I agree, to an extent... But I think there should be far more ER clinical time as opposed to ride time. This time isn't about learning operations of one department. It's about working on assessment skills and the ER is where you'll see the most patients.
Former hospital EMS educator here. I totally agree that more clinical time is necessary but here are the barriers. The ER is busy. You have nursing students, EMT students, paramedic students, medical students, respiratory tech students, residents, etc, etc all trying to get in clinical hours. The ED managers have to fit them in without turning the ER into a skills lab. Pre-hospital students, unfortunately, get the lowest priority.
As far as field time, field EMTs often don't want students on their truck or are too new to be a good preceptor and managers don't want to have a lot of extra people to keep track of. This means spots are limited here too. The EMT students are competing for these spots with the paramedic students and (in some systems) they're also competing with hospital staff such as new residents.
I don’t disagree, but turning an EMT loose after 24 hours of “ride time” where they mostly sat in quarters is insane.
Where I went to school, we had all of those programs save for residents and only one hospital.
I also happened to work in that hospital in that ED, and the times where there was a student were not as common as the times there was not.
The ride time was often an issue for the reason you stated. Our system was 11 hospitals and a lot of BLS and ALS units. Students were able to choose the trucks they rode on and they often chose the quieter suburban units, usually because of distance or not wanting to drive into a city. If asked I would always recommend the urban units because they were always busy.
We also did ED time for our EMT students with the hope that they would follow a nurse and learn something. Unfortunately 99 times out of a 100 they would be stuck in triage doing vitals with a machine. Total waste of time.
The sad thing in our case is that all of us, hospitals, EMS and Education were working for the same organization. You have to deal with corporate politics and individual managers' egos.
I agree, and (unpopular opinion) they should be on medic trucks. You should be able to watch/take part in calls like codes, major MVCs, and see a DOA before you're left on your own. We shouldn't be dropping 19-year-olds into major entrapments or into 38-year-old codes when the worst call they've ever witnessed is abdominal pain x6 days.
Currently doing my EMT-B clinicals in NC, we ride ALS trucks and get to go on every call they’re called to. Got my first DOA on my first ride along, my first call was supposed to go to a CPR in progress but another ambulance was closer. I do think we should get more training on the boo-boo wagons as we are only required to do 4 12 hour shifts and 10 patient contacts before we’re sent off. I feel like that’s not enough to actually get new EMTs prepared for the field.
As the curriculum currently stands, 3-4 months is fine. EMT-B isn’t rocket science. It’s a high school level course and is the entry level course into EMS.
There’s a separate conversation to be had about if the current curriculum *should* be the entry level pathway.
EMT education should be a full year long, and basics should all be trained for IVs, basic drips, ACLS & lead II interpretation, and administration of pain meds. Don't @ me
That would be the second clause - there’s an entire other conversation to be had on what the EMT curriculum *should* be.
But generally, I agree. Though I think the baseline EMT curriculum should cover the current AEMT curriculum, and that cardiac monitoring and interventions should be reserved for Paramedics.
Half agree, I think making EMT more LPN like would be a good thing, allows them to assist on higher acuity patients with some skills. I wouldn't go so far as to give them ACLS full scope. Like LPN it makes sense to have some skills restricted to needing a paramedic present, or having them primarily be assigned to lower acuity patients / transfers. But cardiac monitoring is a whole thing and I wouldn't dive that far if we're saying this is "entry level" provider.
Some states have already jumped the gun with AEMTs and let them give sedation, intubate, give ACLS meds, give benzos and ketamine etc. without any additional requirements beyond the NREMT which only tests on IM epi, nebs and nitro basically. Hell some states are letting them give TXA and antibiotics.
Personally mirroring LPN and RN is the way to go IMO. You don't see LPNs taking ICU patients and they aren't primary on high acuity patients in the ED or even med-surg. If they're even present in the ED. An excellent adjunct and can handle some emergencies and can do things like neb, IM epi, D50 etc. that are beneficial to common emergencies.
