EMT Instructors getting paid...

[PFDRes47cue 653]

I am just curious as to how state EMT instructors are payed. I have heard on several occasions that their pay is based on how many EMT they produce in each class. Is this true??? If so could this be part of the reason why it seems there are more and more "new" EMT's who are not sufficiently prepared for EMS and lack basic skills? Are instructors pushing students through the course to collect a bigger paycheck? I am NOT trying to blame the instructors because I firmly believe that you get out of the course what you put in. I am just trying to answer some questions. I guess this is really two different topics, one about how instructors are payed and why there are so many "new" EMT's who lack basic skills and fail to properly perform the daily tasks of an EMT.

Edited March 17, 2010 by PFDRes47cue

[JJB531 652]

I am just curious as to how state EMT instructors are payed. I have heard on several occasions that their pay is based on how many EMT they produce in each class. Is this true??? If so could this be part of the reason why it seems there are more and more "new" EMT's who are not sufficiently prepared for EMS and lack basic skills? Are instructors pushing students through the course to collect a bigger paycheck? I am NOT trying to blame the instructors because I firmly believe that you get out of the course what you put in. I am just trying to answer some questions. I guess this is really two different topics, one about how instructors are payed and why there are so many "new" EMT's who lack basic skills and fail to properly perform the daily tasks of an EMT.

I think the problem with new EMT's who are insufficiently prepared for EMS lies with the EMT curriculum and not so much instructors pushing students through the program. I don't believe there is enough emphasis placed on field training/rotation hours spent actually working on an ambulance encountering real patients. Role playing in a classroom or performing skills on a mannequin is a good start, but you truly learn "the job" by encountering real life situations, treating real life patients, and overcoming real life problems that may come up on "routine" calls.

Of course, then there are inherent problems with field training, such as finding a qualified EMT/Paramedic to act as a FTO. With the high turnover rates in EMS systems, finding experienced, competent providers can be a challenge all in its own.

The other problem with the cirriculum is that it's too cookbook. EMT's are not taught to think, they are taught a cookbook form of medicine which doesn't fly in real life scenarios because nothing is routine, and each call presents its own unique set of circumstances. Two real life examples I can think of:

#1) EMT responds to a reported chest pain. EMT arrives on scene and finds a patient complaining of chest pain. Patient states they fell a week ago and has been having chest pain ever since. EMT administers aspirin because, well in EMT class, they are taught chest pain=aspirin. Would be correct if we were talking suspected cardiac chest pain, which this is not.

#2) EMT responds to an unresponsive. Arrives and finds an unresponsive male in front yard of house. Patient was installing roof shingles in the middle of July while downing a couple beers. You can cook a steak on the patients body, but in EMT school, we learned that unresponsive=oral glucose. EMT is seen shoving tubes of oral glucose down the patients throat. The reason as it was relayed to me, he's unresponsive and we're taught to give oral glucose to unresponsive patients (which is incorrect all in its own, but that's for a different discussion). Two examples of cookbook medicine at its finest.

Hopefully a CIC can correct me if I'm wrong, but I believe the EMT programs do receive money from the State based on the number of graduates from their programs... I'm not sure how much of that money goes directly into a CIC's pocket though. I know when I was teaching as a CLI, my pay, as well as the CIC, was based on the training institutions pay scale, not based on how many students we graduated.

[helicopper 1,050]

I am just curious as to how state EMT instructors are payed. I have heard on several occasions that their pay is based on how many EMT they produce in each class. Is this true??? If so could this be part of the reason why it seems there are more and more "new" EMT's who are not sufficiently prepared for EMS and lack basic skills? Are instructors pushing students through the course to collect a bigger paycheck? I am NOT trying to blame the instructors because I firmly believe that you get out of the course what you put in. I am just trying to answer some questions. I guess this is really two different topics, one about how instructors are payed and why there are so many "new" EMT's who lack basic skills and fail to properly perform the daily tasks of an EMT.

EMS instructors are usually hourly employees or they are full-time staff at the training facility where they teach. EMS course sponsors receive a nominal stipend for each new EMT certified that is associated with a volunteer EMS agency. Non-affilated and/or commercial candidates receive no state aid. The cost of the course far and away exceeds what the reimbursement is from the state.

