My thoughts on EMT for pre-med

[kylek044]

More in the interest of discussion than trying to start an argument, I think the OP is wrong.

1. You don't learn "basic emergency medicine" as an EMT. You learn to be an EMT. While that might be cool, I'm not sure that it gives you better insight into what being an MD is like than shadowing or doing some other thing. In my mind that's like saying that being a scrub tech teaches you "basic surgical skills."

2. Not nearly everyone who goes to med school has the personality to be an EMT. I have plenty of friends who are nice, quiet people who will be great docs but are gravitating towards slower-paced, clinic-based specialties.

You're not an EMT, are you?

EMT means EMERGENCY MEDICAL TECHNICIAN. Emergency medicine. You learn the basics of assessing an emergent pt. You become familiar with the procedures involved in stabilizing a patient. You get an understanding of the tools you need to use. Not for nothin, but you also do a good amount of emergency medicine (yes, at a very basic level) under circumstances that get you thinking unconventionally and keep you on your toes. Have you ever had to take BPs and vitals while straddling over a toilet bowl to get to your pt who fell out of the tub? You get an understanding of having to adapt, multi-task, and keep the patient safe. While docs won't have to straddle that toilet bowl, they will have other obstacles thrown at them which EMT will help prepare them for.

A scrub tech doesn't provide surgery. An EMT provides emergency medical care. Apples and oranges.

You say not nearly everyone who goes to medical school don't have the personality to be EMTs. Ok. Maybe not. There's a lot of people who go to medical school, though, that don't have the personalities to become doctors. It might not be for everyone, but the skills that you learn in an EMT-B class will prove helpful in learning just about anything in medicine down the road. The OP didn't say that it makes you a doctor faster, but just that it helps in the learning process.

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[kylek044]

P.S. You absolutely have to be a doctor to "practice medicine." If EMTs/RNs/RTs/etc "practiced medicine" then they would have to share in the massive malpractice liabililty.

Any EMT can tell you that getting sued is a very real possibility.

 

[el aye]

Any EMT can tell you that getting sued is a very real possibility.

Indeed.

As for the discussion, I just recently became an EMT (took the course my second year as a freshman), so I don't have a lot of experience with it but I am a part of my local volunteer FD and the first response org. at my college. I think being an EMT will be a good way to spend your time volunteering, but also giving you some decent experience in dealing with patients versus just watching a doctor do his/her thing. I would like to become a paramedic, but I don't see how I can fit that in with my undergrad right now... perhaps a CC course in a year or two.

 

[pmdc222]

P.S. You absolutely have to be a doctor to "practice medicine." If EMTs/RNs/RTs/etc "practiced medicine" then they would have to share in the massive malpractice liabililty.[/quote]


So what would you be prepared to tell all these people they are doing with their lives? Are they merely there to serve the doctors?

 

[pmdc222]

P.S. You absolutely have to be a doctor to "practice medicine." If EMTs/RNs/RTs/etc "practiced medicine" then they would have to share in the massive malpractice liabililty.

So what would you be prepared to tell all these people they are doing with their lives? Are they merely there to serve the doctors? I understand that the technical term of "practicing" medicine is traditionally reserved for doctors, but that doesn't mean that others in healthcare don't have an strong understanding of medicine. I frequently see the nurses in the major city hospitals around here telling the first year residents what they need to do. I know we are off topic.

 

[AmoryBlaine]

Any EMT can tell you that getting sued is a very real possibility.

According to hpso.org a full-time EMT-B can get a million dollar malpractice policy for $145.00 anually.

 

[AmoryBlaine]

So what would you be prepared to tell all these people they are doing with their lives? Are they merely there to serve the doctors? I understand that the technical term of "practicing" medicine is traditionally reserved for doctors, but that doesn't mean that others in healthcare don't have an strong understanding of medicine. I frequently see the nurses in the major city hospitals around here telling the first year residents what they need to do. I know we are off topic.

I never said that they were only there to servce doctors, where did you come up with that? None of these professions operate independently (except a few advanced practice nurses). All are ultimately under the direction of an MD. If you tell someone you "practice medicine" for a living they're going to assume you're a doc. Once again, semantics.

