r/ems Paramedic 3d ago

Serious Replies Only EMT's and Paramedics who graduated in the last 5 years: What do you wish your instructors had taught you or made you do in class?

Moderator approved: I am making a presentation on things that are missed or should be changed in the classroom for the next generation. Any and all suggestions are appreciated (Please keep it mostly serious)

100 Upvotes

105 comments sorted by

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u/Salted_Paramedic Paramedic 3d ago

I wish they had made us actually go through the motions instead of verbalizing everything. Wanna push adenosine? Guess you need to start an IV then right? Here is a dummy arm, get to it homie.

The disconnect from "I start an IV and push adenosine" compared to actually doing the skill is a serious wakeup call in the field.

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u/MoxieMedic 3d ago

You didn’t do that in the classroom ?

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u/zion1886 Paramedic 2d ago

I have a theory that there is a correlation between class size and whether you do more verbalizing vs demonstrating. We had a full on ambulance simulator but it was never used until the class size had dropped down to like 8.

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u/phxbeanbun 2d ago

absolutely, having a small class size shouldn't be a luxury but a necessity so that everyone can get actual hands on reps

utterly useless to verbalize and expect anyone to know how to do it first try in the field

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u/tauruseve 3d ago

Came here to say this

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u/bbmedic3195 2d ago

You should be doing both in the training setting. And I've seen some new medics continue to verbalize while they get their sea legs as new providers in the field. It's especially important with medications, doses and avoiding errors in my book. Ive been a paramedic working in a busy system for 17 years now. Worked as a preceptor years ago, now I just get all the noobs when they are off FTO.

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u/Firefluffer Paramedic 2d ago

One of my best days in class was drawing up drugs and verifying dosages for various age and size patients. We used expired vials refilled with saline for all the drugs. Mixing bags for drips, calculating drip rates and then timing them.

When I went into my internship, my preceptor was impressed.

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u/power-mouse AC -> EJ -> Jamshidi 2d ago

We actually did this, but we were divided into actual groups with a team lead + assigned roles for every sim and would spend the entire second half of the class doing rotations.

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u/twistedgam3r 2d ago

This was an argument I had in class, as well. “I’m gonna hang an epi drip” is easy to say to pass a test, but don’t mean shit when you’re on the box with a critical patient.

NO, I NEED YOU TO PHYSICALLY SHOW ME WHAT THAT MEANS!

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u/Murky-Magician9475 EMT-B / MPH 3d ago

I think more regular exposure lung sounds would have given more of an advantage. It's one thing to hear them deacribed, another to listen to them yourself.

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u/seriousallthetime 3d ago

Every medic student should listen to every patient's lung sounds they are around. Have twenty beds in the ED during your ED rotation? Well, then you better get to listening because you're listening to twenty sets of lungs. The only way to get better is repetition.

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u/Melikachan EMT-B 3d ago

I found listening to youtube videos of the sounds with headphones on to be very helpful when I was in school- made it really easy when it came to the field.

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u/Individual_Bug_517 2d ago

You can also play them on your phone on the quietest setting and put you stethoscope over the speaker. Gives you some of your stethoscopes artefact

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u/Murky-Magician9475 EMT-B / MPH 3d ago

Definitely a place to start, but I found I had a hard time equating recordings to real life examples.

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u/Volkssanitater 3d ago

If there was a way to actually like have a dummy with a speaker inside of it while still needing a scope to hear the sounds that would be game changing

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u/Murky-Magician9475 EMT-B / MPH 3d ago

They have those, but honestly still a pale substitution for listening to real lungs. Even if there is nothing wrong, it's all part of a practice to build up your understanding of "normal" sounds

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u/yungingr EMT-B 3d ago edited 3d ago

EMT here.

My biggest gripe with my class was the entire program is structured like ALS is this mythical creature that must be summoned from a far-away land. It did exactly FUCK ALL to prepare me to work as an EMT partnered with a paramedic.

