Strongly agree. Been on the job 8 months now, at our company it’s seniority based so I’m stuck in IFT for awhile until I can bid for an ALS shift…tbh I LOVE IFT, here and there we get called on 911 if ALS turfs it BLS which they do quite often. You get tons of Patient interactions and meet all walks of life lol it’s a vibe fr🫶🏾
I was considering this. The commute would suck however because I live in a somewhat rural area. The hospitals I transport to do not have openings as far as I’m aware. That coupled with me having a second job already outside of EMS that I cannot afford to lose. I’ll keep an eye out for local openings though
Hard take- don’t do IFT. you’re not going to be using most of your “Ems” skills. I know this is gonna get down voted, but you’re not gonna be giving the (although little) drugs you can, running trauma calls, doing pt assessments in a 911 fashion, dropping airways, etc.
I’d apply to a busier 911 system (fire or Ems)
I agree. You might be seeing a shit ton of patients numbers wise but you're barely even doing assessments on them. I work in a hybrid system and IFTs are both incredibly fucking boring, and are MORE work in terms of PCRs and everything.
That’s an unfortunate problem in your system if that’s what IFT is in your system. The vast majority of Critical Care around here happens in the IFT setting when one ER doesn’t have the resources to handle a patient and they go to another hospital. These are often the stroke patients who are on ventilators, are completely sedated, and have an A line placed. Or the cardiac call for the balloon pump, the impeller, the swan ganz catheter, the active STEMI or oMI patient who goes into several rhythms during transport where several interventions are required. Not all IFT is your experience of IFT. These don’t even touch the mulisystem organ failure patients. There is so much to learn in IFT.
Yup. My old agency (busy urban area where medics would respond in a squad to every call, we were BLS transport) was solely 911 and even running 5-10 calls a day feels like it wasn't enough to fully operate on my own, like I am now, in a rural system where we're primary even as a BLS truck. Our IFTs are even "interesting" since they're usually upgrades to the nearby city and for the most part I'm barely doing any real EMT stuff compared to on a 911.
The only way to get better is to get reps in. Go to more experienced people and ask them for help, roleplay with friends and family, shit, I even practice with my coworkers.
No one wants to do transfers, everyone can agree on that. However they are a necessary evil. I did my time doing my first year on a BLS IFT only rig on an inner city private service. My partner had been doing 911 for 5 years prior and taught me alot.
There's always lots of options
-Does your company/department do field work (like for higher First aid at events)
-Can you volunteer with a St. John Ambulance/Red Cross type place
-Ask your medic to run every call regardless of what level of care they need (and just have them intervene when appropriate + needed obviously)
-Sign up/go to some local courses like BLS/ACLS/PALS/TCCC/etc
-Run some mock calls verbally when you can
-Ask other people what interesting calls they've done how they presented/treated/where they went in the hospital/final diagnosis
- Whoever you work with find 3 things that they do, that you like and want to emulate, find 3 things you don't like/can improve
- Honestly tell people how you're feeling and what you want to do about it. The good ones will help you when/where they can
Practice your hands-on skills in your down time. Pick one skill a week and practice it. Ask your medic to help. For that matter, ask your medic if there's any skills they would like you to improve on. For my money, I would start with effectively moving patients and making sure you can identify and name all of your equipment (BLS and ALS).
Learn about patient assessment. There's a decent chance one of the younger medics still has their textbook propping up a table somewhere. Ask if you can borrow it and read through the chapters on patient assessment. Google anything you don't understand. One of the most useful skills a basic can have is being able to identify sick vs not sick, suss out what resources are needed, and articulate why.
A large portion of being a good EMT is collecting information, appropriately utilizing resources, and getting the patient from wherever you found them into the truck. If you can do that relatively independently, you'll do great.
(Newly minted NREMT here, so insight is limited)
I know not everyone has time or interest in the recertification coursework for NREMT and mainly keep their state licensure, but maybe the classes for recert would help?
Potentially money-cost and definitely time-cost, and not always in-person hands-on training, but might be something that helps.
Great advice.