I never said that other medical professions don't have a strong understanding of medicine. Look, I have stated many times on these forums that the average experienced nurse or medic can teach a mountain of information to the average intern. The fact that ICU nurses run the show around the poor interns scared ears for the first few months does not mean that they are on par with physicians. As some of you get further along in medical training you will see how much stuff you have to learn and realize that even as a very inexperienced doctor your mind is running circles around that of the average medic.

That does not mean that doctors are better than nurses or medics, it means we have a different job.

 

[AmoryBlaine]

You're not an EMT, are you?EMT means EMERGENCY MEDICAL TECHNICIAN. Emergency medicine. You learn the basics of assessing an emergent pt. You become familiar with the procedures involved in stabilizing a patient. You get an understanding of the tools you need to use. Not for nothin, but you also do a good amount of emergency medicine (yes, at a very basic level) under circumstances that get you thinking unconventionally and keep you on your toes. Have you ever had to take BPs and vitals while straddling over a toilet bowl to get to your pt who fell out of the tub? You get an understanding of having to adapt, multi-task, and keep the patient safe. While docs won't have to straddle that toilet bowl, they will have other obstacles thrown at them which EMT will help prepare them for.

No, I have never taken a BP while straddling a toilet bowl. Have you ever pre-rounded on post-operative patients, assisted on a c-section, written medical orders, or taken a Step of the Medical Licensing Exam?

Do you see how pointless this game is?


I would refer you to post #28, in which gotmeds? and I agreed that we were debating the semantics of the term "basic emergency medicine." In that same thread I made it clear that my definition is different than yours. I think we can live with that.

 

[154465]

That isn't to say there aren't also some gentle, harmless Detroit citiziens. Take the Lions, for example.

lol damn it, thats true.

 

[viciouz]

so whats it take to be an EMT... U take a class? then what? Just start working?

 

[voirlesetoiles]

so whats it take to be an EMT... U take a class? then what? Just start working?

You take an EMT-Basic course where it's locally offered, usually a cc. During the course, you complete a skills evaluation for the certification. There's also a written examination to pass after taking the class.

After being certified, you contact an EMS agency and go from there. The EMS station probably has a beginner's packet and 3rd person (probationary) period for new volunteers to complete before they move up to 2nd person (active).

 

[pmdc222]

I never said that they were only there to servce doctors, where did you come up with that? None of these professions operate independently (except a few advanced practice nurses). All are ultimately under the direction of an MD. If you tell someone you "practice medicine" for a living they're going to assume you're a doc. Once again, semantics.

I never said that other medical professions don't have a strong understanding of medicine. Look, I have stated many times on these forums that the average experienced nurse or medic can teach a mountain of information to the average intern. The fact that ICU nurses run the show around the poor interns scared ears for the first few months does not mean that they are on par with physicians. As some of you get further along in medical training you will see how much stuff you have to learn and realize that even as a very inexperienced doctor your mind is running circles around that of the average medic.

That does not mean that doctors are better than nurses or medics, it means we have a different job.

Ok, I apologize if I misunderstood you. I was under the impression that you thought basic emergency medicine does not begin until you are a doctor. I appreciate the clarification and I'm sorry if we got off track and misunderstood each other.

 

[trichomoniasis]

Ok, I apologize if I misunderstood you. I was under the impression that you thought basic emergency medicine does not begin until you are a doctor. I appreciate the clarification and I'm sorry if we got off track and misunderstood each other.

so if

Emergency Medical Tech : Emergency Medicine Doctor :: Radiology Tech : Radiologist


does that mean Rad Techs are doing basic Radiology?

 

[pmdc222]

so if

Emergency Medical Tech : Emergency Medicine Doctor :: Radiology Tech : Radiologist


does that mean Rad Techs are doing basic Radiology?

I really don't know anything about radiology techs and what their job entails so I can't really comment on that

 

[greytmedic]

Just out of curiosity, for those of you who don't think that EMT's perform basic emergency medicine what is your impression that EMT's do?

Another question that was raised was about taking directions from a doctor. Just because a person takes directions from a doctor does this mean they don't practice medicine? What about a PA? PA's are trained and educated under the medical model, but take directions from phsicians. Does this mean they don't "practice medicine" and only have a "strong understanding" of medicine?