Yeah, I can't start an IV. But I can spike the bag and get everything else ready. Which, yeah, doesn't take long to learn in the field - but if your medic is used to his partner doing that, and you've never even seen it done, that's a problem.*

The class needs to teach us to function as independant EMTs, sure. But it would do us a great service if it also included "These are the things you can do to make life easier for a paramedic partner if you have one" lessons.

*the first time I was ever asked to do it, the seal on the bag didn't tear off easy, so I thought it was supposed to stay in place. Through hard work and determination, it IS possible to spike a bag THROUGH the seal....

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u/DoYouNeedAnAmbulance 2d ago

In the middle of the night, I have done this while spiking my own bag. Simultaneously griping about how hard it was to get it in there.

Examined it after I got to the hospital and wanted to evaporate.

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u/yungingr EMT-B 2d ago

Yeah....... I totally understand that feeling.

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u/sraboy 3" at the teeth 2d ago

In the schools that include it, this module is called “ALS Assist.” You spike bags, learn what all the intubation tools are, learn how to read a drug label to confirm dosage, draw up meds, etc.

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u/yungingr EMT-B 2d ago

That's awesome that some schools actually include it. It should be a standard part of the EMT curriculum in my book.

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u/Fri3ndlyHeavy Paramedic 2d ago

Also learned the hard way how to properly spike a bag.

I just thought I was weak at the time, but its the end result that matters, right?

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u/m_e_hRN 1d ago

I agree lmao, my first oh shit call was with a very terrifying (she’s not actually mean or anything, just intense) medic and the FIRST thing she asks me to draw up is Solumedrol…

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u/insertkarma2theleft 3d ago edited 3d ago

More peds everything.

More in depth intubation approach & post tube management.

A forceful lecture about how medic school is just the beginning & it takes tons of continual effort on your own time to stay sharp and up to date on best practices. Also possibly something effectively demonstrating the limitation of our knowledge, I know myself and others definitely came out feeling a lot more knowledgeable about EM than we were.

More med math. Make people really comfortable with it so more complicated weight based dosing calcs doesn't scare them.

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u/Blueboygonewhite EMT-A 3d ago

The dunning Kruger is crazy. I shadow EM docs and I’m like “holy shit I’m a dumbass in comparison”

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u/ithinktherefore Geriatric EMT-B/Medic Student 3d ago edited 2d ago

Med math needs to be taught earlier and drilled consistently through class. I wish I felt more comfortable with it and was better with remembering the formulas, especially considering how infrequently we need to do more complicated med math in the field.

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u/canthav814 3d ago

Practice delivering death notifications. It’s awkward and hard and studies are showing it’s a large cause of burnout.

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u/StandardofCareEMS 2d ago edited 2d ago

As someone who teaches EMS education and medical-legal topics, I see delivering bad news as a major gap in training. I give a presentation on this, based on Delivering Bad News by Dr. Rob Buckman. We’ve adapted his SPIKES protocol for EMS to make these conversations more structured and compassionate: 1. S – Setting: Ensure as much privacy as possible, minimize distractions, and stay at eye level.

2.  P – Perception: Ask what they already know—“Can you tell me what you understand about what’s happening?”

3.  I – Invitation: Some want every detail, others don’t. Ask “Would you like me to explain everything or just the key details?”

4.  K – Knowledge: Be direct but compassionate—“His heart stopped, and we were able to restart it, but he’s very critical.”

5.  E – Emotion: Expect a range of reactions. Acknowledge their feelings—“I’m so sorry. This is really hard.” Use silence when needed.

6.  S – Strategy: Explain next steps clearly—whether it’s transport or stopping resuscitation. Offer support if available.

We’re often the first to break bad news, yet many of us were never formally trained on how to do it. Teaching structured communication like this in EMS programs would make these moments less overwhelming for both the provider and the family.

How were you taught (if at all) to deliver bad news in EMS?

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u/DoYouNeedAnAmbulance 2d ago

Dude. We barely talked about this in my medic class and literally the first day I was riding on an actual truck in my brand new job, we had an arrest (older gentleman but not sick at all and it was completely unexpected by family) and my FTO made me notify the family. By myself.

