Rookieworld: What I WISH I had learned in EMT School

I knew I wanted to go into medicine when I was 5. At first, I wanted to be a paramedic (just like my dad), then switched to wanting to be a doctor (because I would get to tell my dad what to do! Imagine that!)

Of course, as I grew up, that reason gave way to other, more important reasons: because I wanted to take care of people and make sure that everyone gets the same quality care. 

Wanting to take care of people pushed me into registering for EMT school in the summer of 2019. I graduated and passed my NREMT exam on my second try. But this isn’t about the result; it’s about the journey. 

My journey? It was rough. I struggled. I cried. I came home after most classes either confused or outraged. 

It was an experience I won’t forget. Because it was an experience that turned my expectations upside-down. There are always positives and negatives to everything, and this wasn’t the exception. But I wonder why it had to be this way. And more importantly, how can we improve education for EMTs entering the profession? 

I did find some positives:

First, a passionate and engaged instructor produces enthusiastic learners. 

If an instructor is genuinely passionate about what they are teaching, students showed more of an interest and participated more in a lecture than if the instructor couldn’t care less. The same went for skills classes. My class had the privilege of learning from younger and older generations of paramedics, nurses, EMTs, and medical students. While many of our instructors genuinely cared for our success in the class, consistently offered extra help, and explained concepts in ways each student could easily understand, some instructors couldn’t be bothered. Which bothered us. 

The number of passionate instructors greatly outnumbered the number of disgruntled ones, but those instructors are still there, telling “war stories”, belittling students, and working against the good instructors trying to make us clinicians

Second, establishing an environment of teamwork and support leads to success. 

The first night of class, I didn’t know anyone in the class and I thought it would stay that way for a while. I was very wrong. 

Almost from the moment we entered the class, we were split into pods (groups of about 10 people). After the initial icebreakers, it felt like I knew them for years. It was reassuring to my pod and me that we were all in this together and that we would help each other learn. 

It’s because of them that I have good memories of the class, and that excitement carried over when I joined my squad. We were a team in class, and even though we all went to different squads, we would still be a team out in the real world. 

Those are pretty strong positives, but there are negatives as well.

For example, why are we still learning about dated and questionable ways to treat people? 

It’s 2022, and for some reason, we are all STILL wondering about why we have to spend an entire month learning about the ever-so-popular KED and the stylish MAST pants (you know, the big pants with the cords that smell like dust, B.O., and mothballs all rolled into one? Yeah, those pants.) Even though the majority of evidence we have available says that these things don’t work, are cumbersome, and in some cases can even cause further harm? (Looking at YOU, long backboard.)

When I took the class, one of the practical skills we were tested on was the KED. So I understand that we had to learn it, and I understand that class content moves a lot slower than science.

But if our instructors say that they have never used a KED in the field? And when some people said that they didn’t even know where the KED was in their ambulance? It just left the entire class to wonder when this was ever going to be needed in an actual clinical setting. So, that begs the question: Why are we learning something that doesn’t have clinical relevance?

How does anyone think that creating a negative learning environment will help students learn and retain information? 

(Now, I’m not the most optimistic person, but I was hoping for even a little positivity here and there.)

One of the most common things heard from my instructor staff and coordinators was, “If you don’t learn this the way you are supposed to, you can kill someone.” That sentence was first spoken on the first night of class and was constantly repeated throughout the duration of the course. 

And it stuck with me. 

I’m probably the most Type-A person you will ever meet, but the fact that this sentence stuck with me for the three months of class pushed me to my limit. Even on the first day of learning a brand-new skill, what the instructors kept telling us, and thus what I kept telling myself, was that it had to be perfect, or else. Your test scores had to be perfect, or you’re never going to make it as an EMT. 

Worse, I knew this wasn’t true. Being a part of The Overrun, I listen to the gang during shows and interviews. Both the people I know well, and the people that come on the show are well-known in their field and smart. They’re excellent at what they do. And the most interesting part of getting to sit in on these discussions is how often they all talk about learning through their mistakes. They get better from learning, and they don’t learn from their wins.

So why do we scare students?

Imagine your instructors are grading your test and call you out in front of the entire class and say something along the lines of, “You got this question wrong? I thought you were smart.” Or, “You want to be a doctor and you can’t figure this out?” Or, “You FAILED this test? I expected so much more from you.” 

These are all things that were said to me. On more than one occasion. 

With constant negativity in a learning environment, how can you expect your students to do well? 

Non-realistic learning is a real thing, and it hurts students. Let me explain.

From what I learned in class, I can tell you what Kussmaul respirations are and how they come about in a patient. I can’t tell you what Kussmaul's respirations sound like. That’s a problem, isn’t it? 

All of our practice exams were done on our classmates, who all had clear lungs. Every practice exam we did, after hearing clear lungs, we were always told what the lungs really “sounded” like. 

How can students know what to look for if they don’t know in the first place? 

Especially in the age of FOAMed, EMS education is caught between a rock and a hard place: what methods work? Which ones don’t? Is it better to learn how something has always been done, or how it will eventually be done in the future based on clinical evidence? 

Why should the future of EMS be held back, when medicine as a field is moving farther into the future?  

There are so many EMS students out there (current and future) that are waiting for their chance to help people. To take that first step. To want to do the right thing. 

EMS education should return the favor by teaching students which equipment still has clinical relevance; how to effectively and empathetically talk to patients; and mentally prepare them for what lies ahead. 

A lot of us graduated from EMT school that August with the mindset that we could treat anybody and everybody because we learned all the skills, all the concepts, and all the other stuff and things that brand-new EMTs need to know (to pass the class and the NREMT exam). 

Not even a year had passed until COVID-19 came along and made itself known by slapping the world in the face. 

Many of the paramedics and doctors that I know have never seen anything like this. 

And that scares me. 

I didn’t learn what to do in a global pandemic. I never was taught how to put on PPE, and then I had to do it in a real-world pandemic, with a virus that we didn’t know a lot about.

Most of all, I didn’t learn how to mentally adapt to the constantly changing world of treating patients who could either have the virus or be asymptomatic carriers.  

They don’t teach us how to deal with seeing a patient who dies right in front of us. They don’t teach us how to deal with screaming parents who want us to save their child…even when you know there’s nothing more you can do. They don’t teach us how to deal with those touchy topics. 

But they especially don’t teach us about how to deal with these situations if that patient is ALSO positive for the virus responsible for the prolonged pause in the world. Or any other deadly virus, for that matter. 

Especially in a time where mental health is being held as a priority, people in EMS still don’t see it that way. Especially in a pandemic. Again, EMT wellness is an afterthought, tough in the first chapters and forgotten in the flood of medical emergencies, patient assessment, and trauma.

I joined my squad in June 2020, right between the first and second waves. All the precautions that we took became second nature. 

But I still felt lost. On top of being a brand-new EMT in the field for the very first time, no one expected a pandemic of a brand-new virus that we knew very little about (but know a lot more about now, in 2022). 

So long story short: how can EMS education take these positives, these negatives, and the pandemic and mold it into a brand-new form of EMS education? An education system where we can feel somewhat prepared for the possibilities that we are coming into? EMS education owes it to the future paramedics and EMTs to teach us these skills AND how to mentally prepare ourselves. 

If EMS education says that we are a team, then prove it to us. Show us that you care. Show us that we’re not just being taken from class and thrown into the middle of a pandemic. Teach us. Be there for us. Don’t leave us behind. 

Because we want to be ready.