“But They Passed the Test”

There were few things that I have been more proud of than when I passed my EMT and paramedic exams.  For the former, I was a 16 year old high school kid.  I was taking my EMT class two nights a week while going to high school during the day.  My parents had to drive me to my exam, and to the post office daily so I could check the mail hoping and praying that the right envelope would be shipped to me by the State of New Jersey.  When I was in college, passing the paramedic exam was arguably the whole reason that I was there.  That card would let me get my foot in the door, and my management education would give me the opportunity to climb the ladder when the chance arose.  Medic school was not easy, but I did it.

Coming out of medic school, I still had a lot to learn.  I have talked about before here, but it took me a good couple of years to really feel comfortable in my skin.  Colleagues who I got my medic with, and some who got their medics after me passed me by in a lot of ways, but eventually I caught up.  The streets were a great place to hone my skills, and Springfield offered a lot of opportunity to do just that.  It was busy, aggressive, and when I got in over my head, I was close to a hospital.  A lot of people will say that EMS is generally like riding a bike.  In the years that I was promoted, I still practiced medicine, but not nearly as much as I used to.  When I moved exclusively back to the field it took me a little time to shake the rust off, but I got back to where I was relatively smoothly.  I had practiced medicine before I got promoted, so when i got back to it, I had already laid the groundwork for my care.

There are some out there who think that simply holding an EMT card in one’s pocket makes them an EMT, and I call bull on that.  The things that one learns in EMT class are the foundations of care.  It tells you what to look for, but generally does not do a good job of describing it to the extent that one will see it in the field.  Putting an EMT card in someone’s pocket gives them the privilege to become an EMT.  It allows them to go out and start to practice medicine on the general public.  That is why doctors do residencies.  That is why any reputable service will put a new EMT or paramedic through a precepting program.  While these vary in degree, the real purpose of it is to give them a chance to experience a service before being cut loose on their own.  It gives them a safety net in the form of a preceptor who can be there while they get their feet wet.

When I look at services that try and get into EMS on the backs of people who simply have a card in their pocket, I cringe.  You have a service with no experience, and an abundance of people who work there who have not practiced patient care to the extent of those who might transport patients for them.  Reading about CHF in a book, or putting a traction splint on someone in a station is a heck of a lot different than seeing it or doing it in the real world.  The unpredictable human factor of our patients is almost never figured in during a student evaluation.

Passing an EMT test does not give one the right to go out and practice medicine on the unsuspecting public.  There needs to be a better process than that.  Handing over responsibility of being a primary care taker to someone who has never practiced medicine under the tutelage of a more experience provider is dangerous.  It is not safe for the prospective patient, and it shortchanges the community that they serve.  No amount of caring can fix that.  Living in the town that one works in will not increase their level of proficiency.  They might be able to say, “Hi, Mr. Smith, I saw you last week at the grocery store!” but when the time comes to actually care for Mr. Smith, running into them in the dairy isle will not make them a better caretaker than someone with experience.

Communities need to think about this, and their leaders need to think about this when they hand over the safety of their citizens to someone who has never worked on an ambulance in their entire career.

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