 

[viciouz]

After reading this thread... My bro (17yrs) and I (21yrs) have decided to get our EMT Licenses and then take it from there. Probably get a job or volunteer at the local hospital.

 

[luv2sd]

ok so besides EMT and shadowing, what other clinical and medical experience do you guys suggest? I personally can't think of any hands-on clicnical and medical experience I can have besides EMT as an undergrad

 

[deleted128562]

luv2sd,

I'd personally recommend getting your CNA license. I'm not kidding, and I say this to you as a working EMT. As an EMT you can do some cool stuff but your "options are limited" if you will. Ambulance or ED. Plus, depending on your area, finding a paying job can be VERY hard.

On the other had, CNA's are in massive demand, at least where I live. My wife was a CNA and never had difficulty finding jobs, some of which payed more than what EMT's make around here (staffing jobs). You can work in a nursing home, for hospice, home health care, or for a hospital (though a lot of places you will need to get 6 mo. or so of nursing home work in before you move on to one of these other things). And, as a CNA in a hospital you can work on just about any floor so you can get a massive variety of experiences. My wife saw a much wider variety of stuff than I see in my job I think.

Plus, CNA training is shorter and I think cheaper too. I don't regret being an EMT - I like my job - but I think CNA is a good way to go. I've had a couple friends go that route and they got into medical school.

 

[gotmeds?]

Just out of curiosity, for those of you who don't think that EMT's perform basic emergency medicine what is your impression that EMT's do?

Another question that was raised was about taking directions from a doctor. Just because a person takes directions from a doctor does this mean they don't practice medicine? What about a PA? PA's are trained and educated under the medical model, but take directions from phsicians. Does this mean they don't "practice medicine" and only have a "strong understanding" of medicine?

Talk about semantics! It's kind of amazing how jealously the medical field protects certain terms, like "practicing medicine." As medics, we can't "diagnose," of course. We only form "field impressions." Of course, when I'm sticking a 10ga needle into someone's chest, I've got pretty strong "impression" that he's got a tension pneumothorax. This "impression" is further confirmed by the pressurized air that comes out once the needle enters the thoracic cavity. Still, that's just my impression as humble paramedic. I certainly can't diagnose a tension pneumo. That requires a medical degree.

I also can't "pronounce" someone dead. Only a doctor can do that. If I show up on scene and find someone asystolic, I can perform CPR, intubate, start an IV, push a couple of rounds of meds and then cease resuscitation efforts if nothing changes. At that point, I can form a "field impression" that my patient is dead, but I can't "pronounce" him dead. After all, I'm just a medic. What do I know about these things?

In some areas, medics can do surgical crics. Oh wait a second, medics can't do surgery -- only doctors can. So even though, it looks just like a surgical cric, they call the scalpel by a different name -- I believe the term is "digital enhancer," or something equally ridiculuous. After all, you wouldn't want a lowly paramedic doing a surgical procedure, would you?

 

[pmdc222]

Talk about semantics! It's kind of amazing how jealously the medical field protects certain terms, like "practicing medicine." As medics, we can't "diagnose," of course. We only form "field impressions." Of course, when I'm sticking a 10ga needle into someone's chest, I've got pretty strong "impression" that he's got a tension pneumothorax. This "impression" is further confirmed by the pressurized air that comes out once the needle enters the thoracic cavity. Still, that's just my impression as humble paramedic. I certainly can't diagnose a tension pneumo. That requires a medical degree.

I also can't "pronounce" someone dead. Only a doctor can do that. If I show up on scene and find someone asystolic, I can perform CPR, intubate, start an IV, push a couple of rounds of meds and then cease resuscitation efforts if nothing changes. At that point, I can form a "field impression" that my patient is dead, but I can't "pronounce" him dead. After all, I'm just a medic. What do I know about these things?

In some areas, medics can do surgical crics. Oh wait a second, medics can't do surgery -- only doctors can. So even though, it looks just like a surgical cric, they call the scalpel by a different name -- I believe the term is "digital enhancer," or something equally ridiculuous. After all, you wouldn't want a lowly paramedic doing a surgical procedure, would you?