As far as EMT skills go, new EMT's are weak because they receive inadequate/superficial training. THAT is because the curriclum is written as a bare minimum and includes virtually no real time for any practical experience. It is nearly impossible to meet all the instructional objectives in the time allotted and when you go over, people complain that the course is too long. Supposed EMS associations have fought tooth and nail against increases to the curriculum because it is too cumbersome for volunteers. To that I cry foul because I don't want inadequately trained responders coming to my house for my family.

EMT's have to recognize that they are healthcare professionals and that requires a commitment to training. THAT will correct the problems that you cite but it will entail more hours being edjumukated. Too many people just want the patch and don't focus on the training.

[PFDRes47cue 653]

EMS instructors are usually hourly employees or they are full-time staff at the training facility where they teach. EMS course sponsors receive a nominal stipend for each new EMT certified that is associated with a volunteer EMS agency. Non-affilated and/or commercial candidates receive no state aid. The cost of the course far and away exceeds what the reimbursement is from the state.

As far as EMT skills go, new EMT's are weak because they receive inadequate/superficial training. THAT is because the curriclum is written as a bare minimum and includes virtually no real time for any practical experience. It is nearly impossible to meet all the instructional objectives in the time allotted and when you go over, people complain that the course is too long. Supposed EMS associations have fought tooth and nail against increases to the curriculum because it is too cumbersome for volunteers. To that I cry foul because I don't want inadequately trained responders coming to my house for my family.

EMT's have to recognize that they are healthcare professionals and that requires a commitment to training. THAT will correct the problems that you cite but it will entail more hours being edjumukated. Too many people just want the patch and don't focus on the training.

Thanks!

[Goose 188]

JJB - any money that a program receives CICs / CLIs don't see any of it directly in the form a bonus or that sort. It goes to fund the program....at least i've never gotten a check of that sort. And yes, generally, instructor staff is an hourly position w/ a CIC as a staff/faculty position depending on the institution.

[Guest alsfirefighter]

I couldn't agree with JJB's and Chris's posts more. I've always disliked the curriculum since its change back around 1999/2000 if I remember correctly, to the watered down generalized version that is still taught today. With the inception of DCAPBTLS, detailed vs. focused assessment and the time honored change from a more detailed instruction/review of anatomy and physiology to the terms used now, like long bone, etc. None of which corresponds to what is actually needed in the field to be an effective provider and to actually have a clue as to what is occurring with patients. It also does not correspond to being effective with certain skills, for example the albuterol administration ability, where I've experienced more admins of albuterol when it was not necessary or flat out incorrect because they didn't have the background ability or experience to differentiate asthma versus some other respiratory issues. I've had more times where I've removed the BLS admin'd albuterol, and for some reason a high number of them were for persons hyperventilating. Sit in any call audit which many today are combined and we're not using such terminology when reviewing calls, not using it in the field and certainly not using it in CME's and other courses like PHTLS, so tell me it makes sense. It also doesn't play well for those who move on or want to move on to the Paramedic level where solid assessment skills are a must in order to be a good paramedic. I'm a firm believer that the old curriculum I got better prepared new EMT's me included at the time to operate in the field more comfortably and prepped me for my future education as a Paramedic. That goes without saying that I had fantastic EMT instructors, Paramedic instructors and excellent Paramedics that I stuck to in order to gain knowledge and learn the craft better as an EMT and when I started my quest to become a Paramedic. Even if I was a pain in the a** to people like Chris192 at the time.

For anyone who is reading this and for those of you that have replied, I posted a thread on EMS continuing Ed and what people are looking for out there. I know I'm tired of the same old stuff and would like to see some things more in detail. For example we talk about penetrating trauma...great...but why not pick one item like ballistics and go over things in detail on that. Environmental emergencies..spend the time on heat illnesses instead of blurbs of each and cold issues on top of it. I'd still like some more input on that as I have the ability and platform to do such things in my instructor position and would like to help make a bigger impact and change the face of training in our area.

