Ready for an unpopular idea?

[truetiger]

I'm not sure what you mean by "make it into an amb" but we get students and new employees all the time who have no business doing this job. Like others have said, the academics are not necessarily hard however its all about attitude and composure, and in my opinion, those are very hard to teach.

 

[Emtsgv]

No one is suggesting that new providers not be given an opportunity and sufficient time to learn the job. However after a certain time if you just don't get it and keep making the same mistakes, more time is simply not the answer. A new career path is.

I agree, but it does depend on which "mistakes" are being made but i do agree after a certain point if you just cant do what needs to be done find a new career path.

 

[Emtsgv]

I'm not sure what you mean by "make it into an amb" but we get students and new employees all the time who have no business doing this job. Like others have said, the academics are not necessarily hard however its all about attitude and composure, and in my opinion, those are very hard to teach.

What i mean by "make it into an ambulance", is pass EMT school, NREMT , Ect.


if you have done all this you have some foundation and knowledge.


Attitude and composure hard to teach, maybe but you develop those over exposure imo, but i understand where you are coming from

 

[Emtsgv]

very often with people who have no business being training officers. level.

i agree with that statement

 

[TheLocalMedic]

I'm a big believer in thinning the herd when it comes to EMT and paramedic students. It's an over-saturated field as it is, and frankly I'm sick of hearing other people coddling students and trainees who simply cannot make the grade. It's not a hard course, it's certainly not a hard test, and the job itself is generally straightforward. I'm sorry if someone is having trouble, but from my experience the people who can't pass the test or are having trouble once they get in the field are either not applying themselves or have a personality that is incompatible with this line of work.

I've had to have the hard talk with both students and trainees, but it has to be done. If you think class is hard, or think your training is tough, it won't be any easier once you're on your own on an ambulance! I remind the people I cut that allowing them to "get a pass" will only do them a disservice. They don't want to be the person everyone despises because they are a weak EMT or medic.

 

[Wes]

I take a week away from EMTLife to go to EMS Expo and come back to find this thread. Awesome!

I've said more than once that there's nothing wrong with an instructor telling someone that maybe EMS isn't for them. In other words, not everyone gets a trophy.

 

[Brandon O]

The trouble is, where do you draw the line?

Some people are naturals. Some take a long time to get the hang of this job. It would be a far more barren and limited field if only the first group was allowed to stay in the game. And for every new guy you were 100% convinced will never hack it, I'll show you one who's running the show a couple years later.

That doesn't mean that everybody has what it takes. But I'll bet you don't know who does.

 

[fma08]

The trouble is, where do you draw the line?

Some people are naturals. Some take a long time to get the hang of this job. It would be a far more barren and limited field if only the first group was allowed to stay in the game. And for every new guy you were 100% convinced will never hack it, I'll show you one who's running the show a couple years later.

That doesn't mean that everybody has what it takes. But I'll bet you don't know who does.

Good place to start is the curriculum. The reality is (gonna step on toes here, but oh well) the curriculum is not overly difficult if you do the work. Does this account for all of the problem? No, but it is a logical starting point. Consistently failing or remediating through the year, and shunting people through is not good for the profession (even if they are good for your school's stats. Oh we have a 98% pass rate at our school!). If someone is consistently getting by at 70%, then they are consistently not learning 30% of the information. I'm not perfect, nor am I claiming to be, but the educational setting is the first place that we could make some widespread changes. (Without trying to turn this into a debate on whether we should have a 2 year degree, or x number of hours, etc. that's been beaten to death in other threads)

Edit: I still think schools should stick to their guns on educational standards they have in place. That's not to say that:
1. There can't/shouldn't be a remediation program in place.
2. People can't reapply and try again if they don't pass the first time around.
If there are many people consistently doing bad at your program, that is a chance for the institution to recognize that maybe they aren't providing a good education on their end. People on both sides need that kind of information and can learn and improve from it.

