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Old 02-10-2007, 04:04   #1
DaleGribble
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New paramedics, talk to me...

I start paramedic next month and have heard countless horror stories. Part of me thinks it's just weak people that crack under pressure and part of me is wondering if it's really as bad as people say.

Clue me in guys and gals!
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Old 02-10-2007, 09:41   #2
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If you have experience as an EMT and pay attention to your medics, it will be easier. It is difficult to get through at different stages. It depends on well you comprehend anatomy, physiology, etc. If you've been a good student in the past and are able to dedicate time to studying you shouldn't have any problems. Here in MI the state adopted the National standards and I know that is significantly tougher than it was in the past.
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Old 02-10-2007, 10:28   #3
DaleGribble
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I breezed through A&P with an A. I'm not so worried about the academics, I always get good grades. It's the time commitment that everybody keeps talking about.
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Old 02-10-2007, 16:59   #4
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I for one fell out of my seat laughing at the "suggested time requirement" for the hospital rotations. They said it would take about 96 hours to get one module done, broken up into 24 hour blocks... HAHAHAHA.

I probably spent almost 200 hours in the hospital getting my intubation modules done, IV module was easy and only took about 8 hours, some of the other OR rotations easily took ten times the "suggested time"... I'd plan to spend at least 1,000 hours in the hospital getting all your rotations done. There's just no way to predict how long the stuff will take. I spent three 8 hour shifts in a busy inner-city OR w/o getting a single tube, and the fourth shift I had doc's coming in to the room while I was in the middle of a tube saying "when you're done there, we have another for you!".

Don't forget, there will be some days everything will be perfect... all the right patients are rolling in... and a med student/PA student/nursing student snatches the assessment/skill from you. It happens. While some students get lucky and get all their rotations done rather quickly, I'd plan for the worst and hope for the best... the day before coursework is due is not the time to be running around the OR like a madman looking for the last skill you need checked off.
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Old 02-10-2007, 21:35   #5
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What state are you in?
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Old 02-10-2007, 23:37   #6
DaleGribble
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I'm in SC.

Our hospital time is going to be around 150 hours. We were told to that we'd be doing intubations in the OR so we could actually get them. There is no way in hell any of us can do 1000 hospital hours in nine months while working and going to school Monday, Wednesday and Friday and doing 250 ambulance hours.
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Old 02-11-2007, 13:25   #7
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I don't know how the program is set up in SC, but the hours that you're being asked to put in seem pretty conservative. I think that I put in about 500 hours on the ambulance and at least that much in clinical rotations.

I think that the best piece of advice is to push yourself outside of your comfort zone. As a P student you will likely be low man on the totem pole, and as such it will be easy to just blend in- but that's not going to help you. Your OR intubations will be relatively easy, so tell the ED docs that you want to tube people there when it is slightly less of a controled setting, and more like what you would see in the field. The same goes for IVs. Tell 'em you want in on the difficult starts and try your hand at a few EJs- which arn't really difficult, but there is a pucker factor which is good to get over before you're in the field. Ask if you can lead a code- you'll be doing that soon enough anyway. Just try to get in on everything that you can, even if it is uncomfortable.

Start studying ACLS and all of your cardiac stuff now. And work as much as you can now and save some $. In my class, I was only one of two people who kept their job to the end.

Good luck.
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Old 02-11-2007, 14:03   #8
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I'm in MD... and don't forget with EJ's, the smallest you want to use is a 16... why on Earth some people decide to try an EJ with a 20 is beyond me... but I've seen it happen.

A tip for before your field ride alongs: if they let you choose where you do your ride alongs, do some pre-emptive scouting. Visit the local fire houses/rescue squads, find some medics who take a genuine intrest in helping students, and request you do your rotations there. A good mentor goes a long way.
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Old 02-11-2007, 15:33   #9
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Quote:
Originally posted by D25
I don't know how the program is set up in SC, but the hours that you're being asked to put in seem pretty conservative. I think that I put in about 500 hours on the ambulance and at least that much in clinical rotations.