[firebuff860 54]

Great responses by those in the know. What bothers me about this post and many others on this site is the lack of basic grammar. The proper word is PAID, not PAYED. If you are a member of emergency services, PAID or volunteer, a basic ability to spell is expected. As a Lieutenant in your VAC, you are looked up to by other members who probably read this site. While your post may have had good intentions, please check spelling before putting out there for all to read.

Some may bash me for being grammar police, but a misspelled PCR could cost you dearly one day.

[PFDRes47cue 653]

Great responses by those in the know. What bothers me about this post and many others on this site is the lack of basic grammar. The proper word is PAID, not PAYED. If you are a member of emergency services, PAID or volunteer, a basic ability to spell is expected. As a Lieutenant in your VAC, you are looked up to by other members who probably read this site. While your post may have had good intentions, please check spelling before putting out there for all to read.

Some may bash me for being grammar police, but a misspelled PCR could cost you dearly one day.

I'm terribly sorry for the mistake. I usually have exceptional grammar and will do my best to pay more attention to proof reading. I wrote the post while I PAID more attention to my music education course that I was sitting in at school. I did not proof read or really put much thought into what I was typing. I just wanted to get the thoughts out there. Do you have any comment pertaining to the topic of the post. (P.S. Did you catch the PAID in the title?)

[PFDRes47cue 653]

quotename='firebuff860' date='02 February 2010 - 10:06 PM' timestamp='1265162801'post='203291']

Ithink it is fine the way it is. Ifcertain "members" are upset by other "members" critiquingresponse times and the number of personell who respond- fix it. If an IA went out that said xyz deptresponded within 2-3 minutes with appropriate apparatus and personell, thenother "members" would have nothing to critique. It is not the Deputy Chief's problemfor pointing out the obvious, maybe it is others problem for trying to ignoreit.

Apparently you joined the Grammar Police Task Force (GPTF) after you made this post awhile back. I'm just kiddingaround! Thanks for pointing my error out. I'll be sure to pay more attentionwhile posting on this site. I agree with you that people need to step up theirgrammar on this site.

Edited March 18, 2010 by PFDRes47cue

[chazEMT 5]

I think the problem with new EMT's who are insufficiently prepared for EMS lies with the EMT curriculum and not so much instructors pushing students through the program. I don't believe there is enough emphasis placed on field training/rotation hours spent actually working on an ambulance encountering real patients. Role playing in a classroom or performing skills on a mannequin is a good start, but you truly learn "the job" by encountering real life situations, treating real life patients, and overcoming real life problems that may come up on "routine" calls.

Of course, then there are inherent problems with field training, such as finding a qualified EMT/Paramedic to act as a FTO. With the high turnover rates in EMS systems, finding experienced, competent providers can be a challenge all in its own.

The other problem with the cirriculum is that it's too cookbook. EMT's are not taught to think, they are taught a cookbook form of medicine which doesn't fly in real life scenarios because nothing is routine, and each call presents its own unique set of circumstances. Two real life examples I can think of:

#1) EMT responds to a reported chest pain. EMT arrives on scene and finds a patient complaining of chest pain. Patient states they fell a week ago and has been having chest pain ever since. EMT administers aspirin because, well in EMT class, they are taught chest pain=aspirin. Would be correct if we were talking suspected cardiac chest pain, which this is not.

#2) EMT responds to an unresponsive. Arrives and finds an unresponsive male in front yard of house. Patient was installing roof shingles in the middle of July while downing a couple beers. You can cook a steak on the patients body, but in EMT school, we learned that unresponsive=oral glucose. EMT is seen shoving tubes of oral glucose down the patients throat. The reason as it was relayed to me, he's unresponsive and we're taught to give oral glucose to unresponsive patients (which is incorrect all in its own, but that's for a different discussion). Two examples of cookbook medicine at its finest.

Hopefully a CIC can correct me if I'm wrong, but I believe the EMT programs do receive money from the State based on the number of graduates from their programs... I'm not sure how much of that money goes directly into a CIC's pocket though. I know when I was teaching as a CLI, my pay, as well as the CIC, was based on the training institutions pay scale, not based on how many students we graduated.

