Becoming a Paramedic

Why become a Paramedic?

Once you have become an EMT and have at least 1 year experience, you may be wondering what you can do to further your career. Some of you may be interested in joining the fire department and see becoming a paramedic as the next step in advancing yourself towards that goal. Some of you may have a general interest in paramedicine and emergency medicine, looking to gain a higher scope of practice and understanding. With that being said, know that the journey to paramedic from EMT is a rough one and can be daunting. It will, without a doubt, at some point take an emotional toll on you and possibly the ones closest to you. It is crucial you are mentally prepared to take on all tasks that are presented to you. 

The Pros

Just like EMTs, there are plenty of positive impacts from becoming a paramedic. As the lead in the calls now, you have a special opportunity to do more within your scope to help others. Leading community activities may also be a new role that you take on as a paramedic, teaching others about subjects you may not have understood as well as an EMT. Broadening your horizons to other branches of the field such as flight medicine, contract paramedic overseas, or swat medic can present financial opportunities not on the horizons prior to obtaining your license. 

 Critical thinking is also a skill you learn as a paramedic that will lead you to be successful in almost every other facet of life. For example, our high efficiency washing machine stopped working. It was new and had computer settings which was different from our last one but the basic foundations were still the same. Based off of our thought process we learned in medic school, either there was going to be a pump problem, an electrical problem, or a volume problem. Considering the electrical panel looked to be functional and the pipes were intact with no leaks, there couldn’t be a pump problem. There had to be some sort of blockage. After checking the filter, we had found the problem and realized what we needed to do for our “treatment”. Using paramedic critical thinking skills, we could think through that problem. As simple as that was, it can be used in firefighting skills or other obstacles in high stress situations. 

You can also gain a new perspective, performing skills most medical healthcare workers cannot. Being able to have constructive, intellectual conversations with other providers, like medical doctors, and creating new ways to do things can be exciting and adventurous. There is no feeling quite like making it through paramedic school and internship then passing National Registry. Once you have done that, it feels almost as if you can do anything.

The Cons

Just as with any career, there are always downsides to becoming a paramedic. As you have already read in our EMT guide, there will be lifestyle differences in this field that are not ideal. With bigger responsibilities as a paramedic, there comes possibilities of failure. During your internship, you will experience failures such as missing an IV or even failing an intubation attempt on a difficult airway. Nailing that learning curve while still on internship is important in your future as you will need to be able to move past that and focus on what’s next. Unfortunately, those skills may be the difference in the progression and success of the call or patient prognosis. Sometimes, it’s being completely lost on a call even with all your medical knowledge. You may get stumped and that’s natural as long as you keep the call progressing. Although you should not take all the failures to heart, it can be extremely stressful. With proper understanding of your responsibilities and proper proactive mental healthcare, it can be manageable. 

Unfortunately, you will also have to take on the responsibility of delivering bad news. It can be cathartic to do so depending on how you approach it. This is where your social skills come in. You should spend as much time you need to as an EMT to become good at becoming a people person. That is one of the biggest weaknesses individuals in this field face if they have not learned it already. It will be especially difficult for those that are not super social or do not have an outgoing personality. It does not make it impossible but it makes it harder. Keying in on non-verbal body language and interpreting what patients and others are trying to tell you is critical in your success on call, especially a psych call. 

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How to become a Paramedic 

Choosing a program that's right for you

When looking into different programs, the main components you want to look at are schedule, payment, and reputation. There are usually a variety of different schedule types including night classes, classes 2-3 times a week, or full time schedules that are 8 hours a day 5 days a week. The variety of schedules can be helpful if you are working or have child care issues. The schedule can also depend on how short or how long the program takes to complete. The duration of the program can change from state to state. There are institutions in which you will receive an associates degree from or even forward you into obtaining your bachelors. Where you see the most differences in cost are community based programs (community college, fire department sponsored) and private institutions (vocation, career colleges). Private institutions tend to be more expensive, as they are for-profit. Some private programs can cost upwards of $15,000 in tuition. They also have advantages like more schedule varieties, more tools and resources, and may have more dedicated instructors. Public resources or community based programs tend to be more affordable but have less leniency in schedule. While taking cost into consideration, make sure to get detailed information about what the tuition includes for example, if this includes exam costs and materials needed to complete the program. 

There are scholarships that are available to paramedic students but there are not a lot and it can be competitive. Obtaining a scholarship takes some research as they are not well advertised. Make sure to research through your school and local EMS community for scholarships available to you. NAEMT has a list of scholarships available (https://www.naemt.org/search-results?indexCatalogue=entire-site&searchQuery=scholarships&wordsMode=0) 

It would be wise to also take into consideration reputation and NREMT (National Registry of Emergency Medical Technicians) pass rate but it's not necessarily a deciding factor. 

Choosing a paramedic program may be limited to your location. If there is only one local program and you don’t have the capability to choose, that’s okay but be sure to do your research on the reputation and what it offers. 

It’s also important to determine whether your state, or state you’re looking to be certified in, offers reciprocity. Reciprocity is the concept that your certification is accepted by another agency or state. For example, in Hawaii, they do not have reciprocity for NREMT because they require more didactic hours to become certified. It is not as simple as obtaining your NREMT-P, you still must take the State of Hawaii’s paramedic exam to submit for approval. 

Whichever program you choose, make sure it’s manageable. Do not set yourself up for failure.  