Agreed. How about when we come across a patient with crushing chest pain, put on the EKG leads and determine he is in SVT at 200... do a 12 lead EKG, start a large bore IV, push 2 rounds of Adenosine, decide the patient is too unstable, push Versed, and then synchronize cardiovert the patient at 50 J and then 100 J....back to a sinus rhythm. All in the back of a moving ambulance. By ourselves. Oh, and never once did we call a doctor and ask them what they thought. I'd say this is practicing medicine.

I work under a doctor's license but mostly under STANDING orders...meaning we don't have to ask for permission or consult before we do any of this stuff. Its standing orders because the docs trust us and our judgment...because............they know we know how to practice emergency medicine at the level we are trained...(notice I put in "at the level we are trained" -- the above example which happened last week is still emergency medicine)

 

[notdeadyet]

Hmmmm..... Have the laws changed? Way back when I was an EMT, we weren't allowed to give any drugs or start IVs. It was a great job, but at the end of the day, it was basically very advanced first aid with lots of structured protocol and very cool tools.

Again, I got my EMT about 17 years ago. Can EMTs now give medicine? I would have a hard time considering myself practicing emergency medicine since I wasn't allowed to give any. Fun stuff, though.

 

[greytmedic]

Hmmmm..... Have the laws changed? Way back when I was an EMT, we weren't allowed to give any drugs or start IVs. It was a great job, but at the end of the day, it was basically very advanced first aid with lots of structured protocol and very cool tools.

Again, I got my EMT about 17 years ago. Can EMTs now give medicine? I would have a hard time considering myself practicing emergency medicine since I wasn't allowed to give any. Fun stuff, though.

Could you apply oxygen when you got your EMT? Oxygen is technically a drug. How about activated charcoal or oral glucose? Maybe not as exciting as adenocard, morphine, or vesed, but still all considered medications given under off-line medical control.

 

[notdeadyet]

Could you apply oxygen when you got your EMT? Oxygen is technically a drug. How about activated charcoal or oral glucose? Maybe not as exciting as adenocard, morphine, or vesed, but still all considered medications given under off-line medical control.

Sorry, when I meant medicine, I meant stuff that a layman couldn't give. You're right about O2 and the rest technically being medicine.

 

[deleted128562]

Talk about semantics! It's kind of amazing how jealously the medical field protects certain terms, like "practicing medicine." As medics, we can't "diagnose," of course. We only form "field impressions." Of course, when I'm sticking a 10ga needle into someone's chest, I've got pretty strong "impression" that he's got a tension pneumothorax. This "impression" is further confirmed by the pressurized air that comes out once the needle enters the thoracic cavity. Still, that's just my impression as humble paramedic. I certainly can't diagnose a tension pneumo. That requires a medical degree.

I also can't "pronounce" someone dead. Only a doctor can do that. If I show up on scene and find someone asystolic, I can perform CPR, intubate, start an IV, push a couple of rounds of meds and then cease resuscitation efforts if nothing changes. At that point, I can form a "field impression" that my patient is dead, but I can't "pronounce" him dead. After all, I'm just a medic. What do I know about these things?

In some areas, medics can do surgical crics. Oh wait a second, medics can't do surgery -- only doctors can. So even though, it looks just like a surgical cric, they call the scalpel by a different name -- I believe the term is "digital enhancer," or something equally ridiculuous. After all, you wouldn't want a lowly paramedic doing a surgical procedure, would you?

Reading through this thread and then reading this post, I am convinced that some people forgot that the discussion was about EMT's and not Paramedics. There is, in my opinion, a night and day difference between the two. About as wide as the difference between a PhD in Chemistry and a 2nd year undergrad in the same field. I don't think anyone would argue against the idea that medics know a fair amount about medicine and do some stuff that might be construed as into the realm of "practicing medicine".