OK, a couple of points in response to your post:

1) I'm not sure the quality of EMTs is the fault of the cirriculum...as stated, you get out of it what you put in...and many EMT students enter the EMT course thinking it'll be a cake-walk, and try to coast through. They need only learn enough to pass the tests, and they're an EMT! It's the responsibility of the instructors to challenge the students, and try to weed out those who aren't putting in any effort.

2) As for the cirriculum being too "cookbook," you need to double-check some of your recipes! In your first scenario, aspirin would NOT be indicated, as there is a clear, strong possibility that the chest pain was caused by TRAUMA...and, per protocol, aspirin is indicated for "non-traumatic chest pain not relieved by nitro or lasting longer than 30 minutes." Even if the EMT is following the "cookbook," aspirin is not indicated. In your second scenario, oral gulcose is containdicated, since the patient is unresponsive and cannot either follow commands or swallow...AND oral glucose is only indicated for AMS with a history of diabetes, NOT simply for any unresponsive pt.

3) ALL EMS training centers receive NY State reimbursement for every student (provided they have signed and submitted a "green" agency verification form) who passes the NY State written (at ALL levels, Paramedic, EMT-B, CFR). That does NOT motivate any program (none that I've been associated with) to pass students through the program.

The EMT programs need to be tougher and more challenging at the COURSE level...the NY State exams are easy enough for most to pass, once they make it to that point. LAZY EMT students should be weeded out during the EMT course.

[Goose 188]

JJB531 said that aspirin was not indicated in the first case and that oral glucose was not indicated in the second case...so i'm not really sure where you are going with the above.

[JJB531 652]

OK, a couple of points in response to your post:

1) I'm not sure the quality of EMTs is the fault of the cirriculum...as stated, you get out of it what you put in...and many EMT students enter the EMT course thinking it'll be a cake-walk, and try to coast through. They need only learn enough to pass the tests, and they're an EMT! It's the responsibility of the instructors to challenge the students, and try to weed out those who aren't putting in any effort.

2) As for the cirriculum being too "cookbook," you need to double-check some of your recipes! In your first scenario, aspirin would NOT be indicated, as there is a clear, strong possibility that the chest pain was caused by TRAUMA...and, per protocol, aspirin is indicated for "non-traumatic chest pain not relieved by nitro or lasting longer than 30 minutes." Even if the EMT is following the "cookbook," aspirin is not indicated. In your second scenario, oral gulcose is containdicated, since the patient is unresponsive and cannot either follow commands or swallow...AND oral glucose is only indicated for AMS with a history of diabetes, NOT simply for any unresponsive pt.

3) ALL EMS training centers receive NY State reimbursement for every student (provided they have signed and submitted a "green" agency verification form) who passes the NY State written (at ALL levels, Paramedic, EMT-B, CFR). That does NOT motivate any program (none that I've been associated with) to pass students through the program.

The EMT programs need to be tougher and more challenging at the COURSE level...the NY State exams are easy enough for most to pass, once they make it to that point. LAZY EMT students should be weeded out during the EMT course.

I think you need to double check my post instead of my recipes. I offered two real life scenarios where emt's performed interventions based on a chief complaint and not on physical assessment. I didn't make these scenarios up, they are actual encounters i have had as well as the responses I received from the emt treating the patient.

[JJB531 652]

JJB531 said that aspirin was not indicated in the first case and that oral glucose was not indicated in the second case...so i'm not really sure where you are going with the above.

Thanks goose, I'm still trying to figure it out myself.

[helicopper 1,050]

OK, a couple of points in response to your post:

1) I'm not sure the quality of EMTs is the fault of the cirriculum...as stated, you get out of it what you put in...and many EMT students enter the EMT course thinking it'll be a cake-walk, and try to coast through. They need only learn enough to pass the tests, and they're an EMT! It's the responsibility of the instructors to challenge the students, and try to weed out those who aren't putting in any effort.

2) As for the cirriculum being too "cookbook," you need to double-check some of your recipes! In your first scenario, aspirin would NOT be indicated, as there is a clear, strong possibility that the chest pain was caused by TRAUMA...and, per protocol, aspirin is indicated for "non-traumatic chest pain not relieved by nitro or lasting longer than 30 minutes." Even if the EMT is following the "cookbook," aspirin is not indicated. In your second scenario, oral gulcose is containdicated, since the patient is unresponsive and cannot either follow commands or swallow...AND oral glucose is only indicated for AMS with a history of diabetes, NOT simply for any unresponsive pt.

