Paramedic

[Guest jehohertz]

I am a cross-roads as to whether to pursue becoming a Paramedic or becoming an MD. Now before the questions start going crazy a little background:

 

I am a little older at 25, I have been working on a part-time degree for a year and a half and will have completed in 4 more years. I also work full-time. Now I took an anatomy and physiology course at Humber College to see if I wanted to go in to Paramedicine, to be sure. Well I am bored with the pace, I want to learn everything and it has become something of a passion! Alot of who I am really started coming out. I don't even watch ER.

 

Now, some people have made mention on some other sites that med schools look down on those who come from nursing backgrounds into med school. I am wondering if they would look down on Paramedics as well. I was just thinking as I work on my undergrad I might has well get a couple years of actual experience working with real situations.

 

As well as anybody in here been in Army Reserves as a medic and gone on to medical school? Would this be a good thing/bad thing, as I am currently in the reserves but Infantry and am thinking about a transfer.

 

Why didn't I take an undergrad right after high school? Let's just say not eveybody has even close to the ideal situation and leave it at that.

 

THanks for any and all advice!!! I have greatly enjoyed the posts thus far, esp. with regards to McMaster who seem to have a very unique program through PBL and they will accept a 3-year part-time undergrad degree.

[Guest jehohertz]

I should add the Paramedic program I would be taking, I would still be taking courses for my degree as well, they would be done concurrently. Just the full time job becomes the College Diploma program.

[Guest mying]

Can't really comment too much about the specifics here, since I don't know... though I would think any sort of "real" experience would be good, not bad. And I don't think it's true that they look down on people with nursing experience.

 

I also know of a guy entering his fourth year at UWO who previously served as a medic on a Peacekeeping mission in Bosnia. We like to tease him about his Nobel Peace Prize.

[Guest macdaddyeh]

I know it sounds cheezy, but as the old adage says, "Why be a nurse when you can be a doctor?" (no slight to nurses intended). What I'm getting at is that if you have the time the, energy and the ambition go for the greater goal. My brother was in engineering technology in a community college but did so well at it his teachers encouraged him (with the expression noted above) to go into engineering itself. He is now an extremely well paid professional engineer.

 

It really boils down to your aspirations. I know a number of paramedics because I did research among paramedics a while back and they are not simply the "glorified truck drivers" or "glorified first aiders" that some people think they are. They are *usually* unionized, well-remunerated and get great benefits and working conditions (ie, not on call, no 24 hour shifts, mandatory days off). Conversely, they are low on the totem pole of hierarch and intervention in that they are never able to diagnose, often make the same or less pay as nurses and there is *rarely* any opportunity to branch out and do other things as a paramedic--it is an end in itself. In other words there is no lateral movement, unlike in nursing or medicine where one could be in peds or emerg or a million other areas or specialties. Paramedics are also extremely monitored and scrutinized by their management and have a GPS system that declares their whereabouts at all times, they consistently complain (rightfully) about barely getting meal breaks and they are literally always mobile! Moreover, if you think about the job itself it caters to trauma; think about that deeply! Do you want to spend your career consistently responding to death, blood, gore, violent situations, etc? Many doctors rarely have to confront consistent trauma if they pick family medicine or lab medicine, or radiology or opthamology etc. so this is another key difference which could lead to burnout! They can also respond to emergency situations in blazing heat or bitter cold or freezing rain, chaotic traffic, extremely crowded populations or remote and rural areas, so be prepared to work in varying environments!

 

Paramedics are also ruthlessly hierarchical to lower trained paramedics; there are level 1, 2, 3 and special transfer and flight paramedics. While I would never challenge their skill, ability or professionalism, I've actually seen some level one paramedics have to sit there and wait while someone is literally dying, because they only wear one stripe on their collar (this same type of chauvinism and rivalry exists among pilots trained in different aircraft and with different credentials as either captain or first officer, etc).

 

Bottomline is that both are honourable professions, but have wildly varying working conditions and reputations. You'll also need to get a university degree (I'm sorry I may not have read your post closely enough, so you might have one already) but paramedicine is rarely a university-level program; in fact in the states, it can sometimes be only a one year college program (which is awful if you ask me). One thought in your direction is that I recently heard that the U of T (Scarborough campus) has implemented a paramedicine program so you might want to talk to them or check out their website...

 

Happy decision-making, but do what is best for you, your goals, your desired lifestyle and the amount of stress you can handle! I hope this was an eye opener; I did a major research paper on this topic in 2001 and have tonnes more info but I'll leave it at that. It's worth noting that while many paramedics enjoyed their job, most personally discouraged me from entering paramedicine so I never did....

[Guest medicator007]

I got little to add to that perfect response by Macdaddyeh... brilliant description of the role of a medic, especially by an "outsider" :lol

 

- U learn to deal with no meal breaks! Its called eating while standing and wolfing it down with mind-boggling speed.

 

- Heirarchy is inherent in many professions! Paramedics, nurses and doctors included. Is it right... NO! Is it there... YES!

 

- While the notion of Blood and Guts trauma may be prevalent in most people's mind & perhaps some medics try and portray the job as such. The reality of the matter is that the VAST majority of ambulance transports I have been on have mostly been of a "medical" (i.e non-traumatic) variety with a life-threatening trauma the exception rather than the rule.

 

Suffice it to say in answer to your question..... yes it is possible for a Paramedic to make it into medical school. There are two in my class, clearly I am one of them. I did my training in Vermont, and have worked/volunteered as a medic all over the place for the past 7 years.

 

Feel free to email me if you have any particular questions.