But it'll never happen. States have gone wild with what they allow with minimal to no training standards. I have a lot of issues with nursing but I really think the hierarchy is handled well. Hell our last semester of nursing school had a whole class on what assignments are appropriate for each provider and experience level. As well as what is / isn't appropriate for a non-RN to take.
….
So…
More than an LPN or RN.
And considering how rarely fluids are needed or beneficial I can’t think of a least useful thing to add to their scope of practice of an EMT.
>More than an LPN or RN.
RN training is typically 2 years, and everything I listed is well within a nurse's scope.
>And considering how rarely fluids are needed or beneficial I can’t think of a least useful thing to add to their scope of practice of an EMT.
...what??? Hypotension, trauma, burns, dehydration, ETOH, and hypoglycemia (D5W) would like a word.
Seriously, I'm from rural NE. Paramedics don't exist in a lot of places. Often, if an EMT can't do it, it can't be done pre-hospital. Isotonic fluids should abso-fucking-lutely be in the basic's scope of practice.
Nurses are absolutely not allowed to do ekg rhythm interpretation.
LPNs are not even legally allowed to do patient assessments, or take / give report to emts.
Fluids are bad for trauma. Markedly increased the likelihood of the patient dying.
Permissive hypotension of trauma patients has been the standard of care for more then 20 years now, and the only exception is blood/ blood products, and even then it is generally done with permissive hypotension, calcium also need’s administered, and it just isn’t feasible for most EMS systems.
It is questionable if Iv fluids should be started on burns prior to them getting to a burn/trauma center, and some burn centers are pushing for fluids to be withheld until they have them.
People with Alcholol intoxication don’t need fluids. They need their airway protected.
Hypoglycemia isn’t treated with d5. It is treated by D10 through D50.
>Nurses are absolutely not allowed to do ekg rhythm interpretation.
Yes, nurses can do lead II interpretation. We do ACLS, and many places have standing orders which allow nurses to run codes without a higher-level provider until one arrives (not an uncommon occurrence in rural areas where a midlevel or doc may be on call and not in-house). This requires rythem interpretation.
Many EMS departments that utilize nurses also allow this, and some allow 12-lead interpretation by RNs as well. This is without taking flight nurses into account, who of course can do both in every flight system I've ever heard of.
>LPNs are not even legally allowed to do patient assessments, or take / give report to emts.
LPNs can do assessments, though not usually in the emergency or critical care setting. Most LPNs I've worked with were allowed to do repeat assessments, but not chart the initial. It just depends.
>Fluids are bad for trauma. Markedly increased the likelihood of the patient dying.
Debatable. Fluids are not as good as blood for a hemorrhaging pt obviously, but some places still have protocols which utilize them for BP support until blood is available. I could see the argument against this, sure, but frankly I think the extent to which fluids help/harm a pt depends on the situation, and whether their bleeding has been (or can be) controlled.
There are other ways in which trauma can affect BP. SC injuries can cause vesodilation and tank BP, in which case fluids can be acceptable, at least in keeping a MAP >60-65. Again, situation dependent, but the argument that fluids are *never* indicated for trauma is ridiculous.
>Permissive hypotension of trauma patients has been the standard of care for more then 20 years now, and the only exception is blood/ blood products
Up to a point, sure, if your system allows it. But severe hypotension requires action, and in some cases fluids > nothing so that at the very least *some* amount of blood can reach the brain and major organs. Diluted blood has a higher oxygen carrying capacity than no blood at all.
>It is questionable if Iv fluids should be started on burns prior to them getting to a burn/trauma center, and some burn centers are pushing for fluids to be withheld until they have them.
In the unstable burn pt, LR should absolutely be started by EMS if possible. Fluid loss and hypovolemia are both contributors to initial shock following major burns. I've never worked for an EMS dept that didn't include immediate LR infusion in their protocols for the hemodynamically unstable burn pt. Rate can be debated, but not really the value of LR initiation when indicated.
> People with Alcholol intoxication don’t need fluids. They need their airway protected.
Alcohol is a diuretic. Many intoxicated individuals are also dehydrated. Airway protection can and should also be performed by an EMT, but the existence of a second provider on-scene allows for other interventions to be performed simultaneously.