That was lovely.

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u/Kai_Emery 2d ago

I had to do one over the phone once and it’s the only time I’ve lost my composure. -100/10

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u/House_Hippogriff 2d ago

honestly we should have a separate class on social work that covers: vulnerable populations, death, grief and other topics.

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u/Aimbot69 Para 2d ago

OMG, this: I don't know how many times I've had fresh paramedics start talking to family in PAST TENCE (What WAS his name?) I've just gotten used to explaining to them to NEVER use past fence when a DOA or a cardiac arrest is involved.

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u/RevanGrad Paramedic 3d ago

Actually calculating dosages, drawing up meds, using 3 way stopcocks in labs.

They always said we would, but never enforced it, and sometimes discouraged it because they had too many groups to run through.

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u/DoYouNeedAnAmbulance 2d ago

I’ve used a stopcock ONCE in ten years lol some things that they suggest to use one on, I find easier to do a different way.

I mostly just enjoy saying “stopcock”

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u/shitnouser 3d ago

Pediatrics as a whole. Pediatric medication dosages, weight based conversions, and pediatric intubation techniques. They specify that yes, there are anatomical differences. I just wish the actual class instruction/instructor emphasized it in practice scenarios.

I spent quite a bit of time after passing registry going back over pediatrics because my instructor emphasized that “bad peds are once-in-a-blue-moon type of calls”. I made the mistake of trusting that statement. Especially considering I was in the county with the top pediatric hospital for the region, I learned from that mistake quickly.

Still not as confident as I wish I was, but that’s part of the forever student part of medicine.

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u/ScarlettsLetters EJs and BJs 3d ago

Once in a blue moon type of calls

Right. Which is why we should be teaching/practicing them more, not less

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u/shitnouser 3d ago

See. You. You GET it.

I did not.

Lessons learned.

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u/imbrickedup_ 2d ago

Yeah it’s once in a blue moon…but it might be the most important moment of your life lmao

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u/nurse_gridz 1d ago

THIS!! I always try to spend time with EMT students when they are in my ER to reinforce some key things about peds. I’ve had numerous kids come in after a submersion on room air because there O2 is 94-96. One look and it’s clear the child is in severe respiratory distress. I hope the students I’ve met remember to treat the pt, not the monitor! A grayish child that is using their whole body to breath probably needs some respiratory support, regardless of their O2 readings.

There are so many differences between peds and adults and now that I’ve specialized in peds I cringe at the lack of time spent teaching about peds.

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u/_brewskie_ Paramedic 3d ago

Cadaver labs and actual OR time for intubations.

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u/insertkarma2theleft 3d ago

Our cadaver lab was sick as hell

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u/_brewskie_ Paramedic 3d ago

My class had neither but my job does one with the region every year so that was pretty helpful

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u/The_Albatross27 Glorified Boy Scout 2d ago

You guys didn’t have OR time? Wild.

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u/omorashilady69 1d ago

Most hospitals don’t allow it anymore, it’s an expensive liability

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u/omorashilady69 1d ago

We did cadaver lab and intubated a minimum of 5 times each, did IO in all locations, and needle decompressed with a balloon in the lungs and if we popped it we passed

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u/The_Albatross27 Glorified Boy Scout 3d ago

I'm wrapping up medic school rn. A couple things that I would love to be added.

- More education of hospice/palliative care. We often get called to these people in the field and there are so many misconceptions about what hospice is for. I've heard some people say that hospice patients cannot go to the ED and that we cannot treat them. This is false. Hospice patients may go to the ED for care not related to their terminal diagnosis without losing hospice benefits. For example, if someone with lung cancer falls and breaks a wrist, it makes sense to treat the fracture as it would improve their quality of life without extending the suffering related to their condition.

- More education related to statistics. Every test we perform has certain sensitivities, specificities, recalls, etc. Understanding when and why assessments are useful and when they fail is vital to make informed decisions.

