Where was I? Oh yeah, pontificating about new paramedics.

First a confession. I have two college degrees, the higher one being a Master of Public Administration (MPA). Which you would think would be beneficial in getting promoted to supervisor or manager. Nope, not at all.

In fact, about the only EMS related benefit that I got in all the years since I got that MPA is that it allowed me to become a Licensed Paramedic in Texas. That, plus taking the excruciating EMS Jurisprudence class that every certified Texas ECA, EMT, AEMT, Paramedic, Licensed Paramedic has to take to become and remain certified or licensed.

The best way to learn to be a paramedic is to respond to calls. Even routine Interfacility Transfers can help you improve your skills. If nothing else you can improve your interviewing skills.

A former co worker went on to be a police officer. I saw him about three years after he graduated from the police academy and he told me that he was in line to be made a detective. I mentioned that it seemed pretty quick and he told me that his agency liked to have paramedics as detectives because we’re good at asking questions and getting people to tell us things that they might not want to discuss. Interesting.

It’s good to practice building a rapport with your patients. It’s also a good practice to build rapport with your co workers, bosses, staff at various facilities. If they trust you, you’ll be surprised at what they might reveal.

Also, improve your examination skills. Doing things like listening to breath sounds on a manikin, no matter how realistic is not like listening to lung sounds on a patient. Once you know what normal sounds like, you will know what abnormal sounds like. Then you can start to learn what various adventitious breath sounds can tell you about your patient.

Go to as many classes as you can find time and money to attend. I’m not talking about the various “merit badge” courses offered by that large national EMS organization.

Very often local hospitals will offer a variety of classes open to EMS providers. Sometimes they even offer a free meal and who doesn’t like that?

Attend classes that you think might be above your level of education or training. You’ll likely learn things that will help you understand some of the things you were taught in paramedic school, but weren’t really comfortable with.

If possible, pick subjects that you weren’t all that good in and don’t find all that interesting. There’s a good chance you’re going to run into a situation where that will be important information.

If you can take cardiology courses, especially those with a concentration on EKG interpretation do that too. All too many paramedics are content to accept whatever the computer based interpretation says is going on. Every doctor I’ve ever discussed this with says that the computers are frequently incorrect and that they always overread the EKG to be sure of what’s going on.

Unlike what we were told in paramedic school sometimes you do have to treat the rhythm.

Know your protocols and Standard Operating Procedures. A lot of medics have a vague understanding of their protocols and that frequently leads to me having to “have a chat” with them about what happened on the call. To compound that problem experienced paramedics and some instructors will let you in on “street paramedic tricks.” For the most part they are shortcuts, often taken by lazy paramedics to avoid the more complicated appropriate treatments. At best these don’t help the patient and in some cases they can cause potential or actual harm.

A medical helicopter operation with which I am familiar has their crews pick a protocol out of their extensive protocol book, read it, and discuss it at the start of their shift. Everyone in EMS should know how to treat Acute Coronary Syndrome, but all too often people miss the subtle clues present with atypical presentations. If you miss those, you miss treating the patient and can cause an adverse outcome.

As boring as they are, read your agency operations manual. You need to know the rules before you can know when and how to skirt them. The goal being to do a better job despite silly rules.

Just remember that your boss never makes a new rule when someone does something smart.

I’m going to go back to education for a minute. So, I suggested business classes with English composition and mathematics included. That will help you whether you want to stay in EMS or move on. Many people in EMS decide that they want to move on for any number of reasons. Some just get burned out, which is always a risk.

That degree in business management is a hedge against having no place to go outside of EMS. You can even work in EMS and something else while you work to transition out.

Looking back, the one regret I have is that I never went to nursing school. By the time I realized the doors that a BSN opened to paramedics it was too late to go back to school and expect a Return On Investment. A lot of what you learn in paramedic school applies to nursing school. If your paramedic program had a college level Chemistry and/or Anatomy and Physiology course, you might be able to transfer some credits. Every nurse I’ve ever discussed this with has told me that Organic Chemistry was the hardest part of nursing school. Once they passed that course, the rest was relatively simple.

If I’d known then, what I know now…

There are nursing career paths that don’t require contact with patients.

I mentioned having an exit strategy, or “Plan B.” Something might happen and you won’t be able to continue in EMS. Well, unless you want to take a pay cut and work in dispatch. Which is less than ideal. I started in dispatch and got out into the field just as quickly as I could.

Which brings me back to non EMS specific education programs. If you already have a Bachelor’s degree of some flavor, a Master of Business Administration is a viable option. In addition to the medical and operational parts of EMS, there is a business side. That’s true whether you are in private,  public, or volunteer EMS. Someone has to figure out where the money goes and where the money comes from. Or should come from.

EMS systems are expensive, even volunteer services. While salaries and benefits are bigger parts of the cost in paid EMS, everything in EMS costs money. Vehicles, fuel, maintenance, a building, rent, utilities, on and on. Someone needs to figure all of that out.

That’s my advice. Consider it for what it’s worth.