3) ALL EMS training centers receive NY State reimbursement for every student (provided they have signed and submitted a "green" agency verification form) who passes the NY State written (at ALL levels, Paramedic, EMT-B, CFR). That does NOT motivate any program (none that I've been associated with) to pass students through the program.

The EMT programs need to be tougher and more challenging at the COURSE level...the NY State exams are easy enough for most to pass, once they make it to that point. LAZY EMT students should be weeded out during the EMT course.

I was an EMS instructor from 1988 to 2006 and can tell you first-hand that the curriculum was dumbed down and does not properly provide the foundation to prospective EMT's.

The watered down curriculum does indeed contribute to the quality because it is difficult for an instructor to raise the bar when the student can say "but that isn't in the curriculum, why is that required"? And agencies and even EMS course sponsors try to do the bare minimum required (probably an economic concern) and don't encourage more, more, more. Quite the contrary, in fact.

You completely missed the point that was being made in the posts about the recipes and calls where EMT's without sound clinical judgement simply followed protocol blindly (without consideration of the altered mental status or nature of the chief complaint). This is not an isolated incident and I'm sure many more EMT's and paramedics can tell similar stories.

I also think that there is a reliance on ALS by some BLS providers who are unwilling to perform an appropriate assessment and initiate treatment even on BLS calls. That's not entirely a training issue but rather a system issue and one that's been discussed here before.

That you know the protocols and recognize that the treatments initiated were inappropriate speaks well of you and your training. Sadly we've all got negative experiences that we can point to illustrating the other extreme.

[INIT915 1,119]

JJB - any money that a program receives CICs / CLIs don't see any of it directly in the form a bonus or that sort. It goes to fund the program....at least i've never gotten a check of that sort. And yes, generally, instructor staff is an hourly position w/ a CIC as a staff/faculty position depending on the institution.

While no CIC's receive bonuses or payment of the sort, programs that get reputations as "too hard" or "too demanding" or get a history of dropping under-performing students mear fear a drop in enrollment, as students could potentially seek out training that is "easier" or "less challenging". So, this is in effect a potential reason programs may push through students that we all would like to have seen be dropped long ago.

And, in a county like Westchester, where without a doubt most of us either are or know all the CIC's, you have a pretty good idea from their reputation which ones push through unqualified candidates and which ones have the ethics to drop those students in the interest of remediation.

[INIT915 1,119]

quotename='firebuff860' date='02 February 2010 - 10:06 PM' timestamp='1265162801'post='203291']

Ithink it is fine the way it is. Ifcertain "members" are upset by other "members" critiquingresponse times and the number of personell who respond- fix it. If an IA went out that said xyz deptresponded within 2-3 minutes with appropriate apparatus and personell, thenother "members" would have nothing to critique. It is not the Deputy Chief's problemfor pointing out the obvious, maybe it is others problem for trying to ignoreit.

Apparently you joined the Grammar Police Task Force (GPTF) after you made this post awhile back. I'm just kiddingaround! Thanks for pointing my error out. I'll be sure to pay more attentionwhile posting on this site. I agree with you that people need to step up theirgrammar on this site.

Priceless.

[Guest alsfirefighter]

OK, a couple of points in response to your post:

It's the responsibility of the instructors to challenge the students, and try to weed out those who aren't putting in any effort.

2) As for the cirriculum being too "cookbook," you need to double-check some of your recipes! In your first scenario, aspirin would NOT be indicated, as there is a clear, strong possibility that the chest pain was caused by TRAUMA...and, per protocol, aspirin is indicated for "non-traumatic chest pain not relieved by nitro or lasting longer than 30 minutes." Even if the EMT is following the "cookbook," aspirin is not indicated. In your second scenario, oral gulcose is containdicated, since the patient is unresponsive and cannot either follow commands or swallow...AND oral glucose is only indicated for AMS with a history of diabetes, NOT simply for any unresponsive pt.