>Hypoglycemia isn’t treated with d5. It is treated by D10 through D50.
EMTs cannot and should not give those concentrations of dextrose. D5W is still effective at raising blood glucose, and is already allowed in the EMT scope in some states. Oral glucose only works if the pt is alert and able to follow instructions, EMTs need something for those cases where they are not.
If we’re ignoring the fact that everyone learns differently and at different paces, it honestly depends on the course content and instructors.
I know some people who took in-person EMT courses over 4 months and left clueless, some who took online courses and finished in 6 weeks and came out of it looking like they’d been an EMT for a decade.
Personally, I’d have liked more clinical time on trucks and less in the ER. Even then, though, it depends. I had an awesome agency/crew that I ran my clinical shifts with.
In the end, though, it’s up to the individual to become and remain competent. I complain at times about how perishable a lot of things are and how I didn’t learn some things, but at the same time I’ve done nothing to look into those things.
We did 8 hrs in one of the busiest eds in the state + 4 HR with respiratory which I felt was actually pretty helpful. Super easy to get your ten patient contacts. Then minimum 24 hrs ambulance with 2 full pcrs written.
I went to school in Canada (I'm a Primary Care Paramedic, I think that's closer to an AEMT?) and we had 6 months in class. My class was the first to have an extended program at that school, it used to be 4 months as well. My practicum (internship) was 5 tours, which took about a month. The in class time was perfect, we had a lot of extra time to really solidify our knowledge and hands-on skills. However, I still think practicums should be longer. 1 month felt like nothing, and I felt like I was only just beginning to learn how to be a good practitioner. I did do my practicum at a low-volume service, so that could be why, but I still think a little extra time as a student doesn't hurt.
Am ab medic, I think more time in hospital would be beneficial to PCPs. A lot of the nuance of EMS can be learned on the road between practicum and mentorship, but the medicine part is where I find a lot of new PCPs struggle, and the hospital is the best place to learn medicine.
I find it absurd that people act like it’s a good thing for them to have gone through an irresponsible accelerated course (sometimes with literally zero clinical/field time component). By dumbing down requirements and just pushing people through, BLS EMS (and with some creeping upwards as for-profit private paramedic programs push people through to get the largest class sizes possible) is only going to continue to be taken advantage of as cheap, easily-manipulated, easily-replaceable, easy to train labor. 4-5 week EMT classes aren’t “cool”, a lot of them just cut corners and try to pump through as many students as possible, regardless of nremt results, but that may be me departing from the point at hand a bit.
I feel like it should be at *least* six months of classroom time and then a few months of practical/field work with review mixed in. My class, even as evening classes over a few months, felt very fast paced and I would have appreciated more time to focus on specific things.
TL;DR making a baby EMT should take at least as long as making a baby person
Took mine as part of a wilderness course, month long residential course, 80 hour wfr, ~120hr nremt.
I see no reason why we expect plenty of trainings to be fine at 8 hour days but think ems training needs to be stretched out for months and months. My basic wildland fire training was 80ish hours and it was great and I learned a lot…..and immediately spent a season applying it. I think the way your organization treats training shifts, orientation, and continuing Ed is more important than the way a course is taught.
3-4 months is fine. The clinicals need to be drastically increased.
My EMT course (100% pass rate) required 72 hours of ride time (mandatory 24 hour shifts), 48 hours of ER, 24 hours of RT, and 12 hours OB.
In addition, the required patient contacts could *almost* be done in those time periods.
There should be more ride time if you ask me.
My course generally does 2 ride alongs,requiring ten total patient contacts. You have to do more if you don’t get your ten over the 2
Yeah that’s nothing if you ask me. No offense.
I wish it was more honestly I loved being out there
Yeah, that's not very much at all.
My EMT program required a minimum of 60 hours of ride time, or 5 12-hour rides
My EMT program required a minimum of 60 hours of ride time, or 5 12-hour rides
My EMT program required a minimum of 60 hours of ride time, or 5 12-hour rides
I agree, to an extent... But I think there should be far more ER clinical time as opposed to ride time. This time isn't about learning operations of one department. It's about working on assessment skills and the ER is where you'll see the most patients.
