I was having a conversation with one of my fellow students from the Paramedic class today and the conversation turned to experience. I was lucky enough to have the BLS skills mastered and have years of experience at assessments prior to going to Paramedic School. He had zero experience and landed a job at the BLS level prior to class being completed. He is still waiting to finish testing for his Paramedic and was struggling to train into a job at the BLS level in a large urban system. He related feelings of not being comfortable on runs and being frustrated. I tried to encourage him in the fact that all of us have been there and the only difference between him and I was experience prior to taking the Paramedic class.
He is lucky in the fact that he did get a BLS job, having an opportunity to learn and begin to master the BLS side of pre-hospital care, prior to taking his Paramedic written test will make him that much better when he transitions to the Paramedic level. If there is one thing I could stress to anyone who would like to pursue a career in the EMS field it would be to become an EMT and find your place first. I have many reasons I say that:
1) If you do not feel comfortable assessing and treating a patient at a BLS level there is no way you will feel comfortable learning it at an ALS level.
2) How can you be sure that BLS treatment will be appropriate when you have not had the time in the box doing it? This prevents over treating your patients possibly creating problems with long term care.
3) There are a number of skills you need to master at the BLS level. Spinal immobilization, knowing how to effectively and efficiently immobilize patients is a core skill and the class room training and skills practices are just the tip of the iceberg. Airway control, knowing when it is appropriate to control the airway using BLS means vs. ALS is a skill that you cannot be taught in a classroom. Mastering those BLS skills on real live patients will build your confidence and give you some assurance when it comes time to intubate your first live patient. Starting IVs, an IV on a training arm and a few live sticks for an Advanced EMT class vs. starting an IV on a patient that has a BP of 60 is a huge difference. I firmly believe that I have gotten IVs based solely on having the confidence to stick them.
4) BTDT, been there done that. Being able to walk in and see a patient having a problem that you have seen in the past is something that a year and a half of class cannot teach. No two patients are the same but, there are similarities. Distinguishing between COPD, Pneumonia, and CHF can sometimes be so subtle that, experience and making the mistake in the past is all you have to draw from to decide. Taking the BLS patient into the hospital for COPD that you find out later was CHF from the ED doc will leave you with a lasting impression and you did no harm at the BLS level.
These are just a few of the reasons and it is time that the National Registry and individual States start to require experience as a prerequisite to Paramedic School. A few hundred hours of clinical time in an ambulance is not enough and the level of training would be better with more time spent on the ALS in school producing better medics. Medics coming out would have a higher confidence level and better understanding of the disease processes that they will encounter. My friend would have been better prepared for school and would not be so overwhelmed now. He will do fine because his attitude and desire to learn is there and he is now using the BLS skills every time he gets into an ambulance. Even he admitted that he would have done better in class at this point than he did.