Eleven years ago this month, I finished up my hospital clinical time and was getting ready to head out into my field internship. Prior to that, I completed my 12 month classroom time, and a grueling hospital schedule that was close to 450 hours in length. Not only did I spend time in the emergency room, but I was also in the ICU, the CCU, the psych unit (not as a patient), the operating room, pediatrics, and the adolescents unit. While skill requirements were not broken down by department, I was required to get numerous IV starts, establish a number of IV drips, successfully intubate 10 patients, and document a number of patient assessments broken down into different categories.
Finishing up my clinical time was like a breath of fresh air. For four months, I was spending over 40 hours a week in different hospital departments, surviving on coffee and little sleep. Now that I was done, I’d start my Field Rotation off with 24 hours in Manhattan and 16 hours in Brooklyn assigned to different FDNY EMS Units.
My experience in New York was like none I’ve ever had before or since. While it wasn’t this battle zone where you were constantly dropping patients and moving on to the next call, it was definitely exciting. The sheer size of the system was staggering. I was able to meet many of my skill requirements down in New York, which allowed me to come back to Massachusetts and spend a good amount of time concentrating on becoming a good paramedic, and not sweating it out for an apneic patient for 200 extra hours, as one of my colleagues had to do.
My sixteen month journey to become a paramedic was worth it, to put it lightly. When I got that card in my pocket a few months after I finished my ride time, I knew I still had more to learn, but the education I’d obtained so far made me ready to step onto the streets.
Then, in 2004, the State of Massachusetts changed the standard, and it seems recently, in the last couple of years, Paramedic programs are starting to adopt the changes in their own programs.
Gone are the days of riding a minimum of 200 hours in your field internship. Gone are the days requiring Field IV Boluses, or BLS skill administrations, miscellaneous meds, and at least one code. What does the State require now? A minimum of 80 hours, and 30 ALS Workups. What is an ALS Workup? Well, they leave that up to the program itself to determine that their student has shown program instructors that they’ve done an adequate job of learning what could be learned in the field.
I will give Massachusetts this though, they require accreditation for training sites, and are seemingly raising the bar on who can train a Paramedic. I say seemingly because in the last ten years, we have gone from two Paramedic Training Programs to five, and that is just in my part of the state.
Paramedic programs seem to be popping up all over the place, and while some of them do a fine job of turning out quality paramedics, others are just there to get paid, and get a card in your pocket. And let’s face it; with what has gone on in Massachusetts over the last year or two, wouldn’t you think the State itself would try to play a better part in making sure its Providers are properly trained?
Ultimately, my beef comes down to time spent in the field for training. With everything we have to learn in the field, and everything we need to do, a minimum of two weeks time doesn’t seem adequate to me for someone to learn the hands on job of being a Paramedic. Sure, some people might take longer, some programs will require more time, and most have some sort of field experience before they even step into the classroom, but if you’re going to judge the work done by most of us based on the least competent Paramedic, then why not train us all better?
Let’s raise the bar, and shoot for a higher quality paramedic rather than a higher quantity of paramedics.
Check out the State’s paramedic training requirements here and let me know what you think. How does it compare to where you got your training, or where you want to go for your training?
While I may be the last person you would expect to be reading this, I completely agree with you. An “ALS assessment” does not teach you how to be a paramedic and in many cases does not give you the opportunity to practice the skills that are needed on those 10% of calls. I see the difference that having to do the “points and hours” system has made for me over the number of calls system. Anyone can do “O2, IV, monitor, 12 lead” but I personally don’t believe anyone should be able to be a paramedic without having pushed a medication, intubated a patient, or “run” a code. This is especially true since there are plenty of times where “new” paramedics are expected to work with a basic EMT. I actually am not one of those people who complain about this configuration since it forces you to think for yourself rather than to sit back and rely on your senior partner. I seem to get much more serious calls when I am with a basic making me glad that I had the extra experience of the “old” rules.
Thanks for the comment, Carl. The motivation for this post mainly came from the fact that I feel that paramedic training has become so diluted. When there weren’t quite as many programs around, and selection criteria was higher, there seemed to be a better quality of paramedic coming straight out of class. People are still learning, and programs are turning out some great paramedics, but it just seems like it takes a little longer for them to get the training wheels off as it did previously.
So what’s the answer? Do you need to require more patient contact time prior to starting a medic program? Do they need stricter entrance testing? I’m not really sure, but we need to make sure that when people hit the streets they are as ready as possible to be there, especially with the new state P/B standards.