Lately, on Facebook, there’s been some debate. (Or what passes for debate on Facebook — AKA, monkeys flinging poo.) The Facebook EMS forums have been all abuzz about the idea that some EMS systems don’t hire you in as a paramedic and that you have to work as an EMT for a couple of years before promoting into a paramedic position, regardless of your state certification level.
Let me say that I think this is a flawed model. Do I have the science behind ALS skills retention and the number of ALS interventions out there? Nope, I don’t. I won’t even deny that there’s only a few patients who really need the whiz-bang ALS stuff such as intubation, but that’s not all there is to being a paramedic. But, I think the way to learn being a paramedic is by being a paramedic. And a good paramedic assessment is something you can perform on every patient. Symptom relief, whether pain management or nausea management is one of those ALS skills as well. Good BLS skills are definitely the foundation of competent paramedic care, but at some point, the “everyone is an EMT for X number of years” model is going to turn away experienced providers. The BLS skills model also works really well when you have short transport times to definitive care as is the case in Boston and most parts of Austin. (Heck, the Houston Fire Department even recognizes this and tells their EMT crews to initiate emergency transport for any trauma patient they encounter in inner Houston.)
As for me, I was very fortunate to have the opportunity to “grow” as a medic in a very high volume, high acuity EMS system with exceptionally broad and aggressive protocols developed and implemented by a full time medical director. New full-time medics went through a FTO process before being released as a second crew member. To be the lead (AKA in-charge) paramedic took an additional FTO process. As for volunteers, you rode as a third crew member while retaining the ability to practice virtually any skill available to your certification level and, after a period of time, could challenge the FTO process. For me, that process worked. It worked quite well. While I’m no longer with that service, I appreciate my experience and routinely refer back to it with almost every call I run.
There’s no secret about these places (most notably Boston and Austin) that hire paramedics into the role of a basic. They tell you in advance that’s what it’s going to be. There’s full disclosure. If you don’t like that process, you don’t have to apply. And while I don’t have the numbers, my supposition is that a lot of experienced providers aren’t interested in such a process. Sadly, many of the younger, inexperienced medics who’d benefit from an extended skills development process and FTO program because of a lack of maturity, both as a person and a provider, also lack the maturity to recognize that they need such processes. Civil service produces a lot of good benefits for medics — namely a well-defined process for HR issues. What it also produces is a relatively static culture that promotes from within, and without careful attention from management, promotes an insular groupthink.
In conclusion, I’d say that the model that Austin and Boston use is the model they’ve decided on. If you don’t like it, don’t apply. But to those services, when you have an extended FTO and promotional process, you have to recognize that you’re unlikely to attract experienced medics. It becomes a self-fulfilling prophecy. You can’t attract experienced medics to such a system, so the system becomes even more rigid to adapt for inexperienced medics requiring more initial training and mentoring.
Yep, when the only tool you have is a hammer, everything starts looking like a nail.