 

[Brandon O]

It's probably smart to distinguish between classroom and field competence. Demonstrating knowledge of a didactic curriculum is obviously important, but there are a ton of methods from the educational world for how to do this, so it shouldn't be the end of the world unless the instructor can't handle it or there's pressure to pencil-whip students past the standards.

 

[fma08]

It's probably smart to distinguish between classroom and field competence. Demonstrating knowledge of a didactic curriculum is obviously important, but there are a ton of methods from the educational world for how to do this, so it shouldn't be the end of the world unless the instructor can't handle it or there's pressure to pencil-whip students past the standards.

Yep, there is a big difference. However, quality field competence starts with strong didactic competence. It's one thing to do the field work, it is another to understand why, recognize what you need to do, and when you need to do it.

 

[Brandon O]

Yep, there is a big difference. However, quality field competence starts with strong didactic competence. It's one thing to do the field work, it is another to understand why, recognize what you need to do, and when you need to do it.

Sure, no doubt. But when many providers complain about the competence of new hires (as in this thread), I would say they typically don't mean their classroom knowledge -- which frankly may not be much greater among the experienced folks. It's about the boo-boos in the practical aspects of the work.

I certainly agree that the other thing should probably be more emphasized. I'm just guessing it's not the point of this thread. But that might depend on whether you're talking to an EMT instructor or an FTO. (Obviously there's some bias here -- students wouldn't reach the latter if they hadn't been passed by the former! So they're seeing different problems...)

 

[Altered Mental Status]

I'd like to say that I suspect it's a lot harder to come up in this business in these times.

Many of you who have been doing this for 10+ years didn't have as much of the worries about getting sued for every freakin thing on your backs and were much more free to focus on getting the job done without worrying about as much of the bureaucratic baloney. When I treat a patient, I can NOT just focus on getting my technique right, I have to focus on being very careful not to say the wrong thing, keeping track of everything that's said, not looking too clumsy or stupid but not coming off as arrogant or overconfident. I have to mince words and avoid common sense conclusions in some situations and am expected to "read between the lines" in other situations and to a degree, I'm expected to walk on the job with a certain amount of that aptitude from day one. There are now circumstances where mistakes made during clinical rotations can get you thrown out of the program.

A good portion of my training from the first day of EMT-B has been centered on NOT taking risks, NOT screwing up, NOT being okay with your mistakes. Dog forbid I forget some by-the-book detail that many of the old-timers with experience haven't bothered with for years. The old-timer will make fun of you for doing it and the school environment will "write you a chit" so-to-speak for leaving it out.

"Sometimes you have to get resourceful and use duct-tape trauma shears in creative ways," says the wise, old-dog medic.

"Never use duct tape or non-approved equipment unless you're prepared to get sued," says the book and the men in suits.

"You don't need to put a nonrebreather on this pt," says the efficient, old-dog EMT. "3L NC will be fine."

"NO! Everybody gets hi-flow O2 and treated for shock zOMG NOW!" says the book.

There's a lot of bureaucratic dissonance and confusion these days for the up-and-comer and there's a marked lack of empathy for the time it takes some of us to RELAX and figure out where we stand. It's often overwhelming.

I am NOT saying y'all didn't and don't deal with a buncha BS too...good lord knows you do and many of you handle it beautifully but not all of us are "naturals" at mastering the book knowledge AND the bedside manner AND the watch-your-step bureaucracy in an environment where we already feel like a lot is at stake if we step wrong. It's a juggling act...complete with circus clowns and a guy in a top-hat, holding a whip.

 

[TheLocalMedic]

I'd like to say that I suspect it's a lot harder to come up in this business in these times.