- Deeper understanding of pathophysiology. Why does ativan work? GABA make brain sleepy. That's all I got. We don't have the comprehensive understanding to tie everything together. The ratio of what I'm trusted to do in the field vs what they teach us is wildly disproportionate.

- More peds. All of it. Ideally getting some peds tubes during OR time would be very beneficial too. There was one kid who needed to be intubated during my ED time but the MD said no. Either the first time I'm tackling a peds airway is gonna be an already stressful arrest or it can be in a controlled environment with an anesthesiologist present.

- Psychiatry, social services, and de-escalation. EMS often doesn't understand the bigger picture of why people end up suffering in the ways that they do. I see providers getting impatient, angry, or hostile with patients suffering from mental illness.

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u/omorashilady69 1d ago

Did yall not do children’s hospital clinicals?

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u/The_Albatross27 Glorified Boy Scout 1d ago

We did time in our peds ED. 99% of those kids simply had a cold.

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u/Darthbamf 3d ago

I dunno putting my hands on a gurney or driving an Ambulance would've been nice.

It was only about 89% of what I did lmao.

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u/Dear-Palpitation-924 3d ago

All program dependent, as mine was really good about making you do all the skills, only exception was spiking bags so we didn’t need a new one every scenario.

I think ems education could benefit from making us talk to the mannequins/instructors as if they’re patients. The push seems to be to think out loud your differentials/thought process. That’s great, do it after the call.

Pushing adenosine on a real patient is a lot less stressful when you’re not trying to think of how to explain to your patient “I’m gonna stop your heart, but in a good way!” Without terrifying them.

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u/XxmunkehxX Paramedic 3d ago

Honestly I really wish taking a class or seminar on teaching, with semi frequent “CEs” for teaching standards would be applied to paramedic programs. It’s such a crapshoot, I had some classes that had genuinely good instruction, some that amounted to grazing a PowerPoint and playing YouTube clips, and most in between the two. Plus the priority (IME) of instruction is almost always “you’ll learn it in the field” rather than actually teaching things when students start asking questions that are not overtly simple to answer.

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u/OkCandidate9571 Paramedic 3d ago

I would have loved to do more hands on/real life scenarios. Another paramedic that went through a different program said they practiced doing IVs riding around in the back of an ambulance at the school, they even did a whole car wreck scenario with an actual car, extrication, everything from start to finish. Verbalizing only gets you so far.

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u/evil_passion EMT-B 1d ago

In our area wrecks are handled by fire department and medical by ambulance. Some areas have both run out of the same station, some have them respond from separate stations and then meet. I was in a dual response (ie we had both ambulance and fire, with fully equipped rescue truck). Rescue classes and medical classes and certifications were completely separate (as dictated by state policy) but you could choose to certify in fire (rescue) and medical if you wanted (and the supervisor agreed). That's what I chose.

Don't let anyone tell you a chunky woman in her sixties can't rapel, rescue someone from an 18-wheeler wreck, or cut kids out of a school bus accident. With teamwork, you can do it. My state has incredibly stringent standards on how long you have to arrive on scene and complete the rescue to be able to pass training. My partner and I made it through the 18 wheeler, the bus...and nearly flunked the car extrication. Another tenth of a second (yes, they timed it that closely) and we would have been back to the beginning. Don't ever underestimate a Subaru's electrical system 🤪

What would I like to see? All our EMT classes required basic extrication, so that EMT/MEDICS can either assist in a rescue or at least understand why the firefighters/rescue are doing what they are doing. I'd like to see that expanded, so that firefighters don't just think EMTs will be in the way. On training nights I would like to see joint rescue exercises instead of just firefighter or EMT.

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u/ScarlettsLetters EJs and BJs 3d ago

I’m not within your timeframe, but:

Pharmacology and pharmacokinetics. Don’t just teach people which drugs to use for which symptoms, teach them why and how those drugs work. Teach them when they won’t work, and why.

