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Process Analysis of a Paramedic Program

The paramedic program I attended, like most across the country, had only one relevant prerequisite, which was having an active EMT-Basic license. To get the Basic licensure I attended a one semester college course which required 120 hours of clinical time which included ER, Obstetrics and Gynecology, Pediatric and Ambulance ride along. Basic skills which had to be practiced in clinical time after being evaluated in class included taking vital signs, primary and secondary assessments and bandaging. These skills were primarily limited in ability to provide medical intervention which resulted in improving or helping the patient remain in their current condition.

Paramedicine builds on this foundation to include more advanced medical procedures that other medical personnel of even higher licensure status (higher level of care) are not able to perform. The program is comprised of first academic portion which, for the program (coinciding with skills lab for practicing such skill sets in a classroom setting) I attended was 6 months. During this time you also begin your clinicals, like EMT-Basic, such as ER, pediatric, OB/Gyn, neonatal intensive care, among others. Required total clinical hours were at least 600 hours. Most of these hours are obtained during the ambulance clinical where you don’t “ride along” with a paramedic crew, you are the second paramedic crew member, the other being a certified paramedic preceptor. Until the EMT-Paramedic license is obtained the student paramedic cannot at any time be alone in the back with a patient while the ambulance is operating as a paramedic unit (opposed to EMT-Basic unit) and the preceptor has ultimate responsibility of patient care until transferred.

One example of this process is learning how to intubate. Intubation is learned via textbook during the advanced airway management unit, followed by practicing intubating on specialized dummies or mannequins. The student’s competency is then tested by a preceptor who utilizes a nationally standardized grading form which includes the student successfully verbalizing indications and contraindications for intubating a patient, setting up the equipment and ultimately placing the intubation tube correctly and securely into the dummy or mannequin as if it were a real patient. As it makes sense to practice on a non-living entity at first until the student is proficient enough to pass evaluation in class and start using that skill under supervision, unfortunately, intubation is one procedure that is not regulated well enough at the paramedic program I attended for the transition from classroom dummy to real patient.

I was required to obtain 3 intubations for which I’d have most success signing up in Operating Room of the hospital for 3 separate days and then waiting until a patient arrived who needed intubation and the physician agreed to supervise me and whose medical license is at stake while I am treating their patient. Most of my class including me had a difficult time getting access to patients who needed intubation - the physicians responsible for intubating the patient did not want to deal with paramedic students.

One study on paramedic-performed intubation success rates states that “Intubation is regarded as one of the most important EMS procedures and has been the standard of care in the United States for more than twenty years” 1)

Most alarming, as stated, to qualify for the state paramedic licensure exam in Illinois only three successful intubations are needed, after which there is no regular continuing education for practicing intubation and or even any oversight to those three intubations by the paramedic program. For example the first patient I tried to intubate in the OR, the physician would not let me perform the whole procedure, he just handed me the breathing tube and said, “Ok I visualized the vocal chords just put the tube in”. I did not find it appropriate to start asserting myself on this “OK do your little paramedic thing and get out” attitude from the physician, so I stuck the tube in and left, not allowing myself to count that as one of three intubations even though he signed off on for me.

Health

1) Paramedic Intubation Errors: Isolated Events Or Symptoms Of Larger Problems? Henry E. Wang, Judith R. Lave, Carl A. Sirio, and Donald M. Yealy Health Aff March 2006 25:2501-509; doi:10.1377/hlthaff.25.2.501

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