Many of you who have been doing this for 10+ years didn't have as much of the worries about getting sued for every freakin thing on your backs and were much more free to focus on getting the job done without worrying about as much of the bureaucratic baloney. When I treat a patient, I can NOT just focus on getting my technique right, I have to focus on being very careful not to say the wrong thing, keeping track of everything that's said, not looking too clumsy or stupid but not coming off as arrogant or overconfident. I have to mince words and avoid common sense conclusions in some situations and am expected to "read between the lines" in other situations and to a degree, I'm expected to walk on the job with a certain amount of that aptitude from day one. There are now circumstances where mistakes made during clinical rotations can get you thrown out of the program.

A good portion of my training from the first day of EMT-B has been centered on NOT taking risks, NOT screwing up, NOT being okay with your mistakes. Dog forbid I forget some by-the-book detail that many of the old-timers with experience haven't bothered with for years. The old-timer will make fun of you for doing it and the school environment will "write you a chit" so-to-speak for leaving it out.

"Sometimes you have to get resourceful and use duct-tape trauma shears in creative ways," says the wise, old-dog medic.

"Never use duct tape or non-approved equipment unless you're prepared to get sued," says the book and the men in suits.

"You don't need to put a nonrebreather on this pt," says the efficient, old-dog EMT. "3L NC will be fine."

"NO! Everybody gets hi-flow O2 and treated for shock zOMG NOW!" says the book.

There's a lot of bureaucratic dissonance and confusion these days for the up-and-comer and there's a marked lack of empathy for the time it takes some of us to RELAX and figure out where we stand. It's often overwhelming.

I am NOT saying y'all didn't and don't deal with a buncha BS too...good lord knows you do and many of you handle it beautifully but not all of us are "naturals" at mastering the book knowledge AND the bedside manner AND the watch-your-step bureaucracy in an environment where we already feel like a lot is at stake if we step wrong. It's a juggling act...complete with circus clowns and a guy in a top-hat, holding a whip.

Is it appropriate to laugh when someone sounds so sincere? Today's EMT and paramedicine courses have in many respects been dumbed down to accommodate the demand for and influx of new practitioners and students. The first paramedics were taught by physicians and were often expect to have physician level knowledge. EMT courses are essentially advanced first aid, and aren't too different from what is taught in the Boy Scouts. Sure, bedside manner is often a learned skill, but saying that watching out for legal pitfalls puts an added burden on "new" practitioners is like saying that "new fangled traffic lights" makes it nearly impossible to get a drivers license.

Yes, both books and anecdotal stories warn of the dangers of making a misstep that will get you sued, but in all my years I have yet to actually go through any serious litigation.

And yes, you ARE expected to "walk on the job with a certain amount of aptitude". You should learn the basics in your course AND have the proper personality and demeanor for this job. Just like you're supposed to have a certain affect as a law enforcement officer, a banker, a salesman or a manager. You must possess a good working knowledge of the job you are expected to perform and have the aptitude to quickly learn and apply the field experience you pick up in training.

And also yes, "NOT being okay with your mistakes" is an inherent part of this work. If I mess up, I'm NOT okay with that. But I learn from it and grow. Accepting failure is not an option! Yes, there is a learning curve during the transition from school to the field, but we WANT the people who accept nothing less than perfection. We WANT people who strive to be the best they can be, and we deride those who accept mediocrity.

It can be a rough, arduous road from civilian to paramedic, but if you truly want to be successful in this job you will apply yourself and learn all you can to do it well. Saying that watching out for potential litigation poses an added hurdle to doing this job successfully is not only insulting, but also demonstrates how little you know about actually doing this job in real life.

The "old dogs" have much wisdom and advice for you "young pups", and you would do well to listen. Before 12 leads we were doing modified chest lead placement in the field, and CHF patients were often nasally intubated because CPAP wasn't an option. Things have changed, and the old dogs have changed with them. The old dogs were running calls before most EMT students were born, and they have seen more than you can probably imagine. They won't always talk about it, but they were there for some of the most wild and crazy times that EMS has seen.