3) ALL EMS training centers receive NY State reimbursement for every student (provided they have signed and submitted a "green" agency verification form) who passes the NY State written (at ALL levels, Paramedic, EMT-B, CFR). That does NOT motivate any program (none that I've been associated with) to pass students through the program.

The EMT programs need to be tougher and more challenging at the COURSE level...the NY State exams are easy enough for most to pass, once they make it to that point. LAZY EMT students should be weeded out during the EMT course.

First its not the job of any instructor of any educational discipline to "weed out" students. Its our job to identify students who have deficiencies or issues and work with them to correct them. I always point out to my students in the beginning of my classes that I am there for them and that its not my job to fail them but to to get them to pass. I put my effort into advising them of any deficiencies or problems that are incurring and either work with them to assist them to overcome them or give them advice on what they can do to solve the problem. If they still don't I then counsel them and drop them from the course with appropriate documentation as to what standard they did not meet by curriculum or course policy. "Weeding out" can often lead to inappropriate actions by instructors and create an environment which could cause or actually be discriminatory. You are correct that you get what you put in to it, and after being advise those type of students often handle the situation for themselves and rarely are successful. The ones who may seem lazy who actually may have a learning disability or another issue or event that is causing the problem. Those are the ones who need assistance and not "weeding."

As far as JJB's "recipes" I'm with the others you're way off base. What is required and what protocol dictates doesn't always lend itself to what the curriculum is actually reinforcing. See my case in point with my "recipe" in regard to BLS albuterol administration. Its great that you know what it says, but you're not in a class nor just on the street. I'm not sure what you were reading with his posts..but you totally missed the point and basically reiterated his point with the correct answer which is not what we're seeing on the street.

In regard to your comment that the EMT course needs to be tougher...again either I have to disagree with you or you're using bad wording. It doesn't need to be tougher...it needs to be more comprehensive and geared towards the potential of future advancement in line with the EMT-I (which I won't get into my opinion on that) and the Paramedic curriculums. Making it tougher does nothing..in fact I'd be interested in what your idea of "making it tougher" entails. You can make testing requirements "tougher" or more stringent, but how do you make a curriculum "tougher?" I don't want "tougher." I want comprehensive, detailed curriculum content that makes for higher educated providers with a good grasp of illnesses, injuries and anatomy.

Please don't feel I'm bashing you, I'm just making points on your comments which I see differently much in line with how you responded to JJB's.

Chris...ALS dependency...isn't even the right word. I'm to the point where often all I can do is shake my head...but point out things not going well, correct something, or try to guide providers to make decisions and act and your nothing but an assh...e. But hey...I'd rather be a professional assh...e who knows what I'm doing, then eat cake, drink kool aid and wear blinders.

[chazEMT 5]

First its not the job of any instructor of any educational discipline to "weed out" students. Its our job to identify students who have deficiencies or issues and work with them to correct them. I always point out to my students in the beginning of my classes that I am there for them and that its not my job to fail them but to to get them to pass. I put my effort into advising them of any deficiencies or problems that are incurring and either work with them to assist them to overcome them or give them advice on what they can do to solve the problem. If they still don't I then counsel them and drop them from the course with appropriate documentation as to what standard they did not meet by curriculum or course policy. "Weeding out" can often lead to inappropriate actions by instructors and create an environment which could cause or actually be discriminatory. You are correct that you get what you put in to it, and after being advise those type of students often handle the situation for themselves and rarely are successful. The ones who may seem lazy who actually may have a learning disability or another issue or event that is causing the problem. Those are the ones who need assistance and not "weeding."

I probably did not word my response properly ("bad wording!") As a CIC, my "weeding out" process is never simply failing students out of the course! I completely agree when you say our job is to identify students with problems/deficiencies and work with them towards correcting them. The "weeding out" I am referring to is regarding those students who fall short of meeting the course standards and objectives because they put in little or no effort, and do not respond to any efforts on the part of the instructors to help them overcome their deficiencies...in short, I'm 100% with you on your response to my point. By "weeding out," I'm also referring to how I administer the courses I teach. I think it's totally inappropriate to simply "teach to the tests." I strive to teach students how to assess and treat a patient, and try to give them the basis and motivation to develop good clinical judgement. Rarely do my modular exams simply have them regurgitate facts & definitions...I try to put in as many scenario-based questions as possible, and challenge them based on affective as well as cognitive objectives.

