Working as a Paramedic to Gain Clinical Experience

Importance of Medical/Healthcare Experience as a Medical School Applicant

Healthcare is a broad field with multiple working parts that all accompany one another. Providers come from all walks of life and contribute a wide range of skills and abilities that each work integrally in order to provide a smooth patient care experience. Everyone that has any patient care responsibility can attest to the hardships—as well as the triumphs—that one faces while working in healthcare.

It is important to have exposure to the medical field as a medical school applicant for a few reasons. Primarily, it will allow you to see both the good and the bad sides of medicine… and it will show you that while similar in some aspects, it is also strikingly different from television shows. An additional reason includes ensuring that you are a good “fit” for the field, especially if you are torn between a few different career options. This is also helpful for determining the type of healthcare provider that you are interested in becoming.

While there are many methods in which to gain healthcare experience, I would like to tell you about my role as a paramedic.

What is a Paramedic Responsible for?

A paramedic is an allied healthcare provider that is responsible for the stabilization of critically ill and injured individuals in emergent situations. While not all calls that Emergency Medical Services (EMS) go on are true medical emergencies, this allows for community outreach opportunities that will be further discussed below.

What is the Difference Between a Paramedic and an Emergency Medical Technician (EMT)?

An Emergency Medical Technician (EMT) is an entry-level pre-hospital care provider. EMTs are responsible for the aspects of Basic Life Support (BLS) and assisting the paramedic with various procedures, patient care activities, as well as safely packaging and transporting the patient to the hospital for definitive care as based on their local protocol, which is determined by a medical director. A medical director (also known as medical control or oversight) is a physician who often specializes in emergency medicine and provides medical guidance and oversight to the pre-hospital care providers.

The National Registry of Emergency Medical Technicians is “a validated and legally defensible attestation of competency” (NREMT), which is the certification body for EMS providers. While National Registry Certification is not always required in each state (or each specific EMS service), 45 of the 50 U.S. States require National Registry Certification as a condition of initial licensure as a paramedic. Because there are only guidelines in terms of national scope of practice, I will compare the scope of practice between an EMT and a paramedic in the state of Kentucky  in a list below. In terms of scope of practice, the paramedic carries more responsibility, but each crew member on the ambulance plays a necessary role in patient care.

Emergency Medical Technician (EMT)- overview of the scope of practice within Kentucky

• Medications
  • Aspirin
  • Nitroglycerin
  • Oral glucose
  • Albuterol
  • Epinephrine 1:1,000
  • Oxygen
  • Activated Charcoal
• Utilize an Automated External Defibrillator (AED)
• Blindly Inserted Airway Devices (BIAD) such as the Combitube, King Tube, IGEL, etc.
• Cardiopulmonary Resuscitation (CPR) when indicated

Paramedic (EMT-P, NRP)

• Responsible for all of the EMT-level skills listed above as well as the following:
• Medications
  • Amiodarone, Adenosine, Lidocaine, Cardizem, Epinephrine 1:10,000, Atropine, Dopamine, Metoprolol, Ipratropium Bromide, Solu-Medrol, Lasix, Magnesium Sulfate, Naloxone, Diphenhydramine, RSI (Ketamine, Rocuronium, Vecuronium, Etomidate), Analgesics (Fentanyl, Morphine), Benzodiazepines (Versed, Diazepam), Zofran, Dextrose, and others based on local protocol.
• Advanced airway management
  • Intubation (direct and visual laryngoscopy)
    • Orotracheal
    • Nasotracheal
  • Continuous Positive Airway Pressure (CPAP)
  • Ventilator management
  • Cricothyrotomy
• Venous access
  • Intraosseous access
  • Intravenous access
  • Umbilical vein catheterization
• Ability to declare death in the field
• Manual defibrillation/synchronized cardioversion
• Team/code leader during cardiac arrest

How do I Become a Paramedic?

Prior to pursuing the path to becoming a paramedic, it is a good idea to make sure that you are interested in working in healthcare! There are different paths to take in order to become a paramedic, but the majority of the courses are about two years in length (some schools offer a more condensed curriculum that lasts about one year). Prior to enrolling in a paramedic program, usually one must already be certified as an EMT. While it is possible to take a course that will allow you to become an EMT in the process of earning your paramedic credentials, this does not allow the individual to develop their basic skills as an EMT before becoming a paramedic.

Often you will hear the phrase “BLS before ALS (Advanced Life Support).” This means that as EMTs, less emphasis is placed on advanced measures, and more emphasis is placed on proper airway management, high-quality CPR, and other BLS skills. It is important to have a solid foundation in good BLS patient management before making the transition to an ALS provider.

Who Should Consider Becoming a Paramedic?

While each individual has their own reasons for becoming a paramedic, I chose to pursue training in order to take on additional responsibility, make autonomous decisions regarding pre-hospital patient care, and gain advanced clinical exposure. I would recommend that an individual who wants to become a paramedic is aware of the time commitment that the training requires (anywhere from 1-2 years), and they feel that they will grow both personally and professionally while becoming—and practicing—as a paramedic.

Most EMS/ambulance services offer ride-along shifts to students. This is an excellent opportunity for individuals who might be interested in becoming a paramedic (or an EMT) to see first-hand the experiences that one can obtain as a pre-hospital care provider. Reach out to the training officer at your local EMS service (or even college EMS service) to see if they offer ride-along shifts for those interested in becoming an EMS provider!

Final (Personal) Thoughts on Becoming a Paramedic Before Medical School

While I have been told that I took a “less traditional” path towards my medical school goal, I would not change my decision to become a paramedic. I recommend that if you decided to pursue the path to becoming a paramedic, that you dedicate the time to do it to the best of your ability.

After working as an EMT for a few years, I decided that I wanted to take on more responsibility from a clinical aspect. While I believe that working as an EMT provided me valuable hands-on experience working in healthcare, I am glad that I chose to pursue further training as a paramedic. In addition to the clinical skills and procedures that I now possess, I have also gained additional responsibilities both individually and professionally. For example, the EMT plays an important role on the team, but the ultimate responsibility—on scene and during a call—falls on the shoulders of the paramedic. Working as a paramedic has challenged me to become proficient at multi-tasking (performing procedures, administering medications, calling report, keeping times for documentation purposes, etc.)—a skill that I am certain will serve me well once I am in medical school.

As a pre-hospital provider, you will be entrusted to enter the home of your patient and provide care to them during their time of need. Because patients call on what is often their “worst day,” they are sometimes anxious, scared, or agitated. It is important to be able to act as a confident, calming presence and quickly gain rapport with the patient and their family. Paramedics play an important role in public health, community outreach, and emergency medical care. I might be biased, but I think that being a paramedic is an awesome job.