today is you can go to medic school tomorrow or delay matriculation and take a 911 job, my vote is for go to medic school

Question: how many years have you spent in a BLS 911 system? because I can tell you almost everything you are describing is nothing like I have spent 15 years ago. You might deal with drunks, psyches, and minor illnesses.... I dealt with shootings, CHF respiratory issues, MVA, weird technical rescues, stabbing, overdoses, more trauma alerts than I can recall, as well as your drunks, psyches, assault victims, and elderly population who got sick and called 911. We were an all ALS intercept system, so we didn't have a medic on the truck to always hold your hand and direct you what to do (and occasionally, didn't even have a medic on those sick calls)

The biggest thing I took away from my 911 experience is the ability to perform a decent patient assessment, how to communicate with patients, how to identify sick vs not sick, and then sick vs dying, when to stay and play vs when to load and go, and most importantly, do I want to do this for the next 5-10 years, before I consider spending 1-2 years of my life in medic school. Can you do this in IFT? sure. But I know waaaaaay too many lazy IFT providers, and waaaay too many IFT companies that are more concerned with billing than clinical competency of their providers. Your agency might be the exception though.

Some places (actually many places) will hire you with no experience as long as you have a medic cert. The better places (and this is everywhere, not just EMS) that are going to pay and treat you better will want you to have some experience, or have a positive reference from within the organization (you might be able to get it in IFT, but it's easier in a 911 system. Also, it's much easier to get a job as a paramedic when you are already working in a 911 system, than trying to get in as a newbie paramedic with 0 experience (and your competing against your classmates for the same job).

I've never been a huge fan of IFT, most paramedics I know feel their skills are not utilized on IFTs, and actually critical care IFT calls are pretty rare. Others might think differently.

If I was in your shoes, I would accept the 911 EMS job, and apply to medic school. your life will suck for a while (medic school has been known to end relationships), but it will put you in a good position for the future, especially if you don't get in the first round.

 

[hometownmedic5]

Question: how many years have you spent in a BLS 911 system? because I can tell you almost everything you are describing is nothing like I have spent 15 years ago. You might deal with drunks, psyches, and minor illnesses.... I dealt with shootings, CHF respiratory issues, MVA, weird technical rescues, stabbing, overdoses, more trauma alerts than I can recall, as well as your drunks, psyches, assault victims, and elderly population who got sick and called 911. We were an all ALS intercept system, so we didn't have a medic on the truck to always hold your hand and direct you what to do (and occasionally, didn't even have a medic on those sick calls)

Give or take a dozen years. I'm not going to bore you with the details. I currently work for a company that runs 10 BLS 911 truck in urban or barely suburban environments, one of them a predominatly low income cesspool of a hundred thousand people.

As is the mantra here, if you've seen one system, you've seen one system. It has been and is my current experience that, the majority(not the totality, but the majority) of call we send our BLS rescue on are the low acuity calls, or as a second due company to a high priority call. Sure, our basics see all the blood and guts stuff, but at a 1:10 or 1:20 ratio. It's a much better use of our resources to send them on the drunks and psychs that might, rarely, turn into a real call and save the medics for the high acuity calls that might, rarely turn into BS.

Things are different all over. No sense in you getting all worked up because in my system we utilize our resources differently than in your. They don't seem to complain about it much. It sure beats the renal roundup.

 

[DrParasite]

It has been and is my current experience that, the majority(not the totality, but the majority) of call we send our BLS rescue on are the low acuity calls, or as a second due company to a high priority call. Sure, our basics see all the blood and guts stuff, but at a 1:10 or 1:20 ratio.

So they don't get to deal with any sick patients without a medic to hold their hand? That sounds kinda sucky, but I agree, it beats the renal roundup.

We send out BLS units first due to all high priority and high acuity calls, and our ALS arrives shortly thereafter. They (BLS) also go solo to low acuity calls. It's simply numbers: we typically have more BLS trucks than ALS ones, which also allows our BLS providers to perform an assessment and determine whether or not ALS is needed. Don't get me wrong, I've given more than my share of taxi ride while working in the city, but we saw some sick patients too.

if i was sending a unit as second due for high priority, i would send the FD just for manpower, and not bother tying up another EMS unit. but that's just me.

 

[hometownmedic5]

So they don't get to deal with any sick patients without a medic to hold their hand? That sounds kinda sucky, but I agree, it beats the renal roundup.

We send out BLS units first due to all high priority and high acuity calls, and our ALS arrives shortly thereafter. They (BLS) also go solo to low acuity calls. It's simply numbers: we typically have more BLS trucks than ALS ones, which also allows our BLS providers to perform an assessment and determine whether or not ALS is needed. Don't get me wrong, I've given more than my share of taxi ride while working in the city, but we saw some sick patients too.

if i was sending a unit as second due for high priority, i would send the FD just for manpower, and not bother tying up another EMS unit. but that's just me.

I didn't design the system. I don't make the rules. I don't dispatch trucks...

 

[NPO]

Go to medic school when you think you're ready.
Do you think you're ready for medic school after 7 months of Los Angeles IFT?

From experience, I say probably not. I did several years of it, and then went to a high volume 911 system where EMS is primary medical control and I learned A LOT more. But youll get out of it what you put in to it.

Also, don't lock down your medic school options. UCLA isn't better than anywhere else, and definitely not worth the price tag, IMO.

 

[Aprz]

I have mixed feelings on this. I say it's up to you.

1) You go to 911 as an EMT. To be honest, I do feel like paramedic school tends to be smoother for 911 EMTs. They kind of are familiar with how things are done, the different equipment, and so on; They've actually seen it in action.

2) You go to medic school with no 911 experience. It might not be as smooth of a ride, but it is very doable. The majority of my medic class had no 911 experience. I had no 911 EMT experience when I went to medic school. This might make you a better candidate for 911 EMT jobs too and help you be a better 911 EMT assisting your medic on things.

I think if I had been hired as a 911 EMT first, I'd probably wouldn't have become a medic, lol. XD

 

[luke_31]

Go to medic school when you think you're ready.
Do you think you're ready for medic school after 7 months of Los Angeles IFT?

From experience, I say probably not. I did several years of it, and then went to a high volume 911 system where EMS is primary medical control and I learned A LOT more. But youll get out of it what you put in to it.

Also, don't lock down your medic school options. UCLA isn't better than anywhere else, and definitely not worth the price tag, IMO.

I agree with NPO, UCLA's rep isn't what it used to be. It's pricey and you get your field internship in LA County which is great if you plan on staying in LA county for your career, if not you will be deficient in many skills, medications, and how things work outside a major metropolitan area. Believe me there is a difference working LA county and just going to Kern County, let alone out of state. LA County IFT won't get you the necessary experience you need for running 911, heck BLS 911 in LA County is barely sufficient, but at least you will see how paramedics operate and get an idea of what you're supposed to be doing.