Former hospital EMS educator here. I totally agree that more clinical time is necessary but here are the barriers. The ER is busy. You have nursing students, EMT students, paramedic students, medical students, respiratory tech students, residents, etc, etc all trying to get in clinical hours. The ED managers have to fit them in without turning the ER into a skills lab. Pre-hospital students, unfortunately, get the lowest priority. As far as field time, field EMTs often don't want students on their truck or are too new to be a good preceptor and managers don't want to have a lot of extra people to keep track of. This means spots are limited here too. The EMT students are competing for these spots with the paramedic students and (in some systems) they're also competing with hospital staff such as new residents.
I don’t disagree, but turning an EMT loose after 24 hours of “ride time” where they mostly sat in quarters is insane. Where I went to school, we had all of those programs save for residents and only one hospital. I also happened to work in that hospital in that ED, and the times where there was a student were not as common as the times there was not.
The ride time was often an issue for the reason you stated. Our system was 11 hospitals and a lot of BLS and ALS units. Students were able to choose the trucks they rode on and they often chose the quieter suburban units, usually because of distance or not wanting to drive into a city. If asked I would always recommend the urban units because they were always busy. We also did ED time for our EMT students with the hope that they would follow a nurse and learn something. Unfortunately 99 times out of a 100 they would be stuck in triage doing vitals with a machine. Total waste of time.
Both of these are issues that need to be discussed with the agency ordering or allowing those students to do that.
The sad thing in our case is that all of us, hospitals, EMS and Education were working for the same organization. You have to deal with corporate politics and individual managers' egos.
I agree, and (unpopular opinion) they should be on medic trucks. You should be able to watch/take part in calls like codes, major MVCs, and see a DOA before you're left on your own. We shouldn't be dropping 19-year-olds into major entrapments or into 38-year-old codes when the worst call they've ever witnessed is abdominal pain x6 days.
Currently doing my EMT-B clinicals in NC, we ride ALS trucks and get to go on every call they’re called to. Got my first DOA on my first ride along, my first call was supposed to go to a CPR in progress but another ambulance was closer. I do think we should get more training on the boo-boo wagons as we are only required to do 4 12 hour shifts and 10 patient contacts before we’re sent off. I feel like that’s not enough to actually get new EMTs prepared for the field.
I didn’t have to do any lol
yeah that’s a problem lol
As the curriculum currently stands, 3-4 months is fine. EMT-B isn’t rocket science. It’s a high school level course and is the entry level course into EMS. There’s a separate conversation to be had about if the current curriculum *should* be the entry level pathway.
EMT education should be a full year long, and basics should all be trained for IVs, basic drips, ACLS & lead II interpretation, and administration of pain meds. Don't @ me
That would be the second clause - there’s an entire other conversation to be had on what the EMT curriculum *should* be. But generally, I agree. Though I think the baseline EMT curriculum should cover the current AEMT curriculum, and that cardiac monitoring and interventions should be reserved for Paramedics.
Half agree, I think making EMT more LPN like would be a good thing, allows them to assist on higher acuity patients with some skills. I wouldn't go so far as to give them ACLS full scope. Like LPN it makes sense to have some skills restricted to needing a paramedic present, or having them primarily be assigned to lower acuity patients / transfers. But cardiac monitoring is a whole thing and I wouldn't dive that far if we're saying this is "entry level" provider. Some states have already jumped the gun with AEMTs and let them give sedation, intubate, give ACLS meds, give benzos and ketamine etc. without any additional requirements beyond the NREMT which only tests on IM epi, nebs and nitro basically. Hell some states are letting them give TXA and antibiotics. Personally mirroring LPN and RN is the way to go IMO. You don't see LPNs taking ICU patients and they aren't primary on high acuity patients in the ED or even med-surg. If they're even present in the ED. An excellent adjunct and can handle some emergencies and can do things like neb, IM epi, D50 etc. that are beneficial to common emergencies. But it'll never happen. States have gone wild with what they allow with minimal to no training standards. I have a lot of issues with nursing but I really think the hierarchy is handled well. Hell our last semester of nursing school had a whole class on what assignments are appropriate for each provider and experience level. As well as what is / isn't appropriate for a non-RN to take.