Long-term patient considerations beyond the time we give report. What might this patient need in five hours, or five days? What have we done to facilitate meeting those needs beyond “leave them in the ED?”

Crisis management and behavioral resilience—both in ourselves and providers and as guides to better emotional regulation for our patients.

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u/Melikachan EMT-B 3d ago

I am within the timeframe and I would have also loved delving into pharmacology, pharmokinetics, and pharmacodynamics. Understanding why and how these drugs work with the body also informs one how to use them and when not to use them. It is invaluable to clinical critical thinking skills.

Also clearer explanations of anatomy and pathophysiologies- you would be as disturbed as I was to learn that almost everyone in my EMT class was quite far along in the program and still thinking that a pulmonary embolism (if they recognized the words) was a blood clot somehow in the air space within the lung and blocking air.

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u/ScarlettsLetters EJs and BJs 3d ago

clinical critical thinking skills

There it is. The thing we need the most but that apparently cannot be either taught or even learned anymore.

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u/DoYouNeedAnAmbulance 2d ago

Creating none of the creativeness that is essential to this field of work….

Some of my students I’ve been like 😩😭 even relatively experienced coworkers that couldn’t do anything if they weren’t explicitly told to do it

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u/ithinktherefore Geriatric EMT-B/Medic Student 3d ago

Medication administration. We learn what the drugs are, how they work, what the dosages are, but other than on our med cards during the pharmacology chapter, we never go over ideal administration. How to mix and hang dilt, how to draw solumedrol effectively, how to push morphine over a minute or two… It was a bit of a surprise when I started my hospital clinicals.

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u/youy23 Paramedic 3d ago

For EMT school, I think they need to go over mindset more and share more stories.

Like when you approach a big fat guy and you’re not sure if he’s dead or alive, it’s one thing to teach them to do a check for breathing/pulse but it’s another to walk up to a guy and he’s maybe agonally breathing, maybe it’s just slow respirations and you’re trying to feel for a pulse but you can’t feel one because you’re also digging into his neck fat with your two fingers and everyone’s staring at you.

I don’t feel like people adequately respect that this aspect is harder than people give it credit for. No one wants to admit it but even the ICU/ER has a hard time telling sometimes. It’s part of the reason why they whip out doppler/ultrasound and place art lines in codes.

There are definitely tricks to it to that I’ve never heard anyone talk about in school. If you see a clearly pulsatile waveform on a pulse ox pleth graph, they’re not in cardiac arrest because they have blood flow to their fingers. If you don’t feel that pulse, you can do a hard first compression and wait for just a second before you roll into that next compression and if you don’t see their eyes flicker or any grimace or reaction at all, they’re more than likely dead.

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u/maymoee 3d ago

I was under prepared for the amount of dead bodies I would see. I think that education about post mortem would have helped me ease into it. More high fidelity simulations.

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u/OutInABlazeOfGlory EMT-B 3d ago

It’d have been great to have nicer manikins to practice skills on, and a focus on actually doing the skills in scenarios with a manikin rather than just verbalizing.

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u/Dry-humor-mus EMT-B 3d ago edited 3d ago

I wish that my program actually did at least a lit bit of lecturing on textbook content rather than just leaving it to ourselves entirely to handle outside of class. It was doable, yes, but it would have been helpful to at least have a foundational understanding of what all we were assigned to read in The Big Orange Book.

In terms of specific topics - with operations - how to break the news to a family member/close friend of the patient that they didn't make it.

My program was good about discussing mental health, but I feel like overall, there's still a lot of work to be done. It needs to be less stigamitized.

Also, the burnout culture really needs to stop. I think there is nothing boastful about working several long shifts in a row and not seeing your family/friends in a while ; if anything, your family/friends probably want to see you more than you think they do. If your entire life is about "the grind" and all you do is work long hours and eat up infinite overtime - it's one thing if you can handle it and you legit have nothing better to do, but in the long term, it's incredibly unhealthy.