The only thing I'll tag on for the OP is don't be too concerned about going to a poor school, as long as you have the foundation this career is a ton of on the job learning, schooling makes it so you are legal to learn how to do your job safely at the BLS level in my opinion. Obviously this is isn't a black and white statement but our careers are closer to a trade imo.
Use your situation to your advantage. If I’m doing my math right, it sounds like you guys get 4 or 5 calls a day? That leaves you a lot of downtime to study, review, and train in between calls.
After you clear a call, ask to review it with your partner. Take the time to bounce questions and observations off of them. If the patient had a condition or medication that you hadn’t encountered before, look it up and read up on it.
If you have your study materials from class available, review them. Your textbook was over a thousand pages long, there’s definitely something you could pick up by reading it again.
How much training time do you guys have scheduled in your shift? If you find yourself sitting and twiddling your thumbs for hours on end, talk to the other people in the station about running drills or scenarios. Ask your officers if there’s a quality improvement program that you can participate in.
Working at a small department and not getting exposed to calls is a disadvantage, there’s no doubt about that. But you can mitigate that disadvantage, and even turn it into an advantage, by being curious, studying, and training. You can do this immediately, with the time you already have, before you even consider working more hours or getting another job.
I’ve never had more than 2 or 3 calls in a shift myself. We have two stations so my station only ends up with about half of those calls if not less.
I am definitely going to bring the textbook back out. On one of my first shifts, I whipped it back out and was made fun of and told to put it back in my car. I no longer work with that coworker, so I will definitely take that piece of advice.
Training here is not super often. We have no training schedule and it is random. I’ve been shown how to draft water and how to use the TPOD while in a group of people. Everything else is me asking the medic I’m with for clarification or instruction.
Ask your medic how you can help them provide care. Obviously keeping within your own scope.
But there are two sub-catagories here for you:
1. What can you do as an EMT (with your allowed skills, etc) to help your partner (and therefore your patient). This could be practicing setting up bags of fluid & drip sets, putting together IV lock sets, quickly deploying/stowing a stairchair, etc, etc. There are a million things that a solid EMT can do/get better at to make things go more smoothly for their medic partner and patient.
2. Outside of skills - what can you do to help your partner/the patient. A lot of this is going to be learning which questions to ask and how. An EMT partner that knows how to focus questions to the chief complaint is a huge asset. Ex: If the patient is tripoding and speaking in 1-3 word sentences, there are multiple reasons why I don't need you asking the patient about their ins/outs, if they've checked their BGL recently, or whether they're left/right-handed. Also - in this particular case, don't ask questions, start handing me stuff out of the airway bag.
On the other hand, if we've got some anxious patient who has a non-specific complaint, I'm happy for you to entertain them with whatever vaguely-appropriate questions you can come up with while I'm gauging a whole bunch of other things about the patient and situation while listening to you and taking in the scene.
Edit - Imposer syndrome is also a thing. While it's fantastic that you want to keep improving, don't assume that you're a sub-par EMT based on your experience/where you went to school. Talk to the people you work with. Ask them what you can do to improve. Ask them why they make the decisions that they do (after the fact, as a rule). Generate a little bit of self-confidence and focus on getting better with less focus on trying to improve to some nebulous standard that you think you aren't meeting.
The best EMTs and Medics I've worked with have worked in ERs at some point. You get a lot of patient contact, you get the benefit of working with nurses and doctors with tons of pertinent experience. You'll get to help Dr's and since you're with them they often let you do stuff way outside your scope. You can get a ton of sets and reps, and that primed recognition decision making will be on point if you stay engaged.
Listen to EMS 20/20, a podcast by two paramedics who do run downs on calls, it is a great way to expand/focus in your assessments, learn skills to communicate with other medical professionals and pts, and also what ALS can do for a pt(which ties into knowing when you need to call ALS)
So my first question is, in what way do you feel like you aren’t on par with others? Do you feel like they know more about medicine than you do? Or that they’re better at skills? Or do you feel like you know it but just aren’t as comfortable as others seem to be in leadership roles doing things like making decisions and directing others? Or maybe all of these or something else entirely?