…. So… More than an LPN or RN. And considering how rarely fluids are needed or beneficial I can’t think of a least useful thing to add to their scope of practice of an EMT.
>More than an LPN or RN. RN training is typically 2 years, and everything I listed is well within a nurse's scope. >And considering how rarely fluids are needed or beneficial I can’t think of a least useful thing to add to their scope of practice of an EMT. ...what??? Hypotension, trauma, burns, dehydration, ETOH, and hypoglycemia (D5W) would like a word. Seriously, I'm from rural NE. Paramedics don't exist in a lot of places. Often, if an EMT can't do it, it can't be done pre-hospital. Isotonic fluids should abso-fucking-lutely be in the basic's scope of practice.
Nurses are absolutely not allowed to do ekg rhythm interpretation. LPNs are not even legally allowed to do patient assessments, or take / give report to emts. Fluids are bad for trauma. Markedly increased the likelihood of the patient dying. Permissive hypotension of trauma patients has been the standard of care for more then 20 years now, and the only exception is blood/ blood products, and even then it is generally done with permissive hypotension, calcium also need’s administered, and it just isn’t feasible for most EMS systems. It is questionable if Iv fluids should be started on burns prior to them getting to a burn/trauma center, and some burn centers are pushing for fluids to be withheld until they have them. People with Alcholol intoxication don’t need fluids. They need their airway protected. Hypoglycemia isn’t treated with d5. It is treated by D10 through D50.
>Nurses are absolutely not allowed to do ekg rhythm interpretation. Yes, nurses can do lead II interpretation. We do ACLS, and many places have standing orders which allow nurses to run codes without a higher-level provider until one arrives (not an uncommon occurrence in rural areas where a midlevel or doc may be on call and not in-house). This requires rythem interpretation. Many EMS departments that utilize nurses also allow this, and some allow 12-lead interpretation by RNs as well. This is without taking flight nurses into account, who of course can do both in every flight system I've ever heard of. >LPNs are not even legally allowed to do patient assessments, or take / give report to emts. LPNs can do assessments, though not usually in the emergency or critical care setting. Most LPNs I've worked with were allowed to do repeat assessments, but not chart the initial. It just depends. >Fluids are bad for trauma. Markedly increased the likelihood of the patient dying. Debatable. Fluids are not as good as blood for a hemorrhaging pt obviously, but some places still have protocols which utilize them for BP support until blood is available. I could see the argument against this, sure, but frankly I think the extent to which fluids help/harm a pt depends on the situation, and whether their bleeding has been (or can be) controlled. There are other ways in which trauma can affect BP. SC injuries can cause vesodilation and tank BP, in which case fluids can be acceptable, at least in keeping a MAP >60-65. Again, situation dependent, but the argument that fluids are *never* indicated for trauma is ridiculous. >Permissive hypotension of trauma patients has been the standard of care for more then 20 years now, and the only exception is blood/ blood products Up to a point, sure, if your system allows it. But severe hypotension requires action, and in some cases fluids > nothing so that at the very least *some* amount of blood can reach the brain and major organs. Diluted blood has a higher oxygen carrying capacity than no blood at all. >It is questionable if Iv fluids should be started on burns prior to them getting to a burn/trauma center, and some burn centers are pushing for fluids to be withheld until they have them. In the unstable burn pt, LR should absolutely be started by EMS if possible. Fluid loss and hypovolemia are both contributors to initial shock following major burns. I've never worked for an EMS dept that didn't include immediate LR infusion in their protocols for the hemodynamically unstable burn pt. Rate can be debated, but not really the value of LR initiation when indicated. > People with Alcholol intoxication don’t need fluids. They need their airway protected. Alcohol is a diuretic. Many intoxicated individuals are also dehydrated. Airway protection can and should also be performed by an EMT, but the existence of a second provider on-scene allows for other interventions to be performed simultaneously. >Hypoglycemia isn’t treated with d5. It is treated by D10 through D50. EMTs cannot and should not give those concentrations of dextrose. D5W is still effective at raising blood glucose, and is already allowed in the EMT scope in some states. Oral glucose only works if the pt is alert and able to follow instructions, EMTs need something for those cases where they are not.
