nicuPAC Posted October 15, 2021 Share Posted October 15, 2021 Hey y’all. I recently moved to a VERY small/rural town with a volunteer EMT unit. I was not an EMT prior to PA school, and have been a NICU PA since graduating/residency in 2014. When everyone in the town found out I was a PA, they’ve been eager for me to come on board and help our unit expand from BLS to ALS, ect. I guess I’m looking for advice moving forward. Clearly I have no paramedic/EMT background and am VERY specialized in my PA practice. I’d love to get out of my niche and expand my role, and I think this is a great place to do that. Any advice? Is there a PA/paramedic bridge? Just looking where to start. Thanks! Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted October 15, 2021 Share Posted October 15, 2021 Just a warning- the pre-hospital environment is very different. Always unpredictable and usually resource-poor in terms of manpower and personnel. Being a great ER PA does not automatically translate in being good at EMS (and vice-versa). 1 Quote Link to comment Share on other sites More sharing options...
MediMike Posted October 15, 2021 Share Posted October 15, 2021 1 hour ago, nicuPAC said: Hey y’all. I recently moved to a VERY small/rural town with a volunteer EMT unit. I was not an EMT prior to PA school, and have been a NICU PA since graduating/residency in 2014. When everyone in the town found out I was a PA, they’ve been eager for me to come on board and help our unit expand from BLS to ALS, ect. I guess I’m looking for advice moving forward. Clearly I have no paramedic/EMT background and am VERY specialized in my PA practice. I’d love to get out of my niche and expand my role, and I think this is a great place to do that. Any advice? Is there a PA/paramedic bridge? Just looking where to start. Thanks! In all honesty I'd strongly consider attending a paramedic course prior to trying to make that step. As mentioned above it's all just...different. The logistics are different, diagnostic modalities (or lack thereof), treatments, whether you'd need to stand by the protocols or the medical director would be more laissez faire...There's just a lot. https://ems.creighton.edu/programs/ems-certificates/paramedic-certification-course-health-care-professionals There's this one, seems to check the boxes in a reasonable amount of time. Clearly you wouldn't need to do the whole shebang of paramedic school as you likely know pharmacology, 12 lead interpretation, IV skills and I'm assuming in the NICU you were intubating? 1 Quote Link to comment Share on other sites More sharing options...
nicuPAC Posted October 15, 2021 Author Share Posted October 15, 2021 This is what I’m looking for! Something to help bridge a little. Our volunteer unit only has EMTs, no paramedics and the MD oversees from 2 hours away (like I said, small/rural). Yes, in NICU I do all procedures: chest tubes, intubations, central lines/IVs, ect. Landmarks are the same, the bodies are just bigger (and have teeth). EKGs and pharm yes, dosing just differs (obviously). I know field medicine is entirely different than hospital, I just want to give back to my community that desperately needs it, but I don’t want to do it in the wrong way. I don’t know what I don’t know, and I’m willing/eager to learn to help be an asset. Thanks for your link- I’ll look into it. 1 1 Quote Link to comment Share on other sites More sharing options...
FiremedicMike Posted October 18, 2021 Share Posted October 18, 2021 I’d link up with their medical director at some point (probably before going to medic school). Introduce yourself, get their thoughts on how you could fit/help, etc.. 1 Quote Link to comment Share on other sites More sharing options...
dmdpac Posted October 18, 2021 Share Posted October 18, 2021 2 hours ago, FiremedicMike said: I’d link up with their medical director at some point (probably before going to medic school). Introduce yourself, get their thoughts on how you could fit/help, etc.. Agree with all of the above but especially the quoted comment. That's great the local squad wants to expand their capabilities. The medical director is going to have to be on board with the change... If s/he even supports the upgrade in services. Make an appointment to meet and get his/her input on moving forward. 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 20, 2021 Moderator Share Posted October 20, 2021 Sounds like a lot to loose and little to gain. Maybe just do emt basic and try it. Prehospital very different. Quote Link to comment Share on other sites More sharing options...
UGoLong Posted October 20, 2021 Share Posted October 20, 2021 The initial basic EMT class fills in most of the details about the prehospital environment. Not sure if they still have it but I knew of an RN/EMT who took a 3 month bridge course and became a paramedic. Depending on your system, if you were an EMT basic, it is possible that the medical director could become your collaborating physician and let you ride and treat at your PA skill level. After all, MDs do occasionally hop on board and take over care at their level even though they aren't EMTs or paramedics. Just a thought. Good luck! Quote Link to comment Share on other sites More sharing options...
MedicinePower Posted October 20, 2021 Share Posted October 20, 2021 I'm not aware of any study which shows ALS actually improves on survival over BLS. Therefore the eagerness to "upgrade" from BLS to ALS might not improve anything. Quote Link to comment Share on other sites More sharing options...
MediMike Posted October 20, 2021 Share Posted October 20, 2021 2 hours ago, MedicinePower said: I'm not aware of any study which shows ALS actually improves on survival over BLS. Therefore the eagerness to "upgrade" from BLS to ALS might not improve anything. I'd sure as hell be eager to upgrade to some pain management if I got my arm caught in a thresher, or grandma falls and breaks her hip. Being able to recognize a STEMI/OMI and call for a flight, provide a definitive airway in the setting of respiratory failure, treat AECOPD or asthma, apply NIPPV and manage appropriately. Were there specific studies you are referencing with your comment? I'm assuming you're thinking of the OPALS study and a variety of the trauma literature out there, my point is that there is a significant benefit to ALS interventions outside of cardiac arrest and massive trauma. Prehospital research is a mix of hot garbage and cool trash half the time. Applying some of these urban studies to rural regions doesn't really work, especially when you are looking at all/mostly volunteer agencies with low volumes. 1 1 Quote Link to comment Share on other sites More sharing options...