So don't say that the new guys have it tough. The old dogs have proven themselves and have demonstrated that they can survive the job and adapt to all the changes that have come. You think the old dogs are immune to litigation? Think again. We're working in the field just like you, and we're just as susceptible to errant (or justified) lawsuits as you are. But the old dogs have learned the tricks of the trade and know how to talk to and treat patients in a way that not only does them the best good but also avoids any potential legal problems.

Learn from the old dogs. They may be a tad hard of hearing, but we can teach you how to survive and succeed in EMS. Your training isn't any harder or easier than ours was, and we dealt with the same struggles when we were new.

 

[Brandon O]

I'd like to say that I suspect it's a lot harder to come up in this business in these times.

Many of you who have been doing this for 10+ years didn't have as much of the worries about getting sued for every freakin thing on your backs and were much more free to focus on getting the job done without worrying about as much of the bureaucratic baloney.

Nah... I think getting sh*tcanned at the drop of a hat is as old as Johnny and Roy.

 

[Christopher]

Sure, no doubt. But when many providers complain about the competence of new hires (as in this thread), I would say they typically don't mean their classroom knowledge -- which frankly may not be much greater among the experienced folks. It's about the boo-boos in the practical aspects of the work.

I certainly agree that the other thing should probably be more emphasized. I'm just guessing it's not the point of this thread. But that might depend on whether you're talking to an EMT instructor or an FTO. (Obviously there's some bias here -- students wouldn't reach the latter if they hadn't been passed by the former! So they're seeing different problems...)

My service may be in the minority, but we stress to our new volunteers and hires that we can get plenty of technicians on scene at the drop of the hat (read: I can request an engine company whenever I want), but what I really need with me are additional clinicians.

I can always cobble together enough folks to move a patient to my truck, and I can always find somebody with a driver's license valid enough to get me to the hospital.

I have a much harder time finding somebody who can help me take care of the patient.

So my big deal is finding folks who put their nose to the grindstone for the didactic portion and realized the operations aspect of the job really aren't anywhere near the rocket surgery some FTO's make it out to be.

 

[Brandon O]

My service may be in the minority

Your service is a bizarre other-worldly utopia as like unknown to normal mortal men.

Plus you get barbecue.

 

[triemal04]

Many of you who have been doing this for 10+ years didn't have as much of the worries about getting sued for every freakin thing on your backs and were much more free to focus on getting the job done without worrying about as much of the bureaucratic baloney. When I treat a patient, I can NOT just focus on getting my technique right, I have to focus on being very careful not to say the wrong thing, keeping track of everything that's said, not looking too clumsy or stupid but not coming off as arrogant or overconfident. I have to mince words and avoid common sense conclusions in some situations and am expected to "read between the lines" in other situations and to a degree, I'm expected to walk on the job with a certain amount of that aptitude from day one. There are now circumstances where mistakes made during clinical rotations can get you thrown out of the program.

That sounds very much like how things have been for a long, long time. The better programs have always been willing, ready and able to dismiss students for failures during their didactic, clinical, and internship time. As they should. And since I've been doing this for more than 10 years, who do I notify so that I can slack of, start pissing off patients, family members, medical professionals, and stop doing my job appropriately?

A good portion of my training from the first day of EMT-B has been centered on NOT taking risks, NOT screwing up, NOT being okay with your mistakes. Dog forbid I forget some by-the-book detail that many of the old-timers with experience haven't bothered with for years. The old-timer will make fun of you for doing it and the school environment will "write you a chit" so-to-speak for leaving it out.

That is nothing new. It's what happens when the educational content for EMT's (and paramedics) is so low and when the standards for school's are minimal.

There's a lot of bureaucratic dissonance and confusion these days for the up-and-comer and there's a marked lack of empathy for the time it takes some of us to RELAX and figure out where we stand. It's often overwhelming.

That is nothing new. How much will an individual will deal with will vary, not by year to year, but from location to location.