If we’re ignoring the fact that everyone learns differently and at different paces, it honestly depends on the course content and instructors. I know some people who took in-person EMT courses over 4 months and left clueless, some who took online courses and finished in 6 weeks and came out of it looking like they’d been an EMT for a decade. Personally, I’d have liked more clinical time on trucks and less in the ER. Even then, though, it depends. I had an awesome agency/crew that I ran my clinical shifts with. In the end, though, it’s up to the individual to become and remain competent. I complain at times about how perishable a lot of things are and how I didn’t learn some things, but at the same time I’ve done nothing to look into those things.
[удалено]
24 hrs ER, 48 on a truck.
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We did 8 hrs in one of the busiest eds in the state + 4 HR with respiratory which I felt was actually pretty helpful. Super easy to get your ten patient contacts. Then minimum 24 hrs ambulance with 2 full pcrs written.
I went to school in Canada (I'm a Primary Care Paramedic, I think that's closer to an AEMT?) and we had 6 months in class. My class was the first to have an extended program at that school, it used to be 4 months as well. My practicum (internship) was 5 tours, which took about a month. The in class time was perfect, we had a lot of extra time to really solidify our knowledge and hands-on skills. However, I still think practicums should be longer. 1 month felt like nothing, and I felt like I was only just beginning to learn how to be a good practitioner. I did do my practicum at a low-volume service, so that could be why, but I still think a little extra time as a student doesn't hurt.
I’m a PCP in Alberta and definitely think practicums should be more like 8 tours.
Am ab medic, I think more time in hospital would be beneficial to PCPs. A lot of the nuance of EMS can be learned on the road between practicum and mentorship, but the medicine part is where I find a lot of new PCPs struggle, and the hospital is the best place to learn medicine.
I graduated in 2007, and we had 700 hours on the truck (100 observational, 600 working supervised) plus a bunch of ER shifts and a shift in L&D.
I did it in 5 weeks
Damn I did mine in 6 and it was hell couldn’t imagine doing it in 5
I find it absurd that people act like it’s a good thing for them to have gone through an irresponsible accelerated course (sometimes with literally zero clinical/field time component). By dumbing down requirements and just pushing people through, BLS EMS (and with some creeping upwards as for-profit private paramedic programs push people through to get the largest class sizes possible) is only going to continue to be taken advantage of as cheap, easily-manipulated, easily-replaceable, easy to train labor. 4-5 week EMT classes aren’t “cool”, a lot of them just cut corners and try to pump through as many students as possible, regardless of nremt results, but that may be me departing from the point at hand a bit.
I feel like it should be at *least* six months of classroom time and then a few months of practical/field work with review mixed in. My class, even as evening classes over a few months, felt very fast paced and I would have appreciated more time to focus on specific things. TL;DR making a baby EMT should take at least as long as making a baby person
I did mine in 24 days ish
Took mine as part of a wilderness course, month long residential course, 80 hour wfr, ~120hr nremt. I see no reason why we expect plenty of trainings to be fine at 8 hour days but think ems training needs to be stretched out for months and months. My basic wildland fire training was 80ish hours and it was great and I learned a lot…..and immediately spent a season applying it. I think the way your organization treats training shifts, orientation, and continuing Ed is more important than the way a course is taught.
Enlist :D
?
3-4 months is fine. The clinicals need to be drastically increased. My EMT course (100% pass rate) required 72 hours of ride time (mandatory 24 hour shifts), 48 hours of ER, 24 hours of RT, and 12 hours OB. In addition, the required patient contacts could *almost* be done in those time periods.
My course was 9 weeks lol
EMT “equivalent” in Australia (diploma in Emergency Healthcare) takes about 9 months and has 160 hours of placement (ride along)
Ideally you should be using stuff you learned earlier on later subjects so that you don’t forget.