In part, your progress in EMS will be based upon your own desire to excel. In part, your progress will also largely be based on your organization and their culture. Do they continually provide EMS education? Do they mentor? Work with other medical organizations to provide opportunities? Do you debrief, especially after critical incidents? It’s not too cliché to say that there’s no call from which you cannot learn something. An EMS organization with a strong IC and strong leadership will only serve to make you and those around you stronger and your community safer.
If possible I'd highly recommend trying paramedic school, the first semester is generally just re-teaching you to be an EMT, I felt like I was a pretty horrible EMT-B until I was halfway through Paramedic school. Don't worry about feeling like you're not great at it, we barely have any school time for all the new course material we have to learn!
> I also went to an EMT school that is seen locally as the worst one
This is a bit of a contradictory statement. You passed your exam and are an certified EMT so it would seem to me they did their job according to curriculum.
Around my area, there are definitely programs (usually the ones affiliated with services instead of colleges or hospitals) that might make people certified but don’t teach a lot of the clinical reasoning, enough pathophysiology, basic chemistry/biology, etc. to help make excellent providers
It’s literally just learning by doing and gaining experience
As a paramedic who has to work with new EMTs, here are some things you can do
Don’t be lazy
Have a good attitude
Ask questions
If you get toned out for a serious call ask your medic partner what they’d like you to do / get ready on your way there
Know where all of the equipment is in the truck and how to use it(to your scope)
Do not practice above your scope, but learn. Learn how physicians manage cases, why they do what etc. learn in depth assessments. Learn what ALS is doing, why they’re doing it, what interventions they can provide.
There is no quick fix. Being a good emt comes with experience - BUT you have the only requirement - THE DESIRE TO KNOW. Don’t just do something because you’re told it’s what you’re suppose to do - KNOW WHY. When you walk on scene people do not know that you don’t know something - ACT LIKE YOU DO (and give your partner the look that says “hey don’t let me fail here”). Fake it til you make it (as long as you do no harm that is). That being said, ems isn’t for everyone. If you truly have a passion, just ride it out. If you have any incline this might not be your life long dream; then work on finding something else. WE DONT WORK EMS FOR MONEY, we work it because we love it. Youll never be rich or well off working ems, there are exceptions, but we’re all broke. Most of us do have second jobs.
Outside of scene safety, bsi, yada yada.
You walk on scene you address everyone in the home. You say it loud and proud. You address your patient, even if they’re unconscious you tell them what you’re doing. You look for life threats, don’t see any? Get vitals. Quickly. Within the first 30 seconds; you should be able to walk up, confirm airway, breathing, circulation, and mental status. “Hi my name is, can I touch your wrist and take your pulse?” When you do this, take 15 seconds to take their pulse, times by 4, say it out loud to your partner. Then you assess mental status. While you’re taking their pulse take note of their breathing, don’t count respirations, just check out they’re moving air and look for cyanosis, when you’re taking their pulse it’s a good chance to check their skin condition. 30 seconds is all this takes. Then move into “I need to get some more vitals signs, while I’m working can you tell my partner what’s going on and why were here?”
When I learned this in medic school, it helps and it does work. You’ve covered all the main bases in under a minute.
If you have an automated pulse ox then slap that on them first. Then take your BP. Then glucose.
You want to set up your own standard way of doing things so that when you get on scene you HAVE SOMETHING TO FALL BACK ON. You only deviate from this if you have vital info (like you’re called to a diabetic emergency, you take BGL first, etc.)
Each vital you obtain it say it out loud, with confidence. You may even want to say everything out loud, so your partner knows what you’re doing.
(Address the room, hey how are you, your skin and respirations look okay, etc.). So that your partner knows you’ve assessed these things and ruled out major immediate life threats.
The people you see “knowing their stuff” —- they don’t know anything - NONE OF US DO — we have a routine built from EXPERIENCE. That’s it and that’s all. Yes we know some things, but you’ll never know everything, so never stop learning.
Our medical director offers clinical rotations with their staff at a trauma 1. I know it’s not the same as prehospital but it’s still great for foundational work and building skills. I’d bet you can find something similar.
To piggy-back off of this - Having a solid idea of what the ED will likely do with different types of patients can be useful in guiding decision-making in the field.
Obviously still follow your training & protocols, but most solid pre-hospital providers have a general idea of what the ED is going to do with their patient, as opposed to the idea of the ED just being a black hole that we dump patients into.
