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Unaffiliated Un-uniformity

February 24, 2012 Leave a comment
EMS

Photo credit: SantaCruzHealth.org

There are plenty of informative sites, blogs, and other variants of social media out there for the already-employed-EMT, but what about those of us that have gone to school, have a license, but have not been hired yet…for two years?

OK, the two years part may not be the norm, but the rest of it might be, to more folks than you may think. I went to a small community college in North Carolina, enrolled in a six-month course, took the state exam, failed the first time, then retested. This was all shortly before moving to New Hampshire.

Reciprocity

But did you know North Carolina does not require NREMT? I didn’t think it was a big deal. I heard of ‘reciprocity’ and thought that it might help. It seems that it does not extend very far. I looked into what was going to be needed for employment in NH, even though I knew I was not to be staying in NH for more than a year, but I desperately wanted to get my career started. I looked up websites, made phone calls, and knocked on office doors. Finally, I had to take a one-day ‘transition class’ for the state of NH. I was actually misinformed about this; the class had no bearing on my NH license.

Everyone tells me to get NREMT. Great, sure, have you read HOW to do this if you are “unaffiliated?” Excessively frustrating, not to mention, living paycheck to paycheck does not allow for it.

Now, I am facing the same thing in my new home state of Maine. There seems to be no ‘reciprocity’ between NC, NH, or ME. It has even been suggested that I may need to take the EMT-B course all over again!

Lack of uniformity

Now more to the point. Where is the uniformity? Hypothetically, if many states use the same detailed textbooks, specifically Brady Books, why is it so difficult for someone without NREMT to transfer to another state? Is what has been learned any different? Is the human body really any different from one state to the next?

I understand differences in protocol, which is why I took the $150 one day ‘transition class’ in NH. Should it really be this difficult (and costly) to transfer credentials from one state to another?

A possible solution

Here is an idea that has worked for me in EVERY other career field I have been in: hire me conditionally, with the stipulation that I get fully-licensed in said state within a specified number of months. This would solve MANY issues.

The issue of not being able to afford the process (as it would be a second income) and also would put me in direct daily contact with people who can steer me in the right direction. I have asked three different people about how to do this. Simply put, I have received three different answers.

So, have I done what is required educationally? Yes. Do I have a valid EMT-B license? Yes. Can I get employment? No.

There must be some sense of uniformity in the education process that could eliminate some of this hassle. How about a simple solution of offering to sit for NREMT along with state exams after completing a class in every state? Why not, if a majority of the schools use the SAME textbooks, right?  

Uniformity, in a career where we wear uniforms, where is it?

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Eric Carlson is a dad, husband, (unemployed) EMT, volunteer firefighter, writer, and fire protection systems specialist. Visit his blog: http://pheenyxsfyre.blogspot.com/

 

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Critical Thinking: The Only Skill We Always Use

October 11, 2011 2 comments

By: Nick Montelauro, NREMT-P, FP-C, NCE

Because of the variety of hats I get to wear, I get to talk to students at many different points in their EMS careers – many who haven’t even started yet.   The question I get asked the most about our profession and the training and education we give is, “When I’m done with class, what do I get to do?”

My standard response is that the successful student will “get to” be trusted with other people’s emergencies. With the upcoming changes to the National Scope of Practice and new National Educational Standards, everyone seems concerned with who “gets to” poke holes in people or expose them to other potentially harmful procedures and medications.

The question I enjoy is another common one, “What’s the hardest part about becoming an EMT (or paramedic)?”

This question, in many forms, is what students and educators always want a simple answer to.   I’ll submit that there are many things required and different students will have different things that come easily and that will require more of their attention.  But when people ask me to name the one skill required to be a proficient EMS provider, there’s only one answer that stands out – you have to be able to make decisions.  Educators call this critical thinking and it’s a skill that touches literally everything you do from the time you report for your shift to the time you go home.

“But, wait, isn’t airway more important?  If the patient doesn’t have an airway, they die!”

What makes airway so important and why do we spend so much time harping on it?  Because you need to be able to make decisions about how best to manage it.  Is the patient maintaining an adequate airway on his own?  Do I need to intervene?  Which airway is most appropriate?  How invasive do I need to be?  How often do I need to reevaluate?  Each of these decisions could be the most important one you make today.

My students love the fact that skills are currently tested from a published, step-by-step rubric that can simply be memorized to ensure a passing score.  What they don’t love is when I tell them to put the skill sheets down so we can talk about “real life.”  They know I’m going to what-if them to death.  They know I’m going to ask them what to do when the equipment doesn’t work right, when the airway won’t fit, when the transport is prolonged, when the patient’s complaints don’t fit squarely in any one protocol, or when the patient won’t cooperate with what the skill sheet says will always happen.

They know we’re in for some heated discussions, a lot of push and pull, and a lot of agreeing that there’s more than one way to skin a cat and that some bridges can only be crossed when you come to them.  What they may not know is, I’m forcing them to sharpen the axe in a way that some don’t think about – the anguish I’m putting my students through is going to pay off on their first non-traditional call.

The ability to make a decision is a skill that can be studied at great length.  Professionals in many fields -pilots, physicians, quarterbacks, and executives – study decision making and the ones who are the best at their jobs are often the ones who make the best decisions.

And next time you’re in class, or between calls, or doing some self-evaluation to look for ways you can be a better provider, don’t forget the one skill you use on every call: critical thinking.