As far as JJB's "recipes" I'm with the others you're way off base. What is required and what protocol dictates doesn't always lend itself to what the curriculum is actually reinforcing. See my case in point with my "recipe" in regard to BLS albuterol administration. Its great that you know what it says, but you're not in a class nor just on the street. I'm not sure what you were reading with his posts..but you totally missed the point and basically reiterated his point with the correct answer which is not what we're seeing on the street.

With regards to the "recipes--" We help the students develop the foundation for "clinical judgement" in class...teach (at least) the cirriculum and the protocols. For example, waaaaaaaay back when you were sitting through your first EMT class you learned the signs, symptoms, causes and physiology behind respiratory failure...now, I'm sure you can spot a patient with "the look" in seconds! But it started with that "recipe." Regarding JJB's first scenario, our recipe doesn't call for aspirin in that situation. Here's the point in class where I would ask the students "...and why not??" And not simply because the recipe says so! For the second scenario, I wanted to make the point that he might have either misinterpreted the recipe, or remembered it incorrectly...unresponsive DOES NOT = oral glucose.

In regard to your comment that the EMT course needs to be tougher...again either I have to disagree with you or you're using bad wording. It doesn't need to be tougher...it needs to be more comprehensive and geared towards the potential of future advancement in line with the EMT-I (which I won't get into my opinion on that) and the Paramedic curriculums. Making it tougher does nothing..in fact I'd be interested in what your idea of "making it tougher" entails. You can make testing requirements "tougher" or more stringent, but how do you make a curriculum "tougher?" I don't want "tougher." I want comprehensive, detailed curriculum content that makes for higher educated providers with a good grasp of illnesses, injuries and anatomy.

I, too, want a comprehensive cirriculum...let's not only teach the "what," but also the "why" and "how!" Again, perhaps I misworded what I wanted to convey. Does the cirriculum need to be "tougher?" Probably not...do we, as instructors, need to consistently evaluate our students and ourselves and ensure we're striving for the best and not just the test? (you can use that slogan if ya want!) Absolutely!

Please don't feel I'm bashing you, I'm just making points on your comments which I see differently much in line with how you responded to JJB's.

I certainly don't feel you're bashing me...while I may not always agree with your opinions on here, I do respect what you have to say, as you speak from experience, and most importantly, you apparently care a great deal both about what you do, and the patients and fellow emergency personnel you deal with...

JJB - my apologies if I came across like an "arse" in my response to your post...didn't mean to "bash," but rather make points on your comments (had to borrow your wording there ALS!)

Anyway, sorry so long-winded...

[chazEMT 5]

JJB531 said that aspirin was not indicated in the first case and that oral glucose was not indicated in the second case...so i'm not really sure where you are going with the above.

Just attempting to clarify what the cirriculum/protocol indicate...we don't teach that "chest pain=aspirin" or "unresponsive=oral glucose." Those instructors who simplify it to that degree aren't providiing complete information.

Sorry if I came across as if I was bashing...my apologies, was only taking issue with what JJB was inidcating is taught.

[chazEMT 5]

EMS instructors are usually hourly employees or they are full-time staff at the training facility where they teach. EMS course sponsors receive a nominal stipend for each new EMT certified that is associated with a volunteer EMS agency. Non-affilated and/or commercial candidates receive no state aid. The cost of the course far and away exceeds what the reimbursement is from the state.

As far as EMT skills go, new EMT's are weak because they receive inadequate/superficial training. THAT is because the curriclum is written as a bare minimum and includes virtually no real time for any practical experience. It is nearly impossible to meet all the instructional objectives in the time allotted and when you go over, people complain that the course is too long. Supposed EMS associations have fought tooth and nail against increases to the curriculum because it is too cumbersome for volunteers. To that I cry foul because I don't want inadequately trained responders coming to my house for my family.

EMT's have to recognize that they are healthcare professionals and that requires a commitment to training. THAT will correct the problems that you cite but it will entail more hours being edjumukated. Too many people just want the patch and don't focus on the training.

Thank you, you worded it better that I apparently am!