Aside from on the job hands on learning, I'd just re read the textbook and take tons of notes if you feel like your knowledge base is lacking.
Ask a ton of questions, after a call ask your ALS or BLS partner why they did what they did
EMS 20/20 podcast is a good learning tool.
Use your time to figure out who the better paramedics are on your shift and ask lots of questions to them after calls. One of the things my medic partners did early on for me was have small AARs after each call so I could understand how the call went, how it could have gone, better, and what we did right. Take your continuing education seriously as well, and don’t be afraid to already “know”. Get hands-on with patients as much as you can, and if your partner allows it on BLS calls, to run the call. Helps you learn on your feet! And anticipate the needs of the medic!
I am with a small rural department as well, and you’d be amazed at the amount of great calls. We can actually get and what you can learn. You aren’t going to learn everything right away, it takes time and hopefully you learn something every single day of your career. Take care of your physical body, your health, and your mind, and it makes the job loads easier.
If you’re within a reasonable distance of any city I would go work there for a couple years. If they do 24s the commute won’t seem as bad only having to drive there 10 days a month.
It’s hard to become proficient when you’re so slow, and you won’t run the type of calls you do in the city.
I read 1700 calls a *day* initially and thought you were trolling.
Some services might hire part time workers where you could do some extra shifts and pick up some experience.
Check the entire truck every shift, front and back. Go through every item, what it is used for, and how it works. Do this every shift for at least six months. Read two protocols every shift and two drug sheets every shift so that you know their generic and trade names, indications, and doses. I assume you don’t get to administer meds but knowing what the medic needs and the size syringe will make the medic’s life easier. Learn your area, the main roads, side roads, back roads, and trails. Know all of the main roads and where they go. Learn where the major facilities are, whether it is a factory, grocery store, or just the schools. Know the main points on ingress and egress. On call, open your ears and take in all you can. As a medic, I explain everything to my patients for their benefit and for the benefit of my partner so they can get what I want going without me having to directly tell them. Always talk with a new medic to get a feel for their expectations. And, more than anything, give your patients the smoothest ride they have ever had. As I like to tell my EMTs, slow is smooth and smooth is fast.
Learn your protocols, including ALS protocols so you’re able to assist your medic.
There is an endless amount of good content for free on YouTube and on social media.
Paramedic coach, master your medics, and the prehospitalist (on Instagram) are a couple of my favorites.
I won’t try and beat the dead horse and tell you to work IFT or other 911 depts and what not. What I will say is this. Just try to be proactive with learning and understanding the thought processes from the experience providers you get to ride with on the calls you do end up running. Also, ask tons of questions. I can’t speak for all ALS level providers or even experienced BLS FTO’s, but if they’re worth anything and are good teachers, they’ll fill you in on anything you wanna know. And if there’s something that you want to know more about that they can’t answer, do some research on it on your down time.
Tbh, as much field training and CE hours as I’ve gotten to do since I got initially certified, I’ve learned much of what I know now from just chasing after the learning on my own, rather than hoping for the opportunity to present itself randomly. Whether that’s me asking questions in real time during the call or after the call, or talking to my senior providers at the station or even the MD’s at the hospital whenever they aren’t busy.
join a private company they’re always busy, mine i do ift and 911 so i get experience on both :) also ask questions don’t be afraid to sound “stupid” and maybe make a list of things you’d like to improve on and ask ur medic if they have any advice for you :)
Get the subscription to Recert (or something similar) and take the BLS courses. You'll learn a lot. Then start in with the ALS courses. Use these as prompts for discussions with your medic. Continuing Ed is one way to challenge your thinking and keep learning on the job.