 

Medicator007

 

PS... Macdaddyeh.. what kind of research among (on) paramedics did you do? I'm left with this image of you standing over a level 1 medic strapped to and struggling on a gurney ready to test some new drug :rollin

[Guest macdaddyeh]

Hey Medicator (and others):

 

I did research concerning the social relations and working conditions among paramedics, hence my considerable knowledge as an "outsider." It was all anthropological in nature. I've never published it but it is rather extensive, and I did inumberable ride-alongs (I'll keep the location confidential).

 

You are also correct in that the majority of calls (depending on where you are) are typically not trauma-related but are often "psycho-social" in nature ie. domestic violence, drug overdoses, mental illness, suicide attempts, etc...It was good to see that variety, but what I was getting at is that the very nature of the job is to be the first responder to an emergency situation and that can often be a trauma. I saw some nasty things which I won't repeat here, but many I thought would never, ever survive.

 

The level one paramedic incident was when a patient got stabbed and the level ones could only intervene as best they were trained and according to local and provincial policy (which is often frustrating for all involved--including patient).

 

I can't go into alot more detail about what I did and what I saw because I signed confidentiality agreements, but it was a great experience and I met some great people and have a new respect for paramedics.

 

And I also met one doctor who was once a paramedic so it is possible as you noted, although I don't know what med school he went to or why he made the jump.

 

Incidentally, it is often doctors who make the decision if a paramedic is competent enough to make the transition to level two or three, so again doctors are always in the equation.

 

Congrats on having made the transition yourself, I didn't know you were a paramedic before.

[Guest medicator007]

Macdaddyeh,

 

That sounds like some very interesting research, too bad it wasnt published.

 

The story u present about the level 1 is unfortunate, but not unheard of in multi-tiered departments. However even worse is being trained at a higher level but not being allowed to practice at that level due to certain legislation.... been there, done that.... not fun!

 

To get back on the original topic, I see no reason why an ADCOM would look down on someone applying to med from paramedicine as long as they had thoroughly thought over the decision to switch and were prepared to "defend it" in their interview. Throughout my interview at McGill i got numerous questions pertaining to my background as a medic (how has that impacted on ur decision to become a doctor? What skills do you think ur medic experience has given you in preparation for being a physician...etc) and overall as far as I can tell it did more to help me than to hinder me.

 

Another bonus paramedicine is that it will give you firsthand experience in the realm of patient care and thus an opportunity to see if you are comfortable with the task. It certainly is not the same as being a physician, but it would give you a loose idea of a patient-provider relationship. I have also heard from similar "converts" that paramedic training was a major help when it came to learning certain clinical skills in medical school. While this would seem to be logical, I cannot really comment on the validity of this statement just yet.

 

Medicator007

[Guest cgb2006]

Warning: This is a really long post.

 

I rarely choose to write on the boards, and the few times I do, it is often to correct some of misperceptions portrayed about other health professions. In this case, I feel there are several things that need to be addressed with regards to Paramedicine.

 

To address the original question: I am an Advanced Care Paramedic going into my second year of med school in Ontario. In no way do I feel I was ever looked down upon during the admissions process in Ontario or any other province. Not at all. Conversely, I don't think its true that just because you are coming from a health professions background you will have an easier time gaining admission. I do feel that having worked in a health profession gives you insight into certain aspects of health care that can't be appreciated in any other way. This insight, if reasonable and used appropriately, is a valuable tool that can be applied to your admissions essays and your interviews and can really help your chances of admission.

 

Now, to the topic I really want to address is that with regards to the statements made regarding the paramedic profession. I have quoted some excerpts below that I wanted to address specifically:

 

"they [paramedics] are low on the totem pole of hierarchy and intervention in that they are never able to diagnose, often make the same or less pay as nurses and there is *rarely* any opportunity to branch out and do other things as a paramedic--it is an end in itself. In other words there is no lateral movement, unlike in nursing or medicine where one could be in peds or emerg or a million other areas or specialties"

 

Every time a hear a reference to the medical hierarchy, it makes my skin crawl. To label paramedics, or any other health professional, as being low on the totem pole subscribes to the idea that medicine itself is a hierarchical structure. Sure, many people perceive health care in this fashion....but I really think it is to the detriment of patients and the MANY health care professionals that comprise it. How we perceive the health care structure is a choice that each of us has to make, and it will formulate many of our attitudes and approach towards the many allied health professionals we will face and depend on everyday in our professional lives. I firmly believe that medicine is not a discipline over which MDs reign. Medicine is the the product of many different professionals that comprise a huge complex health care team - one which should be viewed as a complex network of individuals, each performing a different role, but each at one level trying to achieve the same end. There really is no need to rank the professions in a hierarchical manner. Everyone is performing a unique and essential role in the care of patients. Ranking them in terms of a hierarchy is ridiculous, degrading, and demoralizing. The goal of health care is to optimize the care delivered to patients, and I believe whole-heartedly that this a combined effort of many TEAM members. To subscribe to the idea that health care is hierarchical is insulting to many people who work tremendously hard every day.

 

I hear the comparison of nurses and paramedics all the time and frankly its irritating. Nurses and paramedics together perform essential roles in the care of patients. Of course, both professions interact on a very regular basis (ie. nurses taking over care of patients from paramedics when they are brought to the unit, ER, nursing home, etc.). The reality is that nurses and paramedics, although working towards a common goal, perform very different jobs. I think its disrespectful to both nurses and paramedics that this constant comparison of salary seems to dominate. I think both professions deserve to be compensated appropriately, but its a serious mistake to compare the salaries of two very different medical professionals. Should you compare the salaries of a radiologist and an ophthalmologist? Both are working towards the same end, but they are performing very different jobs under very different conditions. Its ludicrous. Let each profession be compared to its own counterparts intra and inter-provincially.... To compare between professions and disciplines does neither profession any good.