I think that the best piece of advice is to push yourself outside of your comfort zone. As a P student you will likely be low man on the totem pole, and as such it will be easy to just blend in- but that's not going to help you. Your OR intubations will be relatively easy, so tell the ED docs that you want to tube people there when it is slightly less of a controled setting, and more like what you would see in the field. The same goes for IVs. Tell 'em you want in on the difficult starts and try your hand at a few EJs- which arn't really difficult, but there is a pucker factor which is good to get over before you're in the field. Ask if you can lead a code- you'll be doing that soon enough anyway. Just try to get in on everything that you can, even if it is uncomfortable.

Start studying ACLS and all of your cardiac stuff now. And work as much as you can now and save some $. In my class, I was only one of two people who kept their job to the end.

Good luck.
Our instructor laid out the hours to us, but he did say it all depends on whether or not we actually get everything done in that amount of hours. So it might really be a conservative estimate.

I've been doing IV's for about a year now. Running my own truck as an I85 has given me more difficult starts than I thought it would and it's definitely the toughest part of this job, at least for me anyway. I'm getting better at blind AC sticks, but I still have a crappy IV percentage compared to the guys who've been doing it for awhile.

Losing my job is not an option either. They're paying my way and I gotta sign a contract, so I can't quit. I'll be locked in that place for three years come hell or high water.

Last edited by DaleGribble; 02-11-2007 at 15:41..
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Old 02-11-2007, 15:41   #10
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Quote:
Originally posted by 4095fanatic
I'm in MD... and don't forget with EJ's, the smallest you want to use is a 16... why on Earth some people decide to try an EJ with a 20 is beyond me... but I've seen it happen.

A tip for before your field ride alongs: if they let you choose where you do your ride alongs, do some pre-emptive scouting. Visit the local fire houses/rescue squads, find some medics who take a genuine intrest in helping students, and request you do your rotations there. A good mentor goes a long way.
We get to choose where we do most of our clinicals, even the hospital time. I'm lucky in that regard. I have two huge hospitals and two very busy ALS services less than 30 minutes away.

I plan on doing the vast majority of my ride time with the neighboring service that is really busy. I'm gonna try to do most of my time on their busiest truck, which is usually staffed by theirbetter medics.

My current partner in our little mayberry type service has 20 years of experience in a busy service and he's teaching me a lot and it's been a big help.
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Old 02-11-2007, 15:58   #11
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Quote:
Originally posted by DaleGribble
My current partner in our little mayberry type service has 20 years of experience in a busy service and he's teaching me a lot and it's been a big help.

Just keep listening, us old farts have learned all the tricks of the trade. I work PT in a small community ER and even I teach them something once in a while, particularly about difficult IV sticks.

If you can, get a PT job in a smaller ER that allows medics to use their skills. I drastically improved my skills by working in the ER, particularly IV starts. I went from about 70% before to 97-98% in a yr or 2.
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Old 02-11-2007, 20:57   #12
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Up here in Michigan the hardest parts were learning your drugs, and your ACLS...If you want it bad enough to where you can stay focused in class, you shouldn't have any problems. The practical field work does wonders when it comes down to the test. Good Luck I'll be rooting for you.


Scott (Firefighter/EMT-P)
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Old 02-12-2007, 11:36   #13
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getting your tubes in the or will be tough..my past experiance is that they welcome students in but are very leery about actually letting them do the skill. When your rotations start talk with your class mates about what doc they had..theres usually one cool doc in the group that lets all the students actually tube...just my experiences...hope all goes well.
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Old 02-12-2007, 12:42   #14
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Quote:
Originally posted by DaleGribble
I breezed through A&P with an A. I'm not so worried about the academics, I always get good grades. It's the time commitment that everybody keeps talking about.
First of all, PM me and let me know where you are going to school and where you work. I work in the Upstate and might be able to give you better answers to your questions.

Second, I'll tell you like I was told by my instructors and that I pass on to students who have the unfortunate chance to ride with me.

"Give me all your free time. I'm going to put it in my desk drawer, I'll give it back to you after graduation."

THAT'S the time commitment!