Ride Alongs/Ride Outs

Ride alongs are a great opportunity to practice your assessments and delegation tasks while not feeling the full pressure of internship. Throughout the didactic (in-class) portion of your program, you should strive to do as many ride alongs as your schedule allows, it will be extremely beneficial in the long run. 

Make sure not to be a “sit-along” meaning all you do is observe. Although observing is a critical part in understanding the flow of a call and treatment, you should be willing to do as much as your program allows. Do not go over your ride along scope and get kicked out of a program! 

Be respectful and have appropriate behavior. 

Oral Boards and Final Simulations

It seems that is varys not only from location but school/program as well. Oral board preparation should start before you have your finals. Most programs will have this at the very end, after ACLS and PALS, and after the end of block exams. Make sure you are putting information in your pocket at the end of each block to set aside for oral boards. This includes your general understanding of the pathophysiology of a disease process, the risks and complications, and your treatment. 

With your final simulations, you must put in work every day. If you are not practicing skills during class time, it would be ideal to stay after class or meet up with your classmates during your off time. This will make your final simulations feel like muscle memory. Majority of the students that do not pass their final simulations did not spend enough time practicing. 

Clinicals

In-hospital clinicals experiences vary from state to state and county to county. Clinicals offer the time to practice your skills without the pressure of internship. IV practice is great because you can work on patients of all ages, medical histories and anatomies. More importantly, practicing assessments and intubations will be extremely helpful. If you have the opportunity to converse with doctors about different cases, pick their brain. This is your chance to see what happens once you bring patients through their doors. 

Always be respectful to patients and hospital staff. Follow hospital and program policies and procedures while still trying to associate the cases you see and things you learn to the pre-hospital setting. If there are any issues that arise, do not hesitate to contact your coordinators. 

Internship 

Making it through your internship will most likely be the hardest part of medic school. Try to obtain a preceptor early on through ride alongs or resources through the field. Ideally, you want to find someone that you would like to emulate as a paramedic and ensure that there are no personality conflicts. This is a stressful time and the last thing you need is to worry about the relationship with your preceptor. 

Start off strong. Show up knowing your stuff. This doesn’t mean going down a rabbit hole of advanced knowledge but you should show up knowing your protocols and knowing the expected standards. Make sure that you understand the expectations your preceptor and crews have for you, including your captains. Putting this on the table early on will diffuse any possible confusion in the future. Proper etiquette is essential for crew cohesion.  

Do not waver. Having confidence in your assessments and treatment plans is what a preceptor is looking for. Even during error, one of the worst things you can do is let those failures affect your mindset and let you “spin”. Overcoming any obstacles, as there will be many, represents your resilience as a paramedic. Our motto, just as in the Fire Service, is to adapt and overcome. You must be able to accomplish this to be successful. 

Just as you must be confident, you must be humble as well. You will be questioned and you will be criticised on a daily basis. Your preceptor may even deconstruct you to build you back up. It is imperative that you be open to the criticism and accept it. Growth comes from humility and vulnerability.  

Graduation

Some schools may have some final events or testing associated with your program but once you have finished and graduated, you are now ready for your National Registry testing. 

National Registry 

You may pass your final testing, internship, and your program but then comes National Registry testing. National Registry can be highly intimidating. Once you are able to sign up, you must choose a location to test and make an appointment. Your program should facilitate your testing, as you will only be able to take the NR exam after you have passed your internship. While attending your appointment, it would be ideal to arrive 30 minutes early. If you are more than 15 min late, you will be asked to return another time and pay another fee to test. 

This exam is computer adaptive, meaning it is based on how well, or poor, you are doing. For example, if you are poor in obstetrics or abdominal emergencies (which most students are), you will continue to get more obstetrics or abdominal emergency questions until you improve. 

You have plenty of time, so take it. They will give dry-erase paper in which you can write whatever you want. We would advise doing any calculations necessary (i.e. BSA % for burns). Just a hint, the parkland formula will be on that test.

Pearson-Vue, who hosts these exams, takes testing very seriously. You must lock up all your items, including your phone, in a locker and will be checked for any potential of cheating. If you are not prepared, do not take the exam. We would suggest not waiting more than 2-3 weeks after finishing your program to test, if able. 

You may check the NREMT website at https://www.nremt.org/rwd/public in 1-2 days (seems to be earlier than that these days) to see if you have passed. It takes approximately 2-3 weeks to obtain the physical certificate via mail.

Get your live scans

Check with the state EMS office on how to obtain the correct live scan paperwork to complete. With California, as most states, the state requires both DOJ and FBI live scans completed. If you have a felony, you are not eligible to become an EMT/Paramedic. 

Register with you local EMS

Once you have completed your paramedic program, passed NREMT, and have obtained your live scans, you may submit for your state and county certifications. Check with your local EMS office for the required documents. Once you have obtained your local certifications, you can at that point start looking for employment. 

Employment options are pretty diverse. Most employers require some sort of testing which usually includes local protocol knowledge and a skills simulation. Static cardiology assessment should be anticipated. Make sure to be familiar with any equipment, especially monitors.

FTO Time

If you are hired into a system that you are new to, make sure to understand your equipment. Your rig and your equipment are your responsibility. Unfortunately, not all training programs are thorough. If you feel you need more assistance or more FTO time, let your FTO or supervisor know. There is no harm in needing more time in a new environment. However, there is potential danger in going out into the field without a proper understanding in your system or equipment. 

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*If you are looking for more information about paramedic programs in the San Diego County, Riverside County, or Los Angeles County areas, please email info@backoftheboxtalks.com for more information