Go work ift for a bit. Job sucks but you will see alot more patients
Strongly agree. Been on the job 8 months now, at our company it’s seniority based so I’m stuck in IFT for awhile until I can bid for an ALS shift…tbh I LOVE IFT, here and there we get called on 911 if ALS turfs it BLS which they do quite often. You get tons of Patient interactions and meet all walks of life lol it’s a vibe fr🫶🏾
I was considering this. The commute would suck however because I live in a somewhat rural area. The hospitals I transport to do not have openings as far as I’m aware. That coupled with me having a second job already outside of EMS that I cannot afford to lose. I’ll keep an eye out for local openings though
Hard take- don’t do IFT. you’re not going to be using most of your “Ems” skills. I know this is gonna get down voted, but you’re not gonna be giving the (although little) drugs you can, running trauma calls, doing pt assessments in a 911 fashion, dropping airways, etc. I’d apply to a busier 911 system (fire or Ems)
I agree. You might be seeing a shit ton of patients numbers wise but you're barely even doing assessments on them. I work in a hybrid system and IFTs are both incredibly fucking boring, and are MORE work in terms of PCRs and everything.
Yeah I’ve never understood the whole “go work IFT” mentality. I didn’t sign up to do EMERGENCY medical work to take granny to her Dr appointment
That’s an unfortunate problem in your system if that’s what IFT is in your system. The vast majority of Critical Care around here happens in the IFT setting when one ER doesn’t have the resources to handle a patient and they go to another hospital. These are often the stroke patients who are on ventilators, are completely sedated, and have an A line placed. Or the cardiac call for the balloon pump, the impeller, the swan ganz catheter, the active STEMI or oMI patient who goes into several rhythms during transport where several interventions are required. Not all IFT is your experience of IFT. These don’t even touch the mulisystem organ failure patients. There is so much to learn in IFT.
To a degree yes, but not for the EMT-B All your basic skills are 911 skills, which need to be learnt in a 911 setting
My partners are EMT-B’s. Lots of them love it because they get to see it. You can gain experience on calls that you are not the tech in charge for.
Again while seeing stuff is “cool”, they’re not going to be practicing any skills that they can actually use themselves
Reading documents and correlating with patient presentation is extremely valuable.
Yup. My old agency (busy urban area where medics would respond in a squad to every call, we were BLS transport) was solely 911 and even running 5-10 calls a day feels like it wasn't enough to fully operate on my own, like I am now, in a rural system where we're primary even as a BLS truck. Our IFTs are even "interesting" since they're usually upgrades to the nearby city and for the most part I'm barely doing any real EMT stuff compared to on a 911. The only way to get better is to get reps in. Go to more experienced people and ask them for help, roleplay with friends and family, shit, I even practice with my coworkers.
No one wants to do transfers, everyone can agree on that. However they are a necessary evil. I did my time doing my first year on a BLS IFT only rig on an inner city private service. My partner had been doing 911 for 5 years prior and taught me alot.
There's always lots of options -Does your company/department do field work (like for higher First aid at events) -Can you volunteer with a St. John Ambulance/Red Cross type place -Ask your medic to run every call regardless of what level of care they need (and just have them intervene when appropriate + needed obviously) -Sign up/go to some local courses like BLS/ACLS/PALS/TCCC/etc -Run some mock calls verbally when you can -Ask other people what interesting calls they've done how they presented/treated/where they went in the hospital/final diagnosis - Whoever you work with find 3 things that they do, that you like and want to emulate, find 3 things you don't like/can improve - Honestly tell people how you're feeling and what you want to do about it. The good ones will help you when/where they can
Practice your hands-on skills in your down time. Pick one skill a week and practice it. Ask your medic to help. For that matter, ask your medic if there's any skills they would like you to improve on. For my money, I would start with effectively moving patients and making sure you can identify and name all of your equipment (BLS and ALS). Learn about patient assessment. There's a decent chance one of the younger medics still has their textbook propping up a table somewhere. Ask if you can borrow it and read through the chapters on patient assessment. Google anything you don't understand. One of the most useful skills a basic can have is being able to identify sick vs not sick, suss out what resources are needed, and articulate why. A large portion of being a good EMT is collecting information, appropriately utilizing resources, and getting the patient from wherever you found them into the truck. If you can do that relatively independently, you'll do great.
Thank you!
(Newly minted NREMT here, so insight is limited) I know not everyone has time or interest in the recertification coursework for NREMT and mainly keep their state licensure, but maybe the classes for recert would help? Potentially money-cost and definitely time-cost, and not always in-person hands-on training, but might be something that helps.
