Zero to Hero

Thom Dick is the author of People Care: Perspectives & Practices for Professional Caregivers. The recently released 2nd edition of this classic text includes seven new features: Death notification skills; suicide intervention strategies; safe procedures for defusing and, when necessary, restraining violent people; cases intended to illustrate the lessons of People Care; and strategies for reconceptualizing burnout and managing it as a balance issue. Click here to order.

You’ve been called for a collision between a pickup and a light rail commuter train in the middle of your response area. Your regular partner is on maternity leave.

You’re working with Bud today. Bud’s a nice guy, but he graduated from one of those zero-to-hero paramedic mills that cater to paramedic wannabes who have never worked as EMTs. So far, Bud has about a year of experience and his street sense is kind of elusive.

You’re driving. As you break a big intersection on your way in, you glance to your right and notice Bud answering a text message on his cell phone. You can visualize the scene about a quarter of a mile away, and it doesn’t look too bad. But thanks to some 12-foot fencing on both sides of the tracks, you won’t be able to get the ambulance anywhere close. You’re first in, and bracing yourself for a hike.

As you park, Bud puts you on scene, transmits a size-up, throws down his headset and disappears. You fetch your gear and watch his backside trotting down the tracks toward the stopped vehicles. His hands are empty. You call him, but he can’t hear you. His portable radio is still in the cab, charging in case he might need it someday. You think about calling his personal cell phone, but dang! He’s not your regular partner so you don’t have his number. And he’s getting farther and farther away.    

Q. See, there ought to be a screening test for common sense. It’s hard enough doing your own job, without having to compensate for people who have the same certs you do, but seem so clueless about the basics of the work. Isn’t there some way to fix that?

A. I think there’s just such a test, and it’s called EMT experience. I think when we don’t insist on that prior to paramedic school, we accept more responsibility than we can handle. I think we should stop precepting paramedic students who have never been full-time street EMTs. In fact, I think we should do that right now, today. Next time a school asks you to take one, inquire about their experience. If they haven’t spent at least two years as a full-time, working ambulance EMT, you’re going to have to teach them how be an EMT and a paramedic, simultaneously. (You’re also going to have to teach them some humility.) If you think you can do it, knock yourself out. But if not, I think you should politely decline.

Q. Wow, I don’t like the way things are but I don’t know what I think about keeping somebody out of P school. I’m wondering what it would have been like if my preceptor had done that to me.

A. Talk to your agency about making this their policy. It’s an important responsibility, but it’s about system design. Somebody above your level should be shouldering that responsibility.

Q. I can say something to them, but I seriously doubt they’ll confront the school about this. I’m just a medic.

A. My agency has been insisting on two years of ambulance experience for some time now. One day we just started doing it. We found the schools acquiesced immediately; we didn’t have to argue with any of them. Want to make it happen in your town? You can use the following sample arguments...

To your agency: This is about safety. I don’t know what these students know, so I am routinely forced to divert my attention away from my responsibilities in order to cover us all.

To the school: Our preceptors are performing a major service to your students, for which you receive financial compensation. You certainly don’t share that with the preceptors. It seems fair to us that at least a student should function at the level of a competent EMT. If they can produce references from an agency where they worked full-time as an ambulance EMT for two years, we’ll take the responsibility for precepting them.

To the student: You’re taking a short cut. You want to become a medic, but you haven’t served as an EMT. Even as a paramedic student, you will be directing the activities of EMTs who have paid their dues and who know more about basic EMS than you do. That’s not right, it’s not fair, and it’s not good for sick people. We wish you well in your ongoing education elsewhere.

Thom Dick has been a passionate advocate of sick people and the safety of their field caregivers since 1970. He has written hundreds of articles and three books on those subjects, including the People Care books (www.emsworld.com/store.) You can reach Thom via Facebook, or at boxcar414@comcast.net.