I am NOT saying y'all didn't and don't deal with a buncha BS too...good lord knows you do and many of you handle it beautifully but not all of us are "naturals" at mastering the book knowledge AND the bedside manner AND the watch-your-step bureaucracy in an environment where we already feel like a lot is at stake if we step wrong. It's a juggling act...complete with circus clowns and a guy in a top-hat, holding a whip.

But you actually are. People have gone through what you have, and go through what you have constantly. And for many reasons will continue to do so.

Stop with the "woe is me" attitude that is displayed in this post. Calm down. Take a deep breath. Take another. And relax. You are making this much harder than it is, and doing it to yourself.

If this is just ranting and blowing off steam, ok, no problem, everybody needs to do that. Just be aware that you've said a lot of innacurate things and are portraying yourself in a terrible light. But if this is your actual attitude, it will come across very clear to those around you, and most likely they will react in kind. It's something to consider since you are having problems.

 

[DrParasite]

Learn from the old dogs. They may be a tad hard of hearing, but we can teach you how to survive and succeed in EMS. Your training isn't any harder or easier than ours was, and we dealt with the same struggles when we were new.

I call BS on this statement.

As someone who respects what a lot of the old dogs went through over the past 30 years, I can honestly say I have heard stories that they have told that not only worry me, but wonder how they can say they did that in the past and now that they are bosses chastize the new guys for doing stuff not nearly as bad. and most of that stuff makes me wish i had been born 20 years earlier and gotten involved in EMS in the early 90s.

There are a lot of old guys who cut corners. and in 90% of the time, there is not problem with what they did. 9%, of the time how they didn't get burned can amaze people. and in that last 1%, well, the only explanation I can give is that it was brushed under the rug.

Their training was a lot different than ours was. there was a lot more hands on, and from what I hear, they learned a lot on the job by trial and error (ie, gaining experience on the job), while many students are expected to be all knowing after school. The mentality was a lot different, and the expectations were higher; similarly, they taught their new people how to do the job, and when you screwed up, you heard about it, from the senior guy, and the FTO, and maybe the boss... without needing a written reprimand.

The old guys saw a lot of stuff, and helped pave the way for what EMS has become.

But I will take a fully educated paramedic vs an EMT who has been doing the job for 20 years and is still doing things this way "just because we have always done it this way" and no one has died yet.

BTW, I would love to drop EMT students who can't pass the test, and fire people who can't do the job. Everyone deserved a second chance, but after a while you need to recognize that this field just isn't for you.

 

[kev]

Hello everybody, long time lurker, first time poster. I am an emt b student currenty and cannot agree more that some people who try this class out are really not cut out for it. It seems, at least in my limited opinion, that most of the students that show up to my class dismayed and looking for reassurance haven't put forth the necessary effort to make sure that they understand the material before class. Granted, it is a lot of information to build a new knowledge base out of, and I have to work hard to make sure I understand it all, but ot should be stressful. That is all preparation for the field. If someone cannot handle the stress of a test in a classroom setting, I don't think I would want them showing up at my house when someone is dying. I'm also not sure how the ems education system works in the rest of the country, but our instructors have no problem dropping students left and right. Last semester only 35% of the students enrolled passed the class. The flip side is that more than 90 % of them passed the state exam. I think that is how ems education should be.

 

[Tigger]

I'm not sure it's valid to say that the people who get stressed about test taking are bound to be stressed in the field. It's apples to oranges. I know plenty of people who get unnecessarily nervous about tests, but still learned the content. While I think saying "I'm a bad test-taker" is a crutch, there are people out there who get overly stressed about examinations, but that does not translate into job performance. Now if someone is really stressed about the test because they didn't bother to learn the material, that's different.

We have an EMT where I work who studied for weeks ahead of our medical director's annual clinical competency visit. She was a total stress case and when it came time to do a scenario or two she totally lost it. Just started barking out random parts of an NREMT trauma assessment for a CHF patient. She just couldn't deal with our doc asking her questions. But when she's out on calls, she's one of our better EMTs, and while a little high strung at times, is always calm and better yet, knows pretty well what she is doing.