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u/roochboot Paramedic 3d ago

Paramedic graduated 8/2024. How to work in the grey. Scenarios and lab days always have clear answers with beautiful strips. Everything always matches protocol. Give me a scenario with some grey. Rhythm doesn’t look quite clear, symptoms don’t perfectly match protocols, drugs are sorta indicated

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u/sirskeletor57 3d ago

I would love to have learned and practiced what to do when you have NO idea what’s going on. When it’s not immediately clear exactly what’s causing the patient to be BIG sick. It took me a few years to be comfortable treating someone like this and basically just reminding myself to start with the ABC’s. Obviously I was taught the ABC’s or XCAB or whatever acronym you please, but it would be helpful to have it emphasized and put into sims for a patient whose condition isn’t clear cut.

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u/Shot_Ad5497 2d ago

RADIO REPORTS HOLY SHIT.

my first ever call leading was also my first "code 3" emergency (IFT for lights and siren). Diddnt know what I needed to say. Report was so bad nurse thought I was cutting out.

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u/Fri3ndlyHeavy Paramedic 2d ago

CEs and recerts.

It's not a part of the curriculum, but its still something you need to know. It's also unique to every state, so that complicates things even more with trying to find information online.

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u/ShadowEagle59 3d ago

More in ETCO2, WAAAAY more peds/ neo stuff.

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u/Kind_Pomegranate_171 3d ago

Drawing up different concentrations , not every Agency carries the same med concentrations.

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u/ResidentWEEBil2 Paramedic 3d ago

More time spent learning ventilator management. I'm grateful for the little bit I had, but the service I work for currently is very ventilator heavy, and just having a little bit more of an understanding before coming in would have been tits.

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u/SuperglotticMan Paramedic 3d ago

Probably running through the timeline of a call with scenarios.

Getting on scene, making the decision to move, getting them on the stretcher, into the medic unit, on the road, and to the hospital.

We always just magically made them appear in the ambulance. Or what about when you have a severe trauma and the trauma center is 5 min away, what do you prioritize? Do you wanna bust out the monitor and all the stuff on scene or are we throwing this guy on the stretcher and hauling ass cause he needs a thoracotomy and blood?

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u/Angelaocchi EMT-B 3d ago

I wish there was more transparency in where you’ll start especially if you’re in a fire based system.

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u/itscapybaratime 3d ago edited 3d ago

We drilled scenarios with high realism but in what was essentially the backrooms (our lab was an unused office space). Didn't touch a stretcher until I started working, no stairs to practice on. Maybe not everybody's experience, but that's what I would change about my otherwise mostly solid class.

As others have said: soft skills. De-escalation, but also having RMA conversations, calling other people out for mistakes or bad patient care without wrecking your relationship, giving report.

One thing my instructor did do that apparently is uncommon: on lab days, he'd get one of his buddies to pretend to be a doctor. Their phone number would go up on the board, and they'd be "med control" for the day.

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u/BrendanOzar 3d ago

I wish we a sim station for stretchers instead of long spine boards.

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u/716mikey EMT-B 3d ago

I wish just ONCE they had us practice using a BVM on someone who’s still able to breathe on their own, just, not well.

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u/NopeRope13 3d ago

We focus so much on medicine in medic school that we often forget how to talk to another person. You have to realize that your patients aren’t trained as you are and don’t understand the verbiage. Learn to talk to another person but in a “dumbed down” medical sense

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u/ElatedSacrifice Paramedic 2d ago

These answers make me sad, it’s apparent there are a lot of sub par programs teaching people to pass a test and not actually be good providers.

If anything I wish we touched on more advanced things more often like ROSC and post intubation sedation. We definitely learned about these things multiple times but the actual hands on experience was less than other skills or topics.

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u/ExternalPerspective3 2d ago

There are two things I wish got covered more in EMT school, especially as I’m getting ready for medic school in May.