 

I also argue that Paramedicine is not an "end in itself". There are many opportunities for professional advancement in the field of Paramedicine. I expect that these opportunities will only continue to grow, as EMS systems across the county continue to evolve. Paramedics are not only limited to to working in an ambulance, as it might appear on ER or Third Watch. Thus far in my paramedic career I have worked in the field as an ambulance paramedic, in the ER of a tertiary care facility as part of the emergency care team, and as an emergency medical dispatcher. In the ambulance arena itself, as alluded to in a previous post, there are several levels of training that can be completed. The highest level of training being that of Critical Care Paramedic (CCP). Depending on which Province or State a CCP works in, the role and scope of practice may vary, but very often CCPs are employed as flight paramedics on air ambulances or on critical care transport units. Many Emergency departments are integrating paramedics into the emergency care team. At the QEII Health Sciences Centre in Halifax, Paramedics have been part of the ER team for well over a decade. Advanced Care Paramedics (ACPs) work within the department, and Primary Care Paramedics (PCPs) perform the triage of all incoming patients to the department. In Bangor Maine, CCPs work as flight paramedics and within the ICU and NICU (neonatal ICU) when not required in the air. Besides the roles I mentioned above, there are opportunities to become involved in EMS education, administration, and research. Paramedics are often employed by off-shore oil companies, industrial sites, etc., to provide medical coverage for employees. In these settings they are often offered advanced training so they are able to practice a unique and broader scope of practice. In progressive systems paramedics are being used to provide public health services in remote areas including vaccination, BP and blood sugar monitoring clinics, and certain elements of home care. Another unique opportunity is that of Tactical Paramedic. Where paramedics are trained to be part of SWAT teams, etc, to provide care under very unique circumstances. The possibilities are endless. To say there is no lateral movement is inaccurate.

 

Now I must address the "they never diagnose" statement. Under the Regulated Health Professions Act of Ontario (and similar legislation in other provinces) the rendering of a diagnosis is a controlled act that can only be performed by a limited few. See the following from the Regulated Health Professions Act of Ontario:

 

No person shall perform a controlled act in the course of providing health care services to an individual unless

 

(a)the person is a member authorized by a health profession Act to perform the controlled act

or

(b)the performance of the controlled act has been delegated to the person by a member described in clause Controlled acts

 

A “controlled act” includes:

 

"Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis"

 

The controlled act of rendering a diagnosis is reserved for few professions, including physicians, nurse practitioners, and chiropractors. In addition, it would be inappropriate for paramedics to render a diagnosis, seeing as they lack most of the tools necessary to make a definitive diagnosis, besides the clinical history and physical exam. Having said this, in order for paramedics to make treatment decisions, they must formulate a clinical impression (~query diagnosis) and treat accordingly. In many instances, we can however be quite certain of a diagnosis. For example, with 12-lead capability, we can be fairly certain of the presence myocardial infarctions, injury, or ischemia (if they present with ECG changes). This combined with a suspect clinical history and response to treatment such as nitroglycerin is quite diagnostic. But of course there are other factors such as cardiac enzymes, etc, that are not available prehospitally. So, my point is that you are correct in that we do not render diagnoses to patients. This would be in violation of the Regulated Health Professions act and simply would be inappropriate without confirmatory lab results and/or imaging where necessary. It is incorrect to imply that paramedics, are not capable formulating a clinical impression and exercising clinical judgment. This simply is not the case.

 

"Paramedics are also extremely monitored and scrutinized by their management and have a GPS system that declares their whereabouts at all times"

 

Paramedic-management relations vary DRASTICALLY between services and areas. Not all services monitor their medics like mice in a maze. This broad generalization is inaccurate.

 

"they consistently complain (rightfully) about barely getting meal breaks and they are literally always mobile!"

 

The job of field paramedics is to serve patients in the community whenever or wherever an emergency arises. Being mobile and missing meals is par for the course. Movement is necessary to maintain appropriate coverage of the service area and to maintain System Status Plans as ambulances are dispatched to emergencies and transfers. As fore missing meals....yes, people complain....I've complained. I think in the end though, we all realize that people don't schedule when they plan to have their MI or deliver their baby.

 

"Moreover, if you think about the job itself it caters to trauma; think about that deeply! Do you want to spend your career consistently responding to death, blood, gore, violent situations, etc? Many doctors rarely have to confront consistent trauma if they pick family medicine or lab medicine, or radiology or opthamology etc. so this is another key difference which could lead to burnout!"

 

Here I echo the words of medicator007, trauma comprises a minority of the calls we face as paramedics. I disagree with the statement that "the job itself caters to trauma". That is inaccurate. Most of the medicine we practice and the skills we perform are medical. Paramedicine evolved from early studies of war combat that demonstrated that field stabilization and transport teams had a huge impact on morbidity and mortality of injured fighters. Todays' studies (ex. Ontario Prehospital Advanced Life Support study - OPALS) also support this, but in addition demonstrate that pre-hospital care, including Advanced Life Support, also has a significant impact on morbidity and mortality related to many medical emergencies, such as respiratory distress, ischemic chest pain, anaphylaxis, etc. So, my point here is that we are not "constantly responding to death, blood, gore, violent situations". This is really really really inaccurate.

 

"They can also respond to emergency situations in blazing heat or bitter cold or freezing rain, chaotic traffic, extremely crowded populations or remote and rural areas, so be prepared to work in varying environments"

 

This is accurate, because again, people cannot schedule where and when they decide to get sick. But, in most cases, patients are picked up at their homes or from a nursing home or similar facility, not in a ditch on the side of the road at 2 am in the pouring rain.

 

"Paramedics are also ruthlessly hierarchical to lower trained paramedics; there are level 1, 2, 3 and special transfer and flight paramedics. While I would never challenge their skill, ability or professionalism, I've actually seen some level one paramedics have to sit there and wait while someone is literally dying, because they only wear one stripe on their collar (this same type of chauvinism and rivalry exists among pilots trained in different aircraft and with different credentials as either captain or first officer, etc)."