FiremedicMike Posted October 20, 2021 Share Posted October 20, 2021 (edited) 8 hours ago, MediMike said: I'd sure as hell be eager to upgrade to some pain management if I got my arm caught in a thresher, or grandma falls and breaks her hip. Being able to recognize a STEMI/OMI and call for a flight, provide a definitive airway in the setting of respiratory failure, treat AECOPD or asthma, apply NIPPV and manage appropriately. Were there specific studies you are referencing with your comment? I'm assuming you're thinking of the OPALS study and a variety of the trauma literature out there, my point is that there is a significant benefit to ALS interventions outside of cardiac arrest and massive trauma. Prehospital research is a mix of hot garbage and cool trash half the time. Applying some of these urban studies to rural regions doesn't really work, especially when you are looking at all/mostly volunteer agencies with low volumes. The last study I'm aware of was out of California (LA or SF I think) which compared a very different system setup but essentially showed a higher mortality rates with ALS care. I believe they concluded the extra time setting up ALS assessment/care was detrimental to the patients and that tossing them in the truck and driving fast had a higher survival rate. Before you ask, I don't remember the study design or sample size, I'm pulling from distant memory, as this was a very old study.. Edited October 20, 2021 by FiremedicMike Quote Link to comment Share on other sites More sharing options...
FiremedicMike Posted October 20, 2021 Share Posted October 20, 2021 IMHO - given the current state of EM and EMS, I think a PA/NP and EMT-P on an ambulance would be an interesting experiment. So many EMS runs and subsequent transports to the ED are general primary care. It would be cool to go beyond paramedic "diagnostic impressions" to actual legal diagnosis and care planning by a licensed provider on scene.. Quote Link to comment Share on other sites More sharing options...
kargiver Posted October 20, 2021 Share Posted October 20, 2021 There are many flaws with the current research that evaluates, and has evaluated, BLS vs. ALS outcomes. The biggest issue of course is injury/illness bias, and no study has appropriately addressed this. That said, there is absolute validity to the findings... Which is why ALS use should be specialized. As long as EMTs can give sugar, Epi pens, narcan, and possibly benzos for termination of seizures, truly, the rest is window dressing. Agree about pain management - if medics exist in the field where you are, pain management should be a priority. But that is another can of worms. PAs/NPs would serve a very interesting role on EMS rigs... but at that point it becomes home health(urgent) care, not EMS. And if you have never been a medic, seriously consider if going from PA to EMT-P is what you want. I've done both for a long time now, and the roles are not particularly translatable, as paramedicine is its own beast. Paramedicine is dirty medicine, held to a far different standard, and what you learn as a PA (or Doc) does not translate well to working and living in the streets. EMS fellowships are trying to address this, but the streets will break the docs as well. G 1 1 Quote Link to comment Share on other sites More sharing options...
TeddyRucpin Posted October 20, 2021 Share Posted October 20, 2021 (edited) I had medical students and EM residents ride with me in the past. While they have a significantly enhanced knowledge base, it may not always translate to our unique "medicine." It's like how in medic school when we participate in anesthesia/OR rotations for airway management, we experience the most controlled/pristine environment to intubate/place an Igel. It's incredibly different to RSI someone in their home, in the back of an ambulance, or on the street. Also, consider everyone to have a full belly. Edited October 20, 2021 by TeddyRucpin 1 1 Quote Link to comment Share on other sites More sharing options...
nicuPAC Posted October 30, 2021 Author Share Posted October 30, 2021 I appreciate all your insight. Because it’s such a small, rural town with minimal on call availability, they’re just eager to get someone on board. I’ve never been an EMT, and told them I’d rather do an EMT-B course and discuss a bridge program in the future. I’m so specialized in hospital/peds/icu care that although I know overall pathophys, outpatient EMS medicine is definitely different. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted October 30, 2021 Share Posted October 30, 2021 I miss riding a box. Best, and most fun, job that I ever had. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 30, 2021 Moderator Share Posted October 30, 2021 If memory serves me. in order to challenge -P you have to already have taken and passed -B. there is nothing in PA school that trains you for EMT unless your school did this specific certification. my knowledge is from 20 years ago. Quote Link to comment Share on other sites More sharing options...
kettle Posted October 30, 2021 Share Posted October 30, 2021 2 hours ago, GetMeOuttaThisMess said: I miss riding a box. Best, and most fun, job that I ever had. I did 12 years in the box, good job but not a good career. PA school definitely does not prep for pre-hospital. Quote Link to comment Share on other sites More sharing options...
Arthropathy Posted October 31, 2021 Share Posted October 31, 2021 (edited) I'm all for volunteering for a good cause, but this seems like a real hassle. Are they going to call you in every time there is an ALS complaint? Or only run ALS when you are on shift? How many hours a week are you volunteering? Who will manage the stock of ALS drugs? Are they going to get you a monitor? Edited October 31, 2021 by Arthropathy Quote Link to comment Share on other sites More sharing options...
TeddyRucpin Posted October 31, 2021 Share Posted October 31, 2021 4 hours ago, Arthropathy said: I'm all for volunteering for a good cause, but this seems like a real hassle. Are they going to call you in every time there is an ALS complaint? Or only run ALS when you are on shift? How many hours a week are you volunteering? Who will manage the stock of ALS drugs? Are they going to get you a monitor? Another specific, who will be the narcotics agent? Locally, you need two and of course, both must be ALS level. Quote Link to comment Share on other sites More sharing options...
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