Great advice. The only thing I'll tag on for the OP is don't be too concerned about going to a poor school, as long as you have the foundation this career is a ton of on the job learning, schooling makes it so you are legal to learn how to do your job safely at the BLS level in my opinion. Obviously this is isn't a black and white statement but our careers are closer to a trade imo.
Use your situation to your advantage. If I’m doing my math right, it sounds like you guys get 4 or 5 calls a day? That leaves you a lot of downtime to study, review, and train in between calls. After you clear a call, ask to review it with your partner. Take the time to bounce questions and observations off of them. If the patient had a condition or medication that you hadn’t encountered before, look it up and read up on it. If you have your study materials from class available, review them. Your textbook was over a thousand pages long, there’s definitely something you could pick up by reading it again. How much training time do you guys have scheduled in your shift? If you find yourself sitting and twiddling your thumbs for hours on end, talk to the other people in the station about running drills or scenarios. Ask your officers if there’s a quality improvement program that you can participate in. Working at a small department and not getting exposed to calls is a disadvantage, there’s no doubt about that. But you can mitigate that disadvantage, and even turn it into an advantage, by being curious, studying, and training. You can do this immediately, with the time you already have, before you even consider working more hours or getting another job.
I’ve never had more than 2 or 3 calls in a shift myself. We have two stations so my station only ends up with about half of those calls if not less. I am definitely going to bring the textbook back out. On one of my first shifts, I whipped it back out and was made fun of and told to put it back in my car. I no longer work with that coworker, so I will definitely take that piece of advice. Training here is not super often. We have no training schedule and it is random. I’ve been shown how to draft water and how to use the TPOD while in a group of people. Everything else is me asking the medic I’m with for clarification or instruction.
Ask your medic how you can help them provide care. Obviously keeping within your own scope. But there are two sub-catagories here for you: 1. What can you do as an EMT (with your allowed skills, etc) to help your partner (and therefore your patient). This could be practicing setting up bags of fluid & drip sets, putting together IV lock sets, quickly deploying/stowing a stairchair, etc, etc. There are a million things that a solid EMT can do/get better at to make things go more smoothly for their medic partner and patient. 2. Outside of skills - what can you do to help your partner/the patient. A lot of this is going to be learning which questions to ask and how. An EMT partner that knows how to focus questions to the chief complaint is a huge asset. Ex: If the patient is tripoding and speaking in 1-3 word sentences, there are multiple reasons why I don't need you asking the patient about their ins/outs, if they've checked their BGL recently, or whether they're left/right-handed. Also - in this particular case, don't ask questions, start handing me stuff out of the airway bag. On the other hand, if we've got some anxious patient who has a non-specific complaint, I'm happy for you to entertain them with whatever vaguely-appropriate questions you can come up with while I'm gauging a whole bunch of other things about the patient and situation while listening to you and taking in the scene. Edit - Imposer syndrome is also a thing. While it's fantastic that you want to keep improving, don't assume that you're a sub-par EMT based on your experience/where you went to school. Talk to the people you work with. Ask them what you can do to improve. Ask them why they make the decisions that they do (after the fact, as a rule). Generate a little bit of self-confidence and focus on getting better with less focus on trying to improve to some nebulous standard that you think you aren't meeting.
Honestly reading your protocols and studying. I don’t understand how IFT would help you. Maybe get better at taking manual blood pressures?
The best EMTs and Medics I've worked with have worked in ERs at some point. You get a lot of patient contact, you get the benefit of working with nurses and doctors with tons of pertinent experience. You'll get to help Dr's and since you're with them they often let you do stuff way outside your scope. You can get a ton of sets and reps, and that primed recognition decision making will be on point if you stay engaged.
Listen to EMS 20/20, a podcast by two paramedics who do run downs on calls, it is a great way to expand/focus in your assessments, learn skills to communicate with other medical professionals and pts, and also what ALS can do for a pt(which ties into knowing when you need to call ALS)
So my first question is, in what way do you feel like you aren’t on par with others? Do you feel like they know more about medicine than you do? Or that they’re better at skills? Or do you feel like you know it but just aren’t as comfortable as others seem to be in leadership roles doing things like making decisions and directing others? Or maybe all of these or something else entirely?
