How To Survive Paramedic School

Read an excerpt from Lights & Sirens here.

Sixty-six EMS books share shelf space in my office. Some are exciting, some are educational, some are boring, and some are barely readable.

Only one is chilling.

Lights & Sirens, the compelling account of a 36-year-old EMT’s academic and practical experiences in UCLA’s world-class paramedic program, got my catecholamines flowing because it reminded me of the many challenges I’d encountered as a middle-aged paramedic student at Stony Brook University during 1994-95. Although I did fairly well in terms of the usual scholastic measures, I found the course difficult and, at times, terrifying.

Like me, Lights & Sirens author Kevin Grange pursued more than one occupation before turning to EMS. His reasons for switching careers—a childhood fascination with rescue vehicles and a desire to save lives—were no more naïve than my own. As we both discovered once we began our paramedic studies, noble sentiments aren’t enough to make it through rigorous programs like Stony Brook’s or UCLA’s, or to succeed at a job many would like to have done but few are willing to do.

In his introduction to Lights & Sirens, Grange, now a paramedic with the National Park Service, wastes no time acquainting us with the subordinate role of EMS interns: see everything, do anything, say nothing unrelated to patient care. In rescue environments like firehouses, paramedic students are lower on the essential-services food chain than anyone except perhaps EMT students.

As the author sprints to his assigned LAFD ambulance for a stabbing, he recalls a classmate who’d missed an alarm the week before and hadn’t been seen since. Grange then provides just enough clinical detail about the ensuing call to engage medical professionals without alienating lay readers. The brisk pace of therapeutics and uncompromising, real-time critique by preceptors should alert anyone who’s planning to train in an intense prehospital setting that there are no excuses and no refunds.

After Grange discusses his reasons for selecting the UCLA program, he begins a nine-month narrative of classroom and field instruction overflowing with insight, often in a self-deprecating tone. While some passages refer to UCLA and LAFD practices that students won’t find in every paramedic curriculum, such as experience prerequisites and lengthy internships, Lights & Sirens is packed with examples of the typical paramedic student’s struggle to keep up with intellectual overload. Consider this paragraph from an early chapter: “I didn’t crack open a book until two p.m., at which point the amount of material I needed to know for the quiz slapped me with a textbook-sized fist. The first chapters of Emergency Care in the Streets and our A & P book weren’t too bad–what overwhelmed me were the 170 abbreviations, 40 medical terms, and dozens of prefixes, suffixes and units of measurement I had to learn for my first quiz the following day.”

My own shock-and-awe moment as a paramedic plebe was discovering I actually had to memorize three sets of protocols before I started practical rotations. I assumed I’d misunderstood the part about memorization until I failed the following quiz because I couldn’t remember all the contraindications for Benadryl. That’s when my decision to attend engineering school 25 years earlier seemed smartest.

I don’t agree with everything Grange wrote; for example, he referred to his classmates as “the best part of paramedic school.” Nothing against my classmates, but whatever relationships we had during our 10 months of anxiety were overshadowed, at least in my mind, by the imminent prospect of life-shattering failure. The best part of paramedic school for me was passing.

Grange and I both had “near-death” experiences involving make-or-break retests in our respective courses: mine involved an IV-drip station and his happened during the dreaded megacode, a cardiac-arrest scenario incorporating CPR, defibrillation, drugs, airway management and anything else a preceptor might imagine to simulate a fight-or-flight response–in the student, not the patient. Grange’s description of what he endured during the weekend after hearing, “I’m sorry, I can’t pass you,” evokes the agony of having only partial control over critical outcomes. I could have dictated this paragraph:
“…I awoke at four in the morning, sweating and feeling nauseated. I still needed to pass my megacode retake. And even assuming I did, I realized the toughest parts of paramedic school were only about to begin.”

And then there’s Grange’s account of missing most of the IVs he attempted during his first hospital rotation. I can relate. I infiltrated three of them my first shift as an ALS provider. I’m not kidding when I tell you I thought of that day almost every time I missed a stick throughout my career.

It seemed to me Lights & Sirens portrays graduation as the endpoint of a paramedic’s education when, in fact, it’s merely a license to continue learning. A senior colleague of mine once warned me I wouldn’t be a “real medic” until after my first refresher (every three years in New York). As glib and condescending as that sounded, I have to admit I didn’t start to feel comfortable in that job until right around the time he forecasted.

An unpublicized feature of Lights & Sirens is its embedded review of generic paramedic-level standards of care. Those procedures won’t be dated until the AHA releases its 2015 ACLS and PALS guidelines; even then, I expect most of Grange’s material to remain current.

If you’re planning to devote a year of your life to paramedic school, you should read Lights & Sirens first. It will either help you prepare or scare you away.

In either case, you’ll be better off.

Order Lights & Sirens from Amazon.

Mike Rubin is a paramedic in Nashville, Tennessee and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.