FIELD CLINICALS, For Paramedics

[MassEMT]

Hello,
I am a Paramedic student in Massachusetts. My instructor has asked for my class' assistance in making his future programs a success. We are basically trying to redesign a paramedic program based on factual research and on the opinions of medics and their past experiences. Each of us has a topic to explore, mine being the field internship portion, or "ride-time", of the program.

I am looking for information about everyone's personal experiences with their field internship, from medics across the country.

Where did you attend medic school? Did you ride with a local service or travel to a distant busy system? Did you ride with a private, fire, or hospital based ambulance? Did you spend extra money for it, or was it incorporated into your tuition? How many hours did you ride to obtain your skills; was this the minimum required? If you rode within your own company, were you treated differently?
Any information would be greatly appreciated. Thank you all!
Steve

[mgr22]

I attended medic school in the Metro NY area in the early 90s. It was a 10-month program. We did all of our ambulance rotations in NY City, and hospital rotations on Long Island. I think the total practical time was a little over 500 hours. Overall, it was a 1000-hour program (now 1200+). The tuition (about $3000 in those days) covered almost everything.

Some of us continued to ride with our own agencies while we were in school. I can't speak for the others, but I don't remember being treated very differently until I became a medic.

Go Sawx!

[MassEMT]

Thank you for your input mgr22.

[dr-exmedic]

Medic school for me was a community college in SW Pennsylvania. We were welcome to ride with whomever would take us and had county-approved preceptors; some services would take all comers, some would only take existing members, but in either case there was no charge (and as the companies didn't get reimbursed for my presence, I suppose you can't really say it was "bundled into tuition," which back then was only $300+book). I ended up running with the local 3rd-service squad. This was back in 1998-9, so we didn't have a minimum number of hours, but had to do 15 BLS and 15 ALS calls.

Needless to say, this was nowhere near a sufficient amount of experience.

[coolmedic]

I did my ride-time in Mass., driving from NH. Had also driven to Portland Maine. Mass. medics were mush more receptive, the Portland folks were down right rude and unwelcoming. My cost of 5K all inclusive. A good ride-time experience should be paired with people who actually want to help mold quality medics. After taking an active role and not settling for mediocrity, I found the quality medics I needed. I've been a medic now for 12 years and welcome medic students on my truck.

[MassEMT]

Thanks for sharing.. This helps me out with my research.
I appreciate anyone else who wants to offer their ride-time experiences.

[RoadDoctor29]

We recently switched over from our Emergency Services Association to the local Community College for Paramedic training. This was due to the total lack of support given by the ESA surprisingly (typical stuff like "we have no money for training supplies because we might need to buy a $500,000 reserve fire engine".)

Anyways, I'm not sure how many hours the program is. However, we redesigned our clinicals and made new agreements with facilities, because the local hospital was basically a "general hospital" and had no specialties. Our students do:
-8 hours Physician shadowing
-32 hours ED Time (we have nurse preceptors in place at the local ED)
-2 days Cardiac Catheterization Lab
-2 evening/nights at Level 1 Trauma Center
-8 hours in Pediatrician's office (mostly for assessments of sick kids- not necessarily aimed at treatment)
-1 day on State Medevac (Maryland State Police)
-At a MINIMUM, 35 ALS calls on 911 ambulance.

We decided to put a minimum number of calls and make the student obtain a 4 or 5 on a Proficiency Scale (5 highest, 1 lowest) of the following areas:
-Patient Assessment
-Venous access
-Airway management
-Drug administration
-Cardiac management
-Medical consultation
-Any other care not covered in above

Each section would have to have a proficiency of 4 or 5 AT LEAST 10 times or more. Therefore, it is possible to do more than one section on many calls, and we changed our focus from quantity to quality. This was the first year we've done this, and it seemed to have worked very well. We also review all calls to make sure the students aren't "escalating" cases just to make them ALS, in order to emphasize the need for quality BLS care as well. If you want a copy of the form to compare, email me PMJRoberts@gmail.com. It won't attach here due to size.

[MassEMT]

Thank you RoadDoctor. Your information really helped, especially since we are trying to look into the "quality vs quantity" idea. Massachusetts is only concerned with the number of skills performed, so at my program we were considering adding in the proficiency factor.

[dr-exmedic]

I'm embarassed that I didn't think about it, but NREMT regularly publishes studies on what correlates with paramedic success on the NREMT exam (which may not be the best indicator of a quality program, but it's certainly important). Two I've blogged (http://blog.dr-exmedic.com/?s=nremt) are here:

http://www.ncbi.nlm.nih.gov/pubmed/18379919
http://www.ncbi.nlm.nih.gov/pubmed/18304056

There are others out there; these are just the two that I had off-hand.

veneficus would probably be amused to note that one of the things that came out of those studies was that people who were attending medic class as a job requirement were less likely to pass than those not doing so. :D

[chedge15]

MassEMT where about is your medic program?

I'm also in medic school in a four year program for Emergency Medical Services Management at Springfield College, and Paramedic is built in (with a summer semester). We just entered our final semester (of 3) for paramedic.

I wanted to say that when we do our field internships, we go (as a class) to New York City and ride with FDNY for week of 40 hours consisting of 5, 8 hour shifts. From what I've heard most people have only done 8-12 calls in the entire week because they have so many trucks on the road. Most people start riding here in Springfield with the contracted 911 company, where I work part-time. And we also can get agreements to work with other area fire dept.s.

Good luck with your studies, not sure if I was any help. Just thought I would add what we do here.

CH

[MassEMT]

My program is through an ambulance company in Cambridge, MA. The class portion is about 11 months long. We started clinicals a couple months into it.

For ride time we have to do at least 100 hours, and we have the option to either ride with the company, ride with where we work, or go to a hosital-based ambulance in NYC (Harlem area). Most of us will probably end up going to NYC. They say its busy to be on, since they don't have near as many trucks as FDNY. I think they do 12's, so we will probably do about 9-10 shifts. . . Good Luck

[firemedicgm]

The program I attended, Iowa Western Community College in Council Bluffs, IA, (right across the river from Omaha), was a 4-semester program, 5 if you were not already an EMT. Required clinicals included 500 total hours, 250 on the truck and 250 in various areas of healthcare (emergency, pediatrics, OB, psych, etc.). In addition, we had to log a prescribed number of specific types of patient assessments (chest pain/discomfort, dyspnea, OB, psych, peds, etc.). We also had to log a set number of skills performed successfully (intubations, IV's, med administrations, etc.). The instructor also required that we complete our clinicals at a variety of locations so that we could see different ways of doing things (rural, metro, transport).

Overall, it was a great program, and I believe it was because of the tough requirements. It helped that we had access to several metro hospitals and specialty centers, instead of doing all of our time in a slow, rural ED. We gained exposure to much more than we could have seen in some programs around Iowa. There's a big difference in learning cardiology at a center with a cath lab, or trauma at a level I trauma center, than at a rural ED with no advanced capabilities. Don't get me wrong...I'm not bashing rural ED's, that's where I work now. They're just not the best teaching facility.