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.

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