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Thursday, February 11, 2010

The Creation Of A Paramedic

When people call 911 (not your bull sh*t calls but your real emergencies) I'm quite positive that the caller never stops to think about the process, training, education and testing that goes into making a paramedic. All they care about is the fact that someone is coming that knows what to do and how to do it. I've been in a bad car accident where I was knocked unconscious. Luckily I came to after about 30 seconds. Hearing the sirens coming was a comforting thing. I knew help was almost there.

I can't speak about how to become a medic in other parts of the country but I know a bit about doing it here in California. There are some variances of course. First, you have to go to EMT school. Lengths vary but it's at least 110 hours for your national license. After passing your national EMT test you are now ready to work in most counties. Some may still have you pass another test. Then, after working for at least 6 months (this is the bare minimum but more time is preferred) you can apply to a paramedic program.

Paramedic programs have different prerequisites. All require experience as an EMT. Some require Anatomy and Physiology courses, Medical Terminology, letters of recommendation, a pre-course put on by the school, entrance exams, interviews and I'm sure a host of other things to make it difficult to get in. It's a competitive process. Some private programs can cost upwards of $15,000. Some programs at community colleges only cost about $1,500. Most are somewhere in between. Program length is anywhere from 12 weeks, where you're in class Monday through Friday from 8-5, to a couple of years where you're in class once or twice a week. There are pros and cons to each of these variables. When all is said and done the paramedic student must pass all the testing in the didactic portion of the program and be able to pass the national exam.

After the in class portion the student starts a hospital rotation. They spend roughly 240 hours in the hospital seeing patients and practicing skills (in some programs this can be done concurrently with the classroom portion). Then the student starts the field internship. This is probably the most terrifying part of becoming a medic. During this time (roughly 500 hours) you have to prove to an experienced paramedic, called a preceptor, that you have what it takes to do this job. They aren't there to teach you (but you do learn a lot). They are there to judge you. I can remember after one particularly stressful call (a 4 year old that had stopped breathing) my preceptor asked me what I had done on that call to make him fail me. My heart sank. I didn't think I had screwed up at all. I made some tough decisions and I stood by them. After letting me stress for about 5 seconds, which seemed like an eternity, he said, "Nothing. you did great. Relax and enjoy the job!" I could have killed him.

Now that I'm on the other side of the process (as an instructor at a local paramedic program) it's interesting to see the students thought process develop. You can see their minds working trying to put together the clinical findings and their knowledge of pathophysiology to determine the correct treatment for a patient. Normally, it's fairly simple. The problems occur when the patient has one or more underlying medical conditions which have their own set of signs and symptoms, but their current "emergency" is based off of something else entirely. An example. A patient may have CHF and emphysema as underlying medical problems. They will probably have some messed up lungs sounds (expiratory wheezing and rales in the bases) but that would be normal for them. They called 911 because they can't breath. While listening to lung sounds the student also hears rhonchi on the right side (in addition to those already mentioned). The patient has a fever and has been coughing up green phlegm. So does the medic treat the CHF, the emphysema or the possible pneumonia? These are the calls where medics earn their paychecks. Hopefully, by the end of their training, my medic students will all know what to do.

 First Day of Paramedic School

Last Day of Paramedic School
 First Day of Paramedic School
Last Day of Paramedic School
This is from a paramedic program's website. There's some truth in there.

So next time you see a paramedic (preferably when they're not responding to a call) take a second and thank him for the countless hours he or she has put in to be able to know what to do when you need them most.


S said...

Great post! Nice reminder that you guys are more than taxi drivers.

Re: that feeling when a paramedic shows up when you truly need one - I just read a wonderful blog post by a UK medic, with a letter from a grateful patient. It is here:

Thought you'd enjoy reading it.

Thanks for your service!

maxwelton's braes are bonny said...

Seriously good post. Yes, the amount of knowledge and skill of a paramedic far out does my RN - even on the best of days. I wish that they were given more credit and better pay. You truly deserve it. I,too, am greatful for when medics helped me after my horrific ski accident. With out them, I wouldn't be here today. Thank you.

melaniek said...

Awesome post...I am so passing this along to my hubby!

Oh and don't want to forget...

Thanks for all you hard work and time away from your family, so you can be out there helping others! It takes special people to do what you guys do!

Hydrant girl said...

I wish I had 6 months experience as an EMT before starting my PCP course.... here you just need the course, not even the provincial / state licence before enrolling in the PCP course. As for high school / college courses? Nope, just a GED or diploma. Makes for interesting / stressful class time.

I think the minimum experience as an EMT would be such an asset to us. Instead they just increased the in-class time extending the course to 3 times the duration.

Firefighter/Paramedic said...

Hydrant girl- I've found that the more experience the EMT has before medic school, the better they do. When you learn about something like CHF (for example) you no longer think of it in an abstract way but think of patient's that you've treated as an EMT.

Max- Not many RN's will concede that point (even though every medic thinks it's true). :)

Anonymous said...

Thanks for the insight, I start medic training in a week!

Alex said...

Such a wonderful, inspiring post for anyone who may be just getting ready to begin their paramedic training!

It's a shame that, in general, we all don't often think about how hard someone works to get where they are. People in EMS are taken for granted so much (from wages to overall societal standing), that it's great to see a post that call attention to this oversight and brings it right to the forefront.

It takes a lot of how work to become a paramedic, and it's FAR overdue that we start commending anyone and everyone who takes the time to train now so that they can save lives later.

Firefighter/Paramedic said...

Alex, a lot of the blame for EMTs and medics not getting the respect of the medical community lies with ourselves. We need to hold ourselves to a higher standard. Once others see that they will begin to view us in the same way. This puts pressure on those that aren't up to par.

That being said, I agree with you.

Anonymous said...

This website is stupid.

Firefighter/Paramedic said...

At least you were man enough to not post that anonymously... Oh wait...

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