-Chris
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Old 02-12-2007, 19:35   #15
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Here was my experience. 32 ride times. 0 if your already hired. 16 ER clinicals, 2 OB, 2 OR (intubations), 2 NICU, 2 ICU, 1 PSY, 1 ME. Lots of time spent OUT of the class. I am doing my fire now and I can say the paramedic was WAY MORE time consuming than fire, and thats that I did the 12 month 1 time a week class. God help me had I chosen the 3 a week 9 month course. I would have had no life. Mega codes can be very intimidating at first but like everything practice makes perfect. Relax and learn the algorithms for vtach/vfib, asystole, and pea. Then most other cases such as CHF, asthma, anaphyllaxis, chest pain etc have their own drugs that can help you remember. At least this worked for me. Chest pain you know its O2, ASA, Nitro, Morphine. I also recommend paying attention to drug calcs. Even though dopamine and lido come pre mixed in all departments down here they still make you know it for the state test. Learn the master formula and then learn the clock method. Good luck man. I had a LOT of fun since me and a friend were the only non hired students, but would not want to go through it again! Its very intimidating the first few months.

One more thing. Use the volume on the LifePak 12.
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Old 02-12-2007, 19:59   #16
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The time requirments are the killer. Also, remember, focus on patient assessment! Being a Medic is 90% assessment. get your assessment down, and the skills will fall into place. Focus on assessment!!!!
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Old 02-13-2007, 07:38   #17
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Dale, congratulations on deciding to pursue, probably the most demanding understaking of your life. When I went through my Medic course I took the academy style 5 day a week 9 month course. It was a sink or swim experience. I learned a lot, but not near as much as I learned in my first month on the street. As others before me have said. Learn your algorithms! The mega code is waiting just around the corner.

Dont let the pharmacology scare you, its not as bad as it seems if you study the drugs in groups.

You may already know this trick with Dopamine, but it has been a lifesaver for me a time or two.

This works only if the pt weighs more than 100 pounds and is used to calculate the dose for 5 mcg/kg/min

Take the pts wt in pounds (yes I said pounds not kg)
drop the last digit in the weight and then subtract 5 from the resulting digit.

example:

The pt weighs 220 lbs (100 kg)

220 drop the last digit (0)
resulting in 22

22-5= 18

18 gtts/min for a dose of 5 mcg/kg/min

Now just double the number above for 10 mcg/kg/min (36 gtts/min), multiply x 3 for 15 mcg/kg/min (54 gtts/min) and so on.

Its not as exact as using the proper formula (which the answer incidentally is 20 gtts/min, but EMS is rarely an exact science and most of the time we are guessing at pt weight anyway.

The same formula will also work for Dobutamine but you have to use 3 instead of 5 for the subtraction.

Good Luck!

Jim
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Last edited by jim2037; 02-13-2007 at 07:40..
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Old 02-13-2007, 18:37   #18
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While most of you probably know this, for those of you that don't:

Pounds to kilos in two easy steps.

1) Divide by two.
2) Take off 10%.

i.e. pt. says she's 160 pounds. Divide by two, that's 80. Take off 10% (8 pounds), you have 72. According to the calculator:

160/2.2 = 72.72.

It's a lifesaver, trust me .
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Old 02-15-2007, 05:26   #19
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Quote:
Originally posted by 4095fanatic
While most of you probably know this, for those of you that don't:

Pounds to kilos in two easy steps.

1) Divide by two.
2) Take off 10%.

i.e. pt. says she's 160 pounds. Divide by two, that's 80. Take off 10% (8 pounds), you have 72. According to the calculator:

160/2.2 = 72.72.

It's a lifesaver, trust me .
I would have failed had I put 72 for a 72.72 answer. The correct answer is 73. That little point whatever makes a difference. Trust me!
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Old 02-23-2007, 16:26   #20
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Although not new I went through paramedic school 6 years ago. The only I can tell you is just take the time to study. Don't worry about thinking too far ahead. I just went with the flow and did just fine. They break down the sections for a reason.
Remember to breathe.

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