 

WOW, what a HUGE generalization. I hope that Medicator007 would agree with me here - the situation you describe is certainly not the norm. My experiences as a Primary Care Paramedic (Level I) were very positive. I was always allowed to practice the full extent of my scope of practice and was never made to sit and wait when patients needed my care. I have NEVER witnessed any advanced paramedics ask non-advanced paramedics to withdraw themselves from patient care (the only time I could see this is if something were being done to endanger the health and well-being of the patient....but it doesn't seem to be the type of situation you're referring to). This is inappropriate, unprofessional, and unacceptable in any profession. We must consider that there are limits to the scope of practice of the different levels of paramedics which would leave non-advanced paramedics not able to perform certain necessary advanced skills. For instance, a primary care paramedic is not permitted to perform a cricothyrotomy even if a patient needs it and would die without it. This isn't in their scope of practice. This does not prohibit each paramedic in a pair to practice to the limits of his or her scope of practice. The situation you describe sounds terrible, and if it was strictly the result of chauvinism, this is sad and unacceptable. But I assure you, this is not the norm. There are always bad apples out there, in every profession. But it is wrong to generalize this to the entire profession. As an advanced paramedic, I can say that I have never EVER disrespected anyone that has worked by my side, nor will I EVER disrespect them in the future. This type of arrogance makes me sick.

 

Lastly, I just want to address the comment that doctors dictate or determine when we progress in our levels of training. This just simply isn't universally true. Any medic can go to school and study to become an advanced paramedic. There are no barriers preventing academic advancement besides the fact that most schools require a certain amount of experience before they will accept someone for advanced training. But, physicians do not make this decision. Perhaps you are referring to advanced training provided within a specific service itself. I just ask you to be careful not to generalize...ANY medic can choose to go to school and advance his or her training. Depending on the restrictions of a particular service, it is possible that the service may not recognize advanced training that is not provided within the service, but this does not preclude someone from securing employment as an advanced paramedic with one of many services that would recognize accredited training across the country. It seems to me that you are referring to a very specific service that has very unique restrictions. Again, its inappropriate to make a generalization.

 

So, Macdaddyeh, I hope you're not insulted. This is not a personal attack. Its nice to see that you have some enlightenment with regards to Paramedicine. Its seems that with this enlightenment you've acquired some negative perceptions. I just really urge you to not to generalize your perceptions to the entire paramedic profession, especially when giving advice to someone else. As you probably are well aware, there are HUGE differences between services intra and inter-provincially in terms of professional opportunities, education, scope of practice, and system delivery. The differences are actually pretty dramatic. Hopefully as EMS policy continues to develop, we can acquire a national standard such that people can actually understand EMS systems and what it is that paramedics actually do.

 

If anyone has any questions about what I've written, please don't hesitate to ask.

 

Medicator007....sounds like you did your advanced training in the US and returned to Quebec to work. I'm sure you share my enthusiasm about EMS policy growth and the development of a national standard. Good luck to you in your second year.

[Guest macdaddyeh]

Hey CGB2006:

 

Absolutely no offense taken. I believe strongly in learning from others and you have corrected some malinformation on my part and for that I thank you. I equally apologize if I offended you.

 

One thing I should have added (and I should have made clearer) is that my study was of an anthropological nature, and therefore you, as a clinician, will not see it the same way as an anthropologist would.

 

In anthro. theory there is a cognized model and operational model; one which is based on the anthropologists observations and one which is based on prexisting cultural assumptions within the group being studied--I represented the former. Therefore, you just proved my theory that as an insider you will automatically (if not nearly always) *not* see things the same way as an outsider and this is the point of research--to flush out some things that the insiders are just not seeing or are reading into differently. What are some of those things? I concluded that social relations were the biggest (ie. hierarachy, mobility, pay, etc)--many of the things that you brought up....so instead of being offended I'm thrilled:) . One thing I would also add is that I may have come across as having generalized about paramedics, but again, you are right in that there is great variation.

 

I recall on this website about a month ago or so when some people were ignorant of the midwifery profession and some people responded so as to enlighten others to the reality..This was your purpose; thanks for enlightening us as to some of the real rigours and skills in the field of paramedicine.

[Guest cgb2006]

Hey macdaddyeh:

 

Thank you for your reply. I really believe that it is important for any health professional to educate themselves as to the role of other health professionals. There is such a misunderstanding between health professions...its incredible. That is my only reason for posting with regards to this topic. Its refreshing that you have taken steps towards this end. Having said this, I think its important for people to recognize that there are variations that exist within professions, in terms of attitude, roles, and scope of practice. Equally important is the recognition that professions evolve over time, and roles change.

 

I have re-read your discussion of the Level I incident, and it seems that this was the result of a non-advanced medic not being permitted to act outside his or her scope of practice, rather than a medic not being permitted to practice within his/her scope by an advanced medic - which is how it sounded in the original post. Being confined to a scope of practice is not unique to Paramedicine. A person is only able to perform to the level he or she is trained and only able to perform skills that fall within their scope of practice. This applies to physicians, nurses, RTs, PTs, etc, etc, etc. For example, it would be inappropriate and professionally negligent for an ophthalmologist to perform cardiac surgery to repair a congenital heart problem, even if he or she knows very well its what a patient needs and would likely die without. In Paramedicine the same holds true. It is frustrating to many medics out there, but if people want to practice at an advanced level, they need to be trained at the advanced level - just like in any other profession. There are exceptions like that alluded to by medicator007, where certain areas or provinces do not recognize advanced training, or where the scope of practice does not include all advanced skills that medics are trained in. But this is due to legislation (unfortunately), not due to chauvinism within the profession itself. This type of situation will hopefull not exist following the adoption of national standards, somewhere in the future.