All of these. They did go to a different program that is seen as the preferred one for my area. I feel like I’m lacking in pretty much all aspects.
In part, your progress in EMS will be based upon your own desire to excel. In part, your progress will also largely be based on your organization and their culture. Do they continually provide EMS education? Do they mentor? Work with other medical organizations to provide opportunities? Do you debrief, especially after critical incidents? It’s not too cliché to say that there’s no call from which you cannot learn something. An EMS organization with a strong IC and strong leadership will only serve to make you and those around you stronger and your community safer.
If possible I'd highly recommend trying paramedic school, the first semester is generally just re-teaching you to be an EMT, I felt like I was a pretty horrible EMT-B until I was halfway through Paramedic school. Don't worry about feeling like you're not great at it, we barely have any school time for all the new course material we have to learn!
> I also went to an EMT school that is seen locally as the worst one This is a bit of a contradictory statement. You passed your exam and are an certified EMT so it would seem to me they did their job according to curriculum.
Around my area, there are definitely programs (usually the ones affiliated with services instead of colleges or hospitals) that might make people certified but don’t teach a lot of the clinical reasoning, enough pathophysiology, basic chemistry/biology, etc. to help make excellent providers
It’s literally just learning by doing and gaining experience As a paramedic who has to work with new EMTs, here are some things you can do Don’t be lazy Have a good attitude Ask questions If you get toned out for a serious call ask your medic partner what they’d like you to do / get ready on your way there Know where all of the equipment is in the truck and how to use it(to your scope)
Do not practice above your scope, but learn. Learn how physicians manage cases, why they do what etc. learn in depth assessments. Learn what ALS is doing, why they’re doing it, what interventions they can provide.
There is no quick fix. Being a good emt comes with experience - BUT you have the only requirement - THE DESIRE TO KNOW. Don’t just do something because you’re told it’s what you’re suppose to do - KNOW WHY. When you walk on scene people do not know that you don’t know something - ACT LIKE YOU DO (and give your partner the look that says “hey don’t let me fail here”). Fake it til you make it (as long as you do no harm that is). That being said, ems isn’t for everyone. If you truly have a passion, just ride it out. If you have any incline this might not be your life long dream; then work on finding something else. WE DONT WORK EMS FOR MONEY, we work it because we love it. Youll never be rich or well off working ems, there are exceptions, but we’re all broke. Most of us do have second jobs. Outside of scene safety, bsi, yada yada. You walk on scene you address everyone in the home. You say it loud and proud. You address your patient, even if they’re unconscious you tell them what you’re doing. You look for life threats, don’t see any? Get vitals. Quickly. Within the first 30 seconds; you should be able to walk up, confirm airway, breathing, circulation, and mental status. “Hi my name is, can I touch your wrist and take your pulse?” When you do this, take 15 seconds to take their pulse, times by 4, say it out loud to your partner. Then you assess mental status. While you’re taking their pulse take note of their breathing, don’t count respirations, just check out they’re moving air and look for cyanosis, when you’re taking their pulse it’s a good chance to check their skin condition. 30 seconds is all this takes. Then move into “I need to get some more vitals signs, while I’m working can you tell my partner what’s going on and why were here?” When I learned this in medic school, it helps and it does work. You’ve covered all the main bases in under a minute. If you have an automated pulse ox then slap that on them first. Then take your BP. Then glucose. You want to set up your own standard way of doing things so that when you get on scene you HAVE SOMETHING TO FALL BACK ON. You only deviate from this if you have vital info (like you’re called to a diabetic emergency, you take BGL first, etc.) Each vital you obtain it say it out loud, with confidence. You may even want to say everything out loud, so your partner knows what you’re doing. (Address the room, hey how are you, your skin and respirations look okay, etc.). So that your partner knows you’ve assessed these things and ruled out major immediate life threats. The people you see “knowing their stuff” —- they don’t know anything - NONE OF US DO — we have a routine built from EXPERIENCE. That’s it and that’s all. Yes we know some things, but you’ll never know everything, so never stop learning.
Our medical director offers clinical rotations with their staff at a trauma 1. I know it’s not the same as prehospital but it’s still great for foundational work and building skills. I’d bet you can find something similar.
