I was MIA for most of last week. I was doing clinicals – 12-hour shifts in an ambulance – for my EMT class, which didn’t leave me much bandwidth for anything else. While I was riding around in an ambulance I had a lot of time to reflect on a recent reader question: Would you consider penning [an] article regarding your EMT course? That’s something I’d be interested in pursuing…
Obviously I think medical knowledge, skills, and abilities are pretty damn important. I also believe I have more than put my money where my mouth is. I attended EMT 15 years ago as a member of the military. It would have been really easy to say, “I’ve been there, got the paper, I’m good.” Instead I recognized that I had some skill gaps, so I signed up to take the class a second time. I’m taking it on my own time and it’s no short, easy class. And that’s in addition to at least half a dozen times through TCCC, some live-tissue labs, paying out-of-pocket for at least one medical class, and a good deal of actual experience treating traumatic injuries.
This isn’t about patting myself on the back, but I want to be absolutely clear that I’m not a “do as I say, not as I do” kind of guy; I highlight my experience only to underscore my belief that this is important.
I really like the Emergency Medical Technician-Basic curriculum. Why, and why not just go to TCCC or Red Cross First Aid? Two reasons. First, I know we all imagine ourselves wading knee-deep into blood-and-guts trauma problems to save the day. The fact is, though, treating trauma isn’t that complicated. The old Marine Corps (and I’ll really date myself here) mantra of, “stop the bleeding, start the breathing, treat for shock” isn’t too far off the mark. There are definitely some finer points, but trauma isn’t that difficult to understand.
Second, there are a LOT of emergency medical problems that aren’t trauma-related. Under emergency/disaster circumstances you may become your family’s healthcare provider for a while. If all you know how to treat is gunshots you are going to be ill-equipped to deal with common medical problems. Just walking through normal society at its very best there are a lot of medical problems that could pop up. Being an EMT isn’t going to make you a doctor, but it may very well help you keep someone alive and more comfortable until you get to definitive care.
To this point I have used the term “EMT” somewhat generically. There are several levels of EMT certification. The first is Emergency Medical Responder (EMR). This class is most often given to police officers, firemen and other first responders that are not direct medical responders. EMR trains to a very basic level. The next level up is EMT-B (Basic), and EMT-B is what I will refer to for the rest of this article. The next level is Advanced EMT (AEMT), followed by EMT-P (Paramedic).
As an EMT-B you won’t be an expert on anything. There just aren’t enough hours in the curriculum to go very in depth on any given topic. I don’t think this is a bad thing; in fact, the beauty of this program is its breadth – you will be very well-rounded and knowledgeable on a bunch of stuff. I was pondering how to explain how broad the EMT curriculum is when it hit me: just show the curriculum. The following are some of the chapters of my textbook. The first eight chapters cover some administrative information, basic anatomy and physiology of the human body, etc. Around Chapter 8 the book gets into treating patients:
8. Lifting and Moving Patients
9. Patient Assessment
10. Airway Management
11. Principles of Pharmacology
13. BLS Resuscitation (CPR)
14. Medical Overview (first chapter in the Medical module)
15. Respiratory Emergencies
16. Cardiovascular Emergencies
17. Neurological Emergencies
18. Gastrointestinal and Urological Emergencies
19. Endocrine and Hematological Emergencies
20. Immunological Emergencies
22. Psychiatric Emergencies
23. Gynecological Emergencies
24. Trauma Overview (first chapter in the Trauma module)
26. Soft Tissue Injuries
27. Face and Neck Injuries
28. Head and Spine Injuries
29. Chest Injuries
30. Abdominal and Genitourinary Emergencies
31. Orthopedic Emergencies
32. Environmental Emergencies (heat stoke, hypothermia, drowning, etc.)
33. Obstetrics and Neonatal Care (first chapter in the Special Populations module)
34. Pediatric Emergencies
35. Geriatric Emergencies
36. Patients with Special Challenges
Again, as an EMT you won’t be an expert on anything. You will, however, have a very well-rounded base of knowledge for what can go wrong with the human body, and how to deal with it. Not only does EMT prepare you to deal with gunshots and stabbings, it also equips you to deal with diabetic emergencies, seizures, allergic reactions, and much more.
What to Expect From the Class
Class Structure: Though some EMT programs are full-time, four or five-week affairs, most EMT programs are run as a part-time, (usually) evening classes. I have done both, the first time through being a full-time, “day” class, and my recent class is part-time. Classes were scheduled for every Monday and Wednesday evening from 6 to 10 PM. Attendance at a few all-day Saturday classes was required. As COVID19 forced the community college to shut down its campus, classes moved to an online format and students were forced to become much more auto-didactic. Required curriculum hours vary depending on state and program from 150 to almost 300 (my course is on the higher end).
I realize that time is going to be the friction point for most people. Consider this, though: nothing worth having is easy. This is a bit of a challenge. It’s not the hardest thing I’ve ever done by a long shot, but they don’t just hand out certificates, either. Make the time to get it done because, like everything, the sacrifice is temporary. It’s a temporary inconvenience that doesn’t last forever. Invest in a few crappy months and become a stronger asset to your family and your community.
