The Logistics of Two-Week Paramedic Training


Last week’s hot EMS topic around social media, and the Inside EMS Podcast Clinical Issue, was Creighton University offering a two-week paramedic certification course for selected healthcare providers.  This came as quite a surprise from a university that offers bachelor’s and master’s paramedics programs taught by highly respected faculty.  I believe that this is bad for EMS and am disappointed that Creighton is doing this.

Here’s the deal…

This two-week course will apply previous clinical knowledge to field situations and supplement it with additional knowledge and skills related to pre-hospital situations. This intensive course will cover such topics as patient assessment, rapid extrication, intubation, pre-hospital medications, equipment and patient management. Successful completion of this course will result in a Paramedic Certificate of Completion for the Paramedic Program and eligibility to sit for the National Registry Paramedic Examination.

Didactic material is covered during the day, while clinical and field internships are held in the evenings and weekends during those two weeks.

Eligible applicants shall hold current and in good-standing licensure as an RN, MD, or DO with a minimum of two years critical care experience. Current EMT certification, ACLS, and BCLS for Healthcare Providers (or equivalent) is also required. Trauma and Pediatric specialty course certifications are strongly recommended.

I suppose that two weeks would be enough time to teach this type of student how to pass the registry exam, but that’s it.  While there is overlap of the skill set, it is not nearly enough time to learn how to apply these skills in an unfamiliar environment, or assess for entry level competence.

Consider a pulmonary edema patient who was driven to the hospital by a family member.  They would be brought to a room and managed by a team.   A nurse would likely start an assessment, apply oxygen, obtain vitals, get an ECG, and start an IV.  A physician would do another assessment, interpret the ECG, discuss a treatment plan, and request the doses of medications to be administered by the nurses.  If the patient required BiPAP or intubation, a respiratory therapist would probably be involved.

Now take that doctor or nurse after a two week paramedic class and put them in someone’s bedroom with an EMT partner.  They would have to coordinate tasks with one person who has less training, interpret the ECG and vital signs, develop a treatment plan, and perform any invasive skills.  Based on how much room there is to work in the home, how difficult it will be to extricate them from the residence, and how far away the hospital is, they would decide how much treatment to deliver in the house, when to move them to the truck, and when start transporting – at which point they would lose their partner.  If the patient did not get better during transport, their two hands would then be tied up ventilating them with a bag valve mask.  Then there’s the decision about whether that is good enough to get to the hospital, whether they should attempt to place an advanced airway, and whether they should pull over to have the partner help to do this.  While the interventions are similar, the logistics of applying them in an unfamiliar environment that takes more than two weeks to practice.

This not to say at all that paramedics have a harder job than doctors and nurses in the hospital.  They provide definitive care, and have to manage the train wreck patients we drop off for several hours.  People who work in critical care are responsible for delivering a much wider variety of potentially dangerous interventions than paramedics, and one doctor or nurse is responsible for managing multiple sick patients.  I also spent more than a few hour as a paramedic  on the clock with my eyes closed, which is not an option for most people who work in the hospital.  It is just different, and like those disciplines, requires many hours of simulation and supervised clinical time to achieve competence.

I am also unhappy with what Creighton’s program says about EMS as a profession.  I suspect it is intended for flight nurses to become cross-trained as paramedics.  Since flight nurses and paramedics have nearly interchangeable roles, paramedic certification would simply allow them to fill more spots on a schedule while doing the same job.  If this is the case, why is there no two week class for flight paramedics to become nurses?  Despite the national shortage of nurses, nursing has increased its educational requirements.  The major hospitals in my area now only accept applications from nurses with bachelor’s degrees.  Meanwhile EMS has 150 hour EMT classes with no field internship and resistance to the requirement for paramedic programs to even be accredited.

If we want EMS to be a profession that pays well and offers diverse career paths, we need to follow the example of nursing.  We need to embrace formal education so that we can be better clinicians and to raise our standards for entry.  Creighton’s two-week paramedic program does the opposite of this.

Comments

  1. I presume it requires ride time?

    • emspatientperspective says:

      Yes, included in the two weeks.

      • Brendan Lower says:

        Creighton doesn’t advertise this on their site, but less than half of the ride time is included in the two weeks.

        They require 50 patient contacts as team lead, and set up 77 hours of ride time with Omaha Fire during the two week course. Most people get 15 to 25 team leads in that time. So, folks either come back for 1 1/2 – 2 weeks to complete their patient contacts, or set up internships in their home state (where allowable) to finish it.

  2. I am having a hard time getting worked up about this program.

    I share your suspicion that the primary audience is flight nurses.

    I also think it is a logical outcome of standards based education vs. hours based education. If the student can demonstrate entry level competency at the skills of the job why does it matter if it takes 2 weeks or 40 weeks to demonstrate competency.

    • emspatientperspective says:

      I agree that we should measure competency instead of hours. Flight nurses may function fine as a flight paramedic, but their education would not prepare them to manage patients commonly encountered by ground paramedics. My problem is that many paramedics could demonstrate competency as nurses in certain environments within a short period of time, but paramedic to RN bridge programs require much more time in and cover areas outside of the ICU. Salaries and career opportunities have grown as nurses increased education requirements. Not so for EMS, and this is another fast way to get in.

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