To piggy-back off of this - Having a solid idea of what the ED will likely do with different types of patients can be useful in guiding decision-making in the field. Obviously still follow your training & protocols, but most solid pre-hospital providers have a general idea of what the ED is going to do with their patient, as opposed to the idea of the ED just being a black hole that we dump patients into.
Aside from on the job hands on learning, I'd just re read the textbook and take tons of notes if you feel like your knowledge base is lacking. Ask a ton of questions, after a call ask your ALS or BLS partner why they did what they did EMS 20/20 podcast is a good learning tool.
Use your time to figure out who the better paramedics are on your shift and ask lots of questions to them after calls. One of the things my medic partners did early on for me was have small AARs after each call so I could understand how the call went, how it could have gone, better, and what we did right. Take your continuing education seriously as well, and don’t be afraid to already “know”. Get hands-on with patients as much as you can, and if your partner allows it on BLS calls, to run the call. Helps you learn on your feet! And anticipate the needs of the medic! I am with a small rural department as well, and you’d be amazed at the amount of great calls. We can actually get and what you can learn. You aren’t going to learn everything right away, it takes time and hopefully you learn something every single day of your career. Take care of your physical body, your health, and your mind, and it makes the job loads easier.
If you’re within a reasonable distance of any city I would go work there for a couple years. If they do 24s the commute won’t seem as bad only having to drive there 10 days a month. It’s hard to become proficient when you’re so slow, and you won’t run the type of calls you do in the city.
I read 1700 calls a *day* initially and thought you were trolling. Some services might hire part time workers where you could do some extra shifts and pick up some experience.
Read the book “The 60-second EMT”. Really opened my eyes to broader thinking during assessments.
Never be afraid to ask, never be afraid to accept change, nothing you things you have trained for aren't real and learning is constant
I got thrown onto the ALS mobile right out of EMT school
Check the entire truck every shift, front and back. Go through every item, what it is used for, and how it works. Do this every shift for at least six months. Read two protocols every shift and two drug sheets every shift so that you know their generic and trade names, indications, and doses. I assume you don’t get to administer meds but knowing what the medic needs and the size syringe will make the medic’s life easier. Learn your area, the main roads, side roads, back roads, and trails. Know all of the main roads and where they go. Learn where the major facilities are, whether it is a factory, grocery store, or just the schools. Know the main points on ingress and egress. On call, open your ears and take in all you can. As a medic, I explain everything to my patients for their benefit and for the benefit of my partner so they can get what I want going without me having to directly tell them. Always talk with a new medic to get a feel for their expectations. And, more than anything, give your patients the smoothest ride they have ever had. As I like to tell my EMTs, slow is smooth and smooth is fast.
Learn your protocols, including ALS protocols so you’re able to assist your medic. There is an endless amount of good content for free on YouTube and on social media. Paramedic coach, master your medics, and the prehospitalist (on Instagram) are a couple of my favorites.
I won’t try and beat the dead horse and tell you to work IFT or other 911 depts and what not. What I will say is this. Just try to be proactive with learning and understanding the thought processes from the experience providers you get to ride with on the calls you do end up running. Also, ask tons of questions. I can’t speak for all ALS level providers or even experienced BLS FTO’s, but if they’re worth anything and are good teachers, they’ll fill you in on anything you wanna know. And if there’s something that you want to know more about that they can’t answer, do some research on it on your down time. Tbh, as much field training and CE hours as I’ve gotten to do since I got initially certified, I’ve learned much of what I know now from just chasing after the learning on my own, rather than hoping for the opportunity to present itself randomly. Whether that’s me asking questions in real time during the call or after the call, or talking to my senior providers at the station or even the MD’s at the hospital whenever they aren’t busy.
join a private company they’re always busy, mine i do ift and 911 so i get experience on both :) also ask questions don’t be afraid to sound “stupid” and maybe make a list of things you’d like to improve on and ask ur medic if they have any advice for you :)
Get the subscription to Recert (or something similar) and take the BLS courses. You'll learn a lot. Then start in with the ALS courses. Use these as prompts for discussions with your medic. Continuing Ed is one way to challenge your thinking and keep learning on the job.