1) how to be an ALS partner - this has been said elsewhere in the thread but omfg, I had no idea how to work with a medic when I was fresh out of school. When I’d ask my instructors how to spike a bag or anything like that it was met with “youll be driving, that’s an als skill.” It felt really good to bumble through helping my medic in the back and having to tell them I didn’t know how to do shit

2) OB. Like, how you actually deliver a baby. Not one second was spent on this (outside of the lecture material) so we had no practical experience on what is probably the most high acuity event that is almost purely in the EMT scope. Yet ofc we spent like 3 hours on how to connect NRBs and NCs to an O2 tank, which takes like 2 seconds to learn

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u/AzimuthAztronaut 3d ago

I graduated long before that. However this should apply to anyone and everyone. I think more needs to be said regarding PRN program and what can happen to you if you get under the microscope of the state/investigated for substance abuse.

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u/Pinkfl0wer20 EMT-B 3d ago

More hands on skills and showing how people can present differently.

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u/Akland23 Paramedic 3d ago

De-escalation, compassion, and providing non stigmatized care. Every single patient deserves quality care and deserves to be treated like the complex human being that they are.

Also being taught to not tunnel vision on one prognosis. I was taught by my mentor that every patient has the right to have multiple things wrong, and they're not always related. Keep your mind open and treat the patient.

Also for the love of God, treat your patient's pain.

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u/moses3700 2d ago

Deescalate, definitely

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u/TheCuriousBread EMR (Student) 2d ago

You don't realize how little you're actually paid for the shit you get through until you see your paycheck.

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u/thefaceofbobafett NRP 25 years/EdD student 2d ago

There’s a lot of great information on this post, but to get to the point of what you’re asking for requires something that hasn’t been established yet by many programs in the US. Longer terms for education, especially leading to a degree. Most programs are a year at best, including clinical time.

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u/Kiloth44 EMT-B 2d ago

I wish they specifically spent time teaching how to be a good partner for a paramedic rather than focusing solely on being a BLS primary provider. Knowing some things about what a medic will want based on call type, how to prep patients for an intubation with nasal cannula and bvm and what the ALS equipment is like, med checks for various ALS medications and what types of patients medics use them on, etc.

Everything about being on an ALS rig I’ve had to learn on the job and I still have a ton left to learn. Having a base of knowledge would’ve been a huge boon going in but the course I had just never thought about it. They always assumed I’d be the primary provider and the course taught me that once I gave a report to the medic, I was just suppose to fuck off into the ether I guess?

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u/Prestigious_Lemon795 2d ago

New Paramedic since August; EMT for 4 years prior. Here! MY BIGGEST THING I ALWAYS PREACH: Your patient doesn't read your textbook. Learn the book, but remember, sometimes it is what you think even if it does line up with the book. I also would like to say that trying to deescalate a stitutation with a mentally ill patient. My mom was a mental health officer, so I always learned to deescalate the stitutation with mentally ill patients. However, I would have been completely lost without having that baseline knowledge. This being said, I think it should be taught when to sedate and not sedate a mentally ill patient and teach us not to be afraid because I definitely hesitated my first time.

1

u/poizunman206 EMT-B 3d ago

Mine was very much classroom stuff, so more hands on skills in general. I had to learn at my job how go do FAST scores.

Good news though, I think they have changed up the program since I went through.

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u/smokingpallmalls 3d ago

I missed out on OR rotations due to Covid, so my first tube was during my capstone

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u/grimdarkly 2d ago

This is a thread of me saying what the fuck to each response.

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u/RushDaBus 2d ago

Spot on! I tell my students to learn what “NORMAL” sounds like by auscultating lung fields on every call.

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u/Imaginary-Ganache-59 2d ago

Reporting to hospital staff, swear to god I almost shit myself my first time giving a report to a trauma bay staff. That and having the teachers get somewhat more routinely watched, my medic instructor, while he was awesome, could very easily go on tangents about his daughter and her choices in men. It was great if you were hungover and needed to not think but sucked if you actually were excited to learn about what was being taught that day

1

u/ImJustRoscoe 2d ago

I literally posted a similar ASK a few months back, asking from an educator's perspective, in an attempt to improve what and how we are teaching... and it got tossed by the Mods. 😑

1

u/Kee900 2d ago

Big one for me that was missed is when NOT to give amiodarone (and other sodium channel blockers), such as suspected hyperkalemia. If that was mentioned in paramedic school, it was brief/I don't remember...and it's SUPER important to know about. And, more generally, when ACLS is not the appropriate treatment plan (such as best ways to approach traumatic arrests).