 

jehohertz:

 

I have a couple of points with regards to your situation.

 

Are you from Ontario? If not, I would highly urge you to try to make at least two of your years of study full-time. My reason for saying this is that as an OOP, it is quite difficult to secure and interview or admission to Mac. I'm sure you are well aware of this if you have been following the Mac forum. Without 2 full time years, you would be left ineligible for admission to many other schools. This is easier said than done, not all of us can put our lives on hold to attend school full-time and I recognize this. So, if full-time is not possible, I wish you only the best at Mac or any other school that will recognize a part time degree. Personally I think that schools need to make progress in this area. Its just simply not reasonable to expect that everyone can fit into the admissions mold....the reality is that many people have responsibilities that make full-time study impossible.

 

As for your experience at Humber College. Your experience in anatomy and physiology is not necessarily reflective of what you can expect to experience in a paramedic program. You will be learning mainly of things that are of clinical relevance and your teaching will consist of didactic and clinical teaching. Its very likely that you will still want to learn more than what you're given in the program. This was the case with me. So, eventually I did my advanced training which was very intellectually satisfying.

 

I think its a great idea for you, if your interest is as genuine as it seems, to train as a paremedic as you continue (or discontinue) your quest for medical school. You may decide that you really like it, as many of my colleagues have, and stay with it. There are many medics out there with university degrees, you would not be alone. If you don't, you can carry your clinical experiences forward to your medical career. It really has been helpful for me this year, especially in clinical skills: history taking, physical exam, technical skills, etc. You would also be able to continue to work in med school if you decide, which would help alleviate the debt you are likely to accumulate. If you haven't done so already, I would urge you to ride-along with the paramedic service in your area to get an idea of what the job itself is like. It certainly is not a lifestyle for everyone. It is equally likely that your rendezvous with Paramedicine may also cause you to realize that you wouldn't enjoy medicine period.

 

One additional thing. I know there is progress being made with regards to this, but I would check and see what the current policy is with regards to medics in the Forces practicing with civilian services. I know that historically medics trained in the forces have not been permitted to practice as civilian medics once they have left the service. I could go on about this one also, but I'll just sum it up by saying I think this is unreasonable. Although I think its unreasonable, it is reality. So if you hope to perhaps one day practice outside the Forces, I would investigate the current policy with regards to this, and consider training in a civilian setting.

 

Oh! Lastly, I wanted to let you know that there is in fact a Pilot Paramedic Degree Program being trialed here in Ontario. It is a joint project between Algonquin College and UofT. I am really sketchy on details here. I believe that the paramedic component is taught at Algonquin, followed by completion of two additional years at UofT completing core requirements for a degree. Like I said, it is in a pilot phase, and not open to applications as far as I know. I believe there are 6 or 8 students being put through this pilot project. Besides this, graduates from several Canadian schools are eligible for degree completion following completion of recognized paramedic programs. For example, the Southern Alberta Institute of Technology (SAIT) has an established degree completion agreement with Athabasca University, which recognizes their Advanced Paramedic Program as two years towards a Bachelors degree. So there are degree options out there for people training as paramedics.

 

Good luck with your decisions.

[Guest Never2Late]

I just thought I might add the following tidbit regarding Mac's admission reqirements. I am an Ontario resident so I am not quite sure about the OOP stipulations but will offer my story in case it helps.

 

I am a registered nurse who has graduated from a three year college program. I am currently working on my (nursing) degree via part time distance education during which I am required to complete 10.5 credits. The course is offered over a four year period where you take 1-2 courses at a time. I have bumped up my course load and am taking 3 at a time - not wanting to drag it all out for four years! I also work full time (and then some!) at a hosptial and therefore I am not currently able to return to university full time.

 

Since I, too, am working towards acceptance into medical school I have had several questions regarding my chances for admission. I finally contacted Mac directly and was informed that (as in my particular case) a degree obtained in this manner is "quite acceptable". (ie: part time, distance ed, degree completion program/10.5 credits/etc)

 

Of course, I have not actually begun the admissions process into med school yet and only hope that I have not been misinformed. It would be a shame to find out (the hard way) that my chances have been hindered for either not going to university full time for two years or for not having completed more than the 10.5 credits. However... according to the response I got.... I should still have a fair shot at it!

 

I have enjoyed all of these posts... and could probaby add several more comments... but I'll leave it at this for now.

 

Hope it's helpful to you.

[Guest cgb2006]

Never2Late:

 

I don't believe you've been misinformed. This seems similar to the information that jehohertz has received. The only reason I suggested 2 years of full-time study if jehohertz was in case he or she was an OOP. It is VERY difficult to get a seat as on OOP student. Not impossible of course, but relatively speaking it is much more competitive to gain admission as an OOP due to the low number of seats reserved for OOPs at Mac. With 2 years of full-time study, there are greater opportunities for admission to other medical schools that are unwilling to consider students who have completed part-time degrees. But as I mentioned (and you've alluded to) not everyone has the luxury of being able to put life on hold and go to school full-time. Its unfortunate that there are not more schools like Mac that take this into consideration.

 

I wish you the best of luck with your Degree completion and your future application to med school. I think your experiences would make you a great candidate! What type of nursing are you doing?

[Guest medicator007]

Hey CGB2006,

 

Those were some seriously long emails , but very nicely stated.

 

With regards to the issue of heirarchy.. I think it is best to remember that as with ANY large group of people (ambulance service, medical school...etc) you are going to have problems with interpersonal dynamics. Have I seen such examples of chauvinsm within the service, absolutely. However, they are by no means the norm.

 

And yes.... I did my basic training here in Montreal, headed down south for my advanced training and after working a little bit in the USA came back to Quebec. While we are honestly the black-hole of EMS in this country steps are being taken in the right direction... currently symptom relief (NTG, ASA, Salbutamol, Glucagon and Epi) is sweeping its way across the provinces MAJOR ambulance services... and here in Montreal an ALS pilot project that has two "specially" trained technicians currently supervised by a doctor is underway with rumour of expansion.