But EMT's? As an EMT I can vouch for the importance of EMT's - but then again, just about every boy and their dog is an EMT anymore. And honestly, some of the folks I graduated that class with (and who then passed the national registry exams) - you would NOT want touching your family member -heck, you would not want these people trying to figure out which way was up on your hamburger bun at McDonald's. Seriously. Some EMT's of course are great, but the fact that I people pass the class who, for instance, started "doing CPR" on a mock patient ACTIVELY COMPLAINING OF CHEST PAIN near the end of class tells me that the requirements for becoming an EMT are pretty much 1) Can breathe 2) memorize the letters ABC

I'm being a little over the top with my last statement of course, and again I know there are GREAT EMT's out there - but my point is that it's pretty silly for EMT's, including myself, to walk around pretending like we know so much when the truth of the matter is that we know some very BASIC protocols and do some very BASIC procedures - which are important, but are not exactly rocket science. So it's time to stop trying to get into a pissing match evelating ourselves to the ranks of "highly educated medical practitioners" or the like. People need to know their place as EMT's, including me, are on the bottom of the medical knowledge food chain, with important duties but with very little medical knowledge compared to doctors, PA's, nurses, etc. Otherwise someone is going to get hurt when an EMT tries to think he/she is capable of being a diagnostician.

Rant over.

 

[gotmeds?]

Reading through this thread and then reading this post, I am convinced that some people forgot that the discussion was about EMT's and not Paramedics...People need to know their place as EMT's, including me, are on the bottom of the medical knowledge food chain, with important duties but with very little medical knowledge compared to doctors, PA's, nurses, etc. Otherwise someone is going to get hurt when an EMT tries to think he/she is capable of being a diagnostician.

I agree with you completely. For the record, I also think that the difference between paramedics and doctors is night and day. I think the reason that most of us medics are so quick to defend EMTs is that the EMT training is the basis for everything we do as paramedics. Really about 90% of being a good paramedic is just being a good EMT (i.e. good BLS skills). Yes, EMT training is rudimentary, but it is still medical training. It's not like when we showed up to paramedic school on the first day they told us that everything we had learned previously was wrong. The things I learned as an EMT -- basic airway and ventilatory managment, recognizing and treating shock, assessing patients -- are all things that I used and improved on as a paramedic and things that I know I will use and improve on as a doctor.

 

[kylek044]

Hmmmm..... Have the laws changed? Way back when I was an EMT, we weren't allowed to give any drugs or start IVs. It was a great job, but at the end of the day, it was basically very advanced first aid with lots of structured protocol and very cool tools.

Again, I got my EMT about 17 years ago. Can EMTs now give medicine? I would have a hard time considering myself practicing emergency medicine since I wasn't allowed to give any. Fun stuff, though.

In NJ, at least, EMT-Bs can give glucose, oxygen, epi, nitro, charcoal, and can help give any prescribed medicines. EMT-Ps carry around 35 drugs on their trucks from narcotics to basic pain relief.

Oh, and for the record, we have NO online medical direction in NJ. EMTs make the decisions in a BLS environment.

 

[Nasrudin]

Very interesting thread. EMT-B/ ED tech here. This sort of thing is one of the the things I would like like to work on in my future in medicine.


How to get the active buy in of all the team members at various skill levels safely with out over turfing everything to death.


My experience working with medics and ex-military medical corpsmen is that the mentality of their background is unique in that its all hands on deck and everybody working together to get the job done--everybody doing what they know how to do. Medics stabilize a patient in the street and in the alleyways and on the bumpy ambulance rides and so forth. If they don't practice medicine the patients don't make it to the folks in white coats.

The civilian hospital hierarchy is antithetical in its mode of operation. Especially is a overly politicized /thick union politics place like San Fran. There its watch your @ss. By the book turf to the right and left, ahead and behind. ED techs have to watch for hater nurses who would tell the boss if they didn't like you not "knowing your place" because you gave 2 liters O2 to a patient whose chief complaint was COPD exacerbation--I'm not ****ting you. There's this constant tension of whose job is it to do what and nobody moves until the right guy with the right license show up. Physicians who use to do things themselves parlay to consult services because they're afraid of getting sued and so on and on.

It made me respect and envy the independence of Medics who handled things on their own did what they could to get the patient to the hospital alive and then jetted.

I'm not advocating for ED tech independence but just that there's a lot that can be learned from looking at the opposing models. Civilian structure would not hold up under the realities of getting troops stabilized and shipped out. We're too bureaucratic. And regardless of my training a lot of what the next guy up on the food chain does ain't rocket science.

PS. Forget what you see on ER-- Doc's would be as useless in the field in a lot of situations that an experienced medic would make look easy.