[helicopper 1,050]

Just attempting to clarify what the cirriculum/protocol indicate...we don't teach that "chest pain=aspirin" or "unresponsive=oral glucose." Those instructors who simplify it to that degree aren't providiing complete information.

Sorry if I came across as if I was bashing...my apologies, was only taking issue with what JJB was inidcating is taught.

See, we're reading jjb's comments two different ways. I read it as EMT's without sound clinical judgement are misinterpreting the patient presentation and applying the wrong treatment regime. He's not saying these EMT's are being taught to do it wrong; they're not being given enough information to do it right.

At least that's how I read it. Either that or I worked with those same EMT's.

[chazEMT 5]

JJB531 said that aspirin was not indicated in the first case and that oral glucose was not indicated in the second case...so i'm not really sure where you are going with the above.

Sorry...was just trying to clarify what is actually taught & in the protocols...chest pain doesn't=aspirin, unresponsive doesn't=oral glucose. My point is that those who are teaching those adages and similar ones aren't teaching correctly, nor are they giving the "whole story."

Sorry if I came across as "bashing."

[chazEMT 5]

I think you need to double check my post instead of my recipes. I offered two real life scenarios where emt's performed interventions based on a chief complaint and not on physical assessment. I didn't make these scenarios up, they are actual encounters i have had as well as the responses I received from the emt treating the patient.

My apologies, JJB, I wasn't looking to bash you or your post...although, in reading my response, I see that's how I came across!

My response was aimed more at the "recipes" EMTs are being taught...those two recipes (as worded) are incorrect, and those instructors who're imparting that information are relaying both incorrect and incomplete info!

[JJB531 652]

My apologies, JJB, I wasn't looking to bash you or your post...although, in reading my response, I see that's how I came across!

My response was aimed more at the "recipes" EMTs are being taught...those two recipes (as worded) are incorrect, and those instructors who're imparting that information are relaying both incorrect and incomplete info!

No worries and no hard feelings... I was not making a reference as to the curriculum teaching all EMT's to give Aspirin to every single chest pain. I was offering two real life scenarios where EMT's hear the words chest pain and right away they shove aspirin in someone's mouth, or they hear altered mental status and are shoving globs of insta-glucose down someones throat. Instead of having a good knowledge base and good clinical judgement skills, they hear the words "chest pain" or "altered mental status" and that's all that registers in their minds.

When I was teaching EMT/Paramedic students, a few of the EMT instructors always taught their students to "play it safe". Is there anything wrong with playing it safe? No, not at all. But after a while it gets a little out of hand with certain scenarios, and EMT's (and even Paramedics alike), don't do a detailed assessment and obtain a good history of the illness, and instead just follow through with protocol to "play it safe", even if certain interventions are not warranted or indicated. It's like using spinal immobilization on someone who tripped and fell on a sidewalk, and who has absolutely not the slighest indication of a spinal injury. Why do we do it... well usually just to "play it safe".

I think the simple parts of the problem are:

1) Not enough time is spent dealing with real patients who present with a chief complaint, and learning how to differentiate and/or make a field diagnosis of the illness in order to provide the correct and proper treatment.

2) Too many EMS providers are cookbook providers. They follow the protocol from A to Z without utilizing good diagnostic and clinical judgement skills. You can chalk up some of this to inexperience, but when I come across providers who have been through 2 or 3 refreshers in their time and are still following the "recipes" we talked about here without performing a good, solid patient assessment, who do we blame them for their skills as a provider?

3) The curriculum has definetly been dumbed down considerably. As long as an EMT student can run through a very basic patient assessment scenario without getting nabbed for a critical failure for something like not using BSI, most students will pass the patient assessment scenario without any real knowledge of how to actually perform a patient assessment. Now in the field, I see EMT's performing this basic "cookbook" patient assessment on every patient they come across. Why is it that I still see EMT's checking pupillary response on a cardiac chest pain? Because that's what they learned and has been forced into their heads in patient assessment. I would rather see EMT students take the time to learn how to perform vectored patient assessments, where they are actually learning how to assess patient who present with certain disease processes. Check for pupillary response on patients who may present with neurological conditions (AMS, stroke, head injury, etc.), not someone complaining of chest pain.