 

I would love nothing more than to see a universally accepted national paramedic curriculum, having spent some time at PAC meetings when they were in Montreal a little while ago I know that people are hard at work towards this goal. Only time will tell!

 

Medicator007

[Guest cgb2006]

Just a quick correction: The pilot paramedic degree program I referred to above is actually a joint project between UofT and Centennial College (not Algonquin College). Sorry about that.

[Guest Sil]

I have yet to see any of my classmates look down on me because of my nursing background but if they did, would I really care? What is more important to me becoming a doctor or the opinion of a couple of people in my class? And if a couple of people in my class were to look down on my nursing degree what does that say about them? I think it reflects poorly on them, why would they look down? Don't they respect nurses or think that their work is worthwhile and necessary. So, if I were you I would not worry about what 2 or 3 or your classmates might think about your undergrad (and by the way no one in your class would probably care). After a while everyone will forget where you did your undergrad or what you where into.

 

And I don't think that nurses are just not ambitious enough. The gold medallist for nursing (close to a 4.0 GPA) simply was not interested in medicine. She would not be able to talk to patients as much, not have as much time to have a family, etc, etc, etc. Some people just have different priorities. Medicine simply is not for everyone and I don't think that those that wish not to pursue it are somehow inferior to me. So you prefer nursing, dentistry, PT, OT, teaching, chiro good for you. I prefer medicine but that is just me.

[Guest Never2Late]

To cgb2006

 

Thanks for your well wishes! I also happen to feel that I have a lot of experiences (both iniside and outside of nursing) that will help with my chances of getting into med school. Enough so that I haven't given up yet anyway!

 

And in answer to your question - I work (full time) on an acute neurosurgical unit and also (part time) with a family physician in his office. (hence the late reply.... working lots!) I enjoy the differences between the two jobs and the varying experiences I get from each.

 

 

To Jeho and Sil

 

In the very first post that Jeho put up he/she questioned whether or not nurses are looked down upon for entering med school. I agree with what Sil has posted and don't think that med school classmates would really care what type of background you have. (of course, Sil would know more about this than I - since I'm not actually in med school YET I have posted elsewhere that I do, however, wonder what some of my nursing colleagues will say when it is out in the open that I wish to become a physician. I have also wondered what it will be like to be a med student and in the position of working in the same areas where I once have nursed. I happen to know the opinions of some of my fellow nurses and can see that some would be quite .... opinionated about a nurse turned md. Having said that - I also really don't give a hoot about what others may think about my personal career choices. I have seen many people who have worked a career in which they are miserable because they have never made the choice to change things... quite simply I do not want that for myself. I like nursing, I feel it's a great career for many, but I want something different for myself and don't want to look back someday and say... "I wish I would have...".

 

Having said all of this, I took Jeho's statement another way. I too have heard stories of the medical school ad coms "looking down" on nurses who want to enter med school. After much questioning and reading this appears to be untrue. I am under the impression that nursing can provide a great background to medicine however (as with any career that you are chosing to remove yourself from) you must be able to define and defend your reasons for wanting medicine. (a process I continue to work with for myself!)

 

Once again... I just thought I'd add my comments (for what they may be worth!)

 

Take care!

[Guest jehohertz]

Just wanted to clarify I wasn't saying anything bad about nurses, quite the opposite two of my Aunts are nurses and I dare not say a bad word of the vital function they perform. I just had found this message about somebody thinking of doing a nursing undergrad in case med school didn't work out and some university looking down that, in one persons opinion. However I cannot find the post currently. >:

 

As for 2 years full time. I wish I could! I am looking into that option however, as I believe if somebody wants something enough, they should be prepared to make the appropriate sacarafice. My problem lies in my high school marks were atrocious due to an incredibly bad home situation (and we'll just leave it at that) andI gained entrance to uni through mature student status. That being said I am considering retaking courses to "upgrade" my marks.

 

This thread has been most illuminating though! The differing replies and sides to the original inquiry have been though provoking to say the least. I am to the point now that if Paramedicine is looked down upon by admissions it would not be a school I would want to go to anyway, not to mention that fact that there are paramedics in med school in this group!!! In that regard my question has been answered. Now the bigger question of what to do in undergrad however is one that I still am investigating, however I would love to see where this thread keeps moving though!

 

Another question however, would a 2-years Masters suffice for 2 years full-time? I have a very specific undergrad, it is a Bachelor of Military Arts & Science taken through the Royal Military College of Canada (well, it is currently in-progress) and I am not sure how a transfer would work as it is a unique degree, however all courses are University courses. And the only other degree that really tickles my fancy is the Bachelor of Health Sciences, however as stated above my marks would hardly get me in the door - McMaster says 88-90% on OAC's is req'd.

 

Thanks for all responses, esp. the longer ones as well as the shorter ones!

[Guest jehohertz]

Oh and I forgot to mention, I am in Ontario.

[Guest druggist]

Hello all,

 

In no means do I mean to post to put down the duties that paramedics do, but myself (as a pharmacy student, EVERYTHING in hospital must be evidence-based) and an emergency room doc looked at the numbers for when paramedics intervened--ie, intubated, IV lines, heavy drugs (usually cardio)--and time and time again ti seemed to show that the best thing for the paramedics to do was the ol' huck and run (ie, to not intervene, and just get the patient safely to an emergency team based in an ER). An anesthesiologist I knwo also did a study during his residency (which, in your defense I admit used only 1 hospital for it's sample), which showed that paramedics intubation success was far from great (not that doctors get it right either, obesity poses complications) and that 23% of intubated patients were not receiving ventilated air. I guess I just wanted you to be aware that sometimes this type of evidence creates turbulence in patient's health-care authority. Some docs at the hospital I worked at tell the paramedics not to bother doing much of anything, and then the medics fight for more rights to use heavier drugs, more responsibilities etc., an ever-cycling fight for who will provide initial primary emergency care.