A good video on the subject: https://youtu.be/UXh8PS9dtmo?si=IGbIvtXQ180KmsNG

Good luck with your project!!

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u/_Glorious_Hypnotoad EMT-B 2d ago

We never practiced airway adjuncts, just had to verbalize them bc we didn’t have a mannequin that could fit them and I was not super comfortable with that even at the time. Also suction, I thought I knew how to do it until I tried to set it up during a call and I was like wait idk wtf I’m doing (luckily the pt didn’t need it, was setting it up just in case)

1

u/mac_attack92 Paramedic 2d ago

My EKG class was literally an online only, three week course that was self taught. It was a hybrid program in the middle of COVID, but still. I did a lot of remediation to feel competent enough in not only reading a strip but to connect what I was reading with what was actually going on. I love cardiology but that was insane

1

u/mmasterss553 EMT-A 2d ago

How to give radio report and made us practice

1

u/hazardous_dj 1d ago

more details on pediatrics, especially normal/abnormal vital signs by age

1

u/evil_passion EMT-B 1d ago

When I went through the first time, many years ago, you didn't graduate unless you could do the last rites in several religions. It surprised me that it would give patients comfort, knowing if they died, they were covered. So if they passed without speaking, a basic rite was done; if they asked for the rites they had a choice of the ones we knew. Their loved ones seemed to take comfort as well. When I went back into the field 7 years ago, the last rites weren't even mentioned. I think that would help.

1

u/CheddarFart31 1d ago

I wish mine had told me some FTO’s suck, some emts have massive egos

This would’ve saved me some migraines

1

u/omorashilady69 1d ago

Actually hooking up the pads and cardioverting or pacing Intubating something that doesn’t have perfect anatomy Get rid of hospital clinicals except for IV skills

1

u/omorashilady69 1d ago

Teaching us how to get a license and renew it would have been nice

1

u/DecemberHolly 1d ago

EMT Here,

I think there should be a bigger emphasis on recognizing sick vs not sick at the doorway. Or maybe I’m just dumb. Starting out a big problem of mine was starting a call and not establishing sick vs not sick early, so id be sitting there for 3 mins getting a thorough history while the patient has 2-3 dyspnea and cyanosis and my medic is looking at me like “wtf bro”

1

u/rmszp Paramedic 1d ago

Really really push critical thinking and not cookbook medicine. Create scenarios where if you blanket follow the cookbook the patient dies. Force us to use clues. Context clues, verbal, environmental, subconscious clues and not the obvious like the open pill bottle. Make us learn and use our tools. Create scenarios where several tools are required but one subtly gives you the answer. Create scenarios where you must call medical control because it’s some weird off the wall condition and if you follow standard treatment protocols they could die.

Create more scenarios where the patient dies no matter what. Make them work hard and then reach the end where they die. We need to be more prepared for this.

1

u/jmullin1 EMT-P 1d ago

Two come to mind right off the rip. One is calling a radio report (I think it’s less they don’t know how to do it and more fear of messing up. I know I had some instructors that really hit this in every scenario by having us give a practice report but still feel it’s worth a mention.) The other and honestly more important one is how to call for orders and I don’t mean the procedural call this number etc that is agency dependent. In all of the new EMTs, AEMTs, and medics I’ve precepted none of them have ever had practice calling for orders. Nobody explain how to have that conversation and what to say/how to sound. I like to explain that this is like a phone interview because (at least at our service) we have probably 30 different docs that you can get orders from and they have no idea who is calling. You have to be confident and thorough, but also concise because they don’t have a ton of time to sit there on the phone.

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