This all goes back to what an earlier poster said, why not just be a doctor is that is your true passion? If you are interested in the skills of a paramedic, then by all means take the course and apply to med school with that degree. It will only better you in the future, but Id say run with med, it will allow you to better yourself unhindered.

Cheers

Hopefully you dont hate me for these stats

Druggist

[Guest medicator007]

Druggist,

 

Nobody is going to hate you for bringing up those stats, which are pefectly valid points:) . The point of this forum is to allow open and frank discussion. As long as the thread does not denigrate into rampant baseless bashing of a healtcare profession there is no need to be concerned.

 

As a medic I think we must recall (cgb2006, im sure u agree) that our FUNDAMENTAL raison d'etre is to get the critical patient to the hospital in the most expeditious manner possible. I will admit that with the expansion of clinical skills available to prehospital providers I have seen first hand (ok, not solid evidence but im sure such a study has been done) an increase in the on-scene times. On many occasions I have had to remind my colleagues to "load & go".

 

However with respect to your studies on IV, Intubation success rates, one has to take into account a very important variable in comparing the success of medics in the field vs. docs in the ER/ICU or OR. The prehospital world is NOT a static and controlled (relatively speaking) environment like a hospital. You don't get perfect lighting, you can't always get the patient's head into that perfect sniffing position or have ample staff to apply Sellick's or prepare ur gear. So i'm not at all surprised that medics have a lower ET success rate. HOWEVER, what one must keep in mind is that in the case of intubation prior to surgery the patient is capable of breathing on their own at the moment, the vast majority of medic ETI's are done in instances where that tube is the only chance the patient has to breathe... and if you are ten minutes out of the hospital and unable to protect your own airway or breathe on ur own you'd pretty well take the 77% chance that the medic is going to hit the placement and breathe for you.

 

Some docs at the hospital I worked at tell the paramedics not to bother doing much of anything

 

Not to bother doing anything? I think that's a little excessive and I'm sure you/doctor was simply overexaggerating to establish a point. We do not want to go back to the days of the ambulance driver, who would conduct the white station wagon to the hospital with a bleeding patient in back w/o applying direct pressure....etc...etc..

 

Since we are all so fond of EBM, here are some examples in defence of prehospital intervention. Prehospital evaluation of potential MI patients using appropriate scales, checklists and ECG telemetry has been shown to decrease the time between ER arrival and administration of fibrinolytic agents and correlated highly with an increased rate of patient survival as compared to patients who went to the ER without an ambulance. Similar data exists in the cases of CVA's. Early defibrillation by first responders and basic EMT's is clearly indicated by the ECC as a major factor in the fight against against sudden cardiac arrest. There are certainly others, but for the moment I can't quite remember them (Sorry, im tired and at the end of a 12 hr shift)

 

What we need to strive for is a nice balance between prehospital treatment and rapid transport

 

You bring up some excellent points, in particular the need for rapid transport to definitive care, rather than lose time on scenes. A point that is very well exemplified in the prehospital "management" following lady diana's crash (which as defence for us medics, was handled by physicians).

 

Medics, doctors, nurses, pharmacists, RT's, technicians (there are so many others, and my omission is more to save time and space and not meant as a slight) are ALL integral parts of the health care chain. No discipline is perfect, all have their flaws and are working towards developping a better manner of integrating towards better patient care. None are looked down upon by admissions committee's, nor should they be by any other health care professionals.

 

As for what route to take, what field to enter into. I don't think that is something that someone can decide for you. You really have to look into all the different possibilities, look within yourself and see what matches.8o

 

Thanks for the frank and open discussion druggist!

 

Medicator007

[Guest cgb2006]

Hi Druggist:

 

Anyone who would hate you for voicing your opinion or understanding probably shouldn't be here on this forum. I hope most of us would look at this forum as a venue to learn new things as well as revise misperceptions we might have regarding any medical topic.

 

I think few, if any, of us would argue against the need for evidence-based medicine (EBM). Historically EBM has been lacking in the field of pre-hospital care. With this acknowledgement has come a push for research into the efficacy and benefit of pre-hospital care. There are several ongoing studies looking specifically at those topics which you discuss in your posting, that is Advanced Life Support (ALS) interventions such as intubation, IV therapy, ALS drugs, etc. One ongoing study I mentioned in a previous post is the Ontario Prehospital Advanced Life Support (OPALS) Study. The objective of the OPALS study is "to assess the incremental benefit in survival, morbidity, and processes of care that results from the introduction of prehospital ALS programs", specifically that of quality of life, survival, disability, process of care measures, and incremental cost per quality-adjusted life year. The OPALS study is looking into three major areas of pre-hospital ALS care: cardiac arrest, major trauma, and respiratory distress. In addition there are several sub-studies that are ongoing which investigate the appropriateness and benefit of ALS intervention in the setting of seizures, non-traumatic hypotension, and chest pain. Most of the studies have been completed yet the final report is still pending. Already in Ontario, I have seen changes to pre-hospital standing orders based on preliminary findings of the OPALS study. Besides the OPALS study, there are many independent studies being conducted around the world on similar topics.

 

I guess my whole point is that I agree with you, there is a dire need for evidence-based medical practice in the pre-hospital arena. I have to say though, as you have acknowledged, that the findings of one study in one hospital cannot be generalized to the entire field of pre-hospital care. There are many physicians who are of the opinion that paramedics should do the "ol' huck and run" with almost all patients. I am of the opinion that this is not universally acceptable, and a system such as this would be a true detriment to patient care. There are many instances where patients in my care have benefited from pre-hospital intervention, and would have likely suffered significant morbidity without it. There are instances where pre-hospital interventions are clearly beneficial such as airway obstruction (foreign body, traumatic), prolonged seizures, anaphylaxis, hypoglycemia, respiratory arrest, and early cardiac arrest. Having said this, there are other times where it might be argued that care can be delayed until hospital arrival such as hemodynamically stable dysrhythmias. My point is that we should let the evidence of properly conducted peer-reviewed research dictate appropriateness of any type of patient care, including that which is delivered pre-hospitally. I have to question the finding that "time and time again....the best thing for the paramedics to do was the ol'huck and run (ie, to not intervene, and just get the patient safely to an emergency team based in an ER)". I'll be the first to acknowledge that there are certainly times when it is more than appropriate for paramedics to provide only comfort care to patients in the pre-hospital setting....and when it is appropriate for us to do so, that is what we do. The majority of calls we respond to do not require any of the ALS interventions you describe, and in these settings ALS interventions are not performed. There are clearly situations where withholding an ALS intervention and doing the "ol' huck and run" would be detrimental to the patient. I think the findings from the OPALS study will support this as well.

 

With regards to the pre-hospital intubation study you describe, I must say that those stats certainly to have a shock factor to them. A recent study conducted by Harborview Medical Center / Seattle Medic One (leading researchers in the field of pre-hospital care), titled "An Analysis of Advanced Prehospital Airway Management", reviewed past statistics of pre-hospital advanced airway management and compiled its own stats from 50 118 patient encounters out of which 2700 (5.4%) of patients required intubation. This study found an overall oral intubation success rate of 98.6% in various settings including traumatic injury, burn/smoke inhalation, cardiovascular emergency, respiratory compromise/distress, neurologic event, Abdominal/GI bleed, cardiac arrest (non-cardiac origin). Within this group, approximately 50% of patients received sedation and/or paralytic agents. Within the subgroup of patients receiving paralytic agents, there was a 97.8% success rate. This study also discusses several past studies which found success rates ranging from 75% (pre-hospital intubations for NON-CARDIAC ARREST patients) to 88% (oral intubation success rate including CARDIAC ARREST AND NON-CARDIAC ARREST patients). Both studies report that altered level of consciousness leading to combativeness, and trismus were leading causes for intubation failure. The study concluded by supporting the use of paralytic agents to facilitate endotracheal intubation in the pre-hospital setting. Why am I including these findings? Well, to make a point. There are many different settings in which intubation can be used...a wide array of "live patient" settings (conscious/semi-conscious/unconscious) and in the setting of cardiac arrest. In most Canadian services (except Alberta), paramedics are not permitted to use paralytics to assist in "live patient" intubations. In addition, most services do not allow the use of sedative agents. As described in the Seattle study, this clearly has a negative effect on the success rate of necessary pre-hospital intubation on live patients. Having spent time in hospital, how many times have you seen an ER physician or an anesthesiologist attempt a needed intubation on a conscious or semi-conscious patient without using a sedative or paralytic agent? My point is that success rate is clearly related to the specific setting/patient you're studying (ie. cardiac arrest vs. live patients) and what type, if any, supplementary therapy is available to assist with the intubation (sedatives and/or paralytics). Because of the variability related to this, it is impossible to conceptualize your stat without further information about the study, or to regard it as being representative of pre-hospital intubation success in general. Preliminary finding of the OPALS study show that in the setting of cardiac arrest patients, there was an average success rate of 95% for endotracheal intubation (from 1995-2002: total of 6749 endotracheal intubation attempts). On top of all of this, Seattle researchers stressed the importance of ongoing training on the success rates of endotracheal intubation.

 

It is relatively easy to find physicians that regard pre-hospital care as unnecessary. I would argue that a huge part of this view is due to tradition, resistance-to-change, turf-protection, and lack of exposure to progressive/developed EMS systems. Certainly turf-protection is not new to the world of pharmacy...I have a sister that is a pharmacist, and I share her frustration regarding this everyday. Wouldn't it be nice if you were permitted to function to the fullness of your capacity? I can tell you that the there is HUGE physician resistance to this also. Despite the strength of physician insistence towards a very limited pharmacist scope of practice, I'm not so sure this view is evidence-based.

 

So, as I mentioned above, I have no hard feelings towards you. I hope that what I've discussed has encouraged you to re-examine the views which you've encountered in the past and reconsider the importance of pre-hospital care. As more evidence begins to emerge in the near future, hopefully paramedicine will also be able to don the evidence-based-medicine cloak that everyone holds in such high regard.

[Guest druggist]

My,

 

I dont believe I was ready for two long well put, EBM loving, justified responses. I had guessed just as I hit the "add reply" that there were many RCTS and well-planned cohorts out there which would proudly boast high percentages, low p values, and clinical significance supporting pre-hospital care up the yin-yang! It was refreshing to hear both of your comments and I do admit that it caused a bit of introversion and examination of hte beliefs that I hold on pre-hospital medical interventiosn. To add to this, as a side-note, I would gladly plead for an amnesogenic benzodiazapine or barbituate before being awake-intubated. A memory that I would not like to hold stored forever. Also, as for the pharmacy bit, I do agree. Pharmacists are truly very well-trained and highly competent professionals--ones which are not utilized to their full degree. However, this battle will continue on as some physicians grow timid as pharmacists attempt ot walk in on medical priviledges (the CMA keeps bringing up "pharmacist prescriptive authority") conventionally only enjoyed by individuals wielding the M.D. degree. However, I took pharmacy as a pre-med.

I was always interested in how spray could make my grannys chest-pain dissapear and the banana stuff in the fridge made my ear pain up and quit.

ha

Cheers and thanks for the replies

Druggist