Instructors: I have had two completely different experiences with this. In my current class the instructors are all working paramedics who teach as a side-gig. They are all on trucks, treating patients, every week. At the previous course I took the instructors’ jobs were “EMT instructors.” They were at the college for eight hours a day, five days a week. To be honest I can’t recall their backgrounds. I will say I am massively more impressed with this program and learning from working paramedics.
Textbook: I found the textbook to be somewhat annoying at first because it is in digital format. This seems to be the way a lot of programs are going, though. By the end of the class I actually liked the text book because it offers a lot of other resources, like recorded lectures and audio-versions of the book. I would generally read the appropriate chapters for upcoming classes, attend the class, then do the online lecture as a review to solidify the knowledge before testing.
Because the program was so auto-didactic, classroom sessions were able to heavily focus on hands-on skills. This isn’t something I remember seeing a lot of time spent on in the program I attended before. We spent a LOT of time going through scenarios and practicing skills (i.e. opening an airway, using a bag-valve mask, splinting a limb, etc.) which I really appreciated.
Your Fellow Students: In my case I am definitely the oldest person in my class… and older than some of the instructors. Most of my fellow students were in their late teens or early 20s. Almost all of them are volunteer firemen, though a couple are not. Of those who are not one is there because her job offers a raise if you are EMT-qualified, and one is there with the intent of going straight into a paramedic program.
Another requirement for completion of the program and state licensure (in my state, at least) is clinical hours and patient contacts. Clinicals involved doing three, 12-hour shifts with our local EMS system. Our clinical coordinator was exceptionally flexible at scheduling clinicals around peoples’ individual schedules. This was absolutely one of the most valuable medical experiences I have ever had. I evaluated and treated a number of patients with a wide range of medical issues. Though I’ve seen extreme trauma I wasn’t really as prepared to deal with a lot of the medical stuff as I thought I was.
When I first laid eyes on our very first patient I had a tiny bit of an “oh shit, I need to sit down for a second” moment. The feeling passed as soon as I was needed to help move the old man and actually started working, but it was an eye-opener. Being asked to treat a bleeding wound is easy – we all know what to do. Being asked to decide what to do for someone with a vague set of symptoms, some of which you might have to tease out of him? Just like anything else, it takes time, repetition, exposure – in other words, getting out there and doing it.
That first call was a blur. It was a very short transport (under 5 minutes) and all I really remember doing is taking his pulse and blood pressure in the ambulance, which for some reason seemed to require my full attention. Each call got a little bit easier; on the next call getting vital signs didn’t require 100% of my focus and I was able to actually think a step ahead and know I needed to get a blood glucose without being told. By the last patient on my last day I was able to apply a blood pressure cuff, pulse oximeter, and a 4-lead ECG without really thinking about it, and while simultaneously gathering some patient history and thinking about whether I needed to start some oxygen or not. Not that I’m some medical wizard – that’s all really, really simple stuff. But I’ll be the first to tell you that without experience, basic stuff can seem really, really complicated.
You will have to pass several tests to become a fully licensed EMT-B. I have not tested for this class yet, but I’m still fairly confident that what I’m about to say is accurate. You will have to take a written test for both your state and the National Registry of Emergency Medical Technicians (NREMT). You will also have to take a psychomotor test, which is really a skill test where you demonstrate various skills and knowledge of those skills. Information about the NREMT pscyhomotor test is freely available from the NREMT’s website.
It may be tempting to forgo the testing if all you care about is the information. I totally get it – certifications just aren’t that important to some of you. I would encourage you to take the test(s) though. The test is a ticket to more opportunities. You can attend more, and specialized training like Wilderness EMT, which focuses on prolonged care in austere environments (might be useful if you’re a prepper?). Being an EMT permits you to volunteer with some agencies like volunteer fire departments, EMS agencies, and rescue squads to keep your skills current (I currently volunteer with a fairly large and very active SAR team).
At this point some of you may be thinking, “I don’t have that gear so I can’t use the training.” I get it – I’m a gear guy, too. But that sentiment is absolutely, 100% not the case.
First, being an EMT doesn’t rely on a whole lot of gear. Some very basic equipment will go a very long way. The curriculum is very much geared toward skills – doing a head-tilt/chin-lift, for instance – rather than throwing gear at the problem. I’d much rather have my knowledge and minimal equipment than a 60-lb bag of goodies but be limited in my knowledge.
Being an EMT-Basic also doesn’t require a ton of expensive drugs that will go out of date, either. Basic EMTs can assist a patient in administering his or her own albuterol, epinephrine, nitroglycerine – all life-saving interventions, and all of which simply use the patient’s own medication. Keep in mind that the drugs EMTs are permitted to administer vary state-by-state and there are serious contraindications to these drugs, so don’t take anything I say here as medical advice.
Second, being an EMT is a gear guy’s dream. If you want the gear, the world is your oyster, man! There are very few things that an EMT-B can use/administer that you can’t go out and buy. Trust me – you can go crazy on cool-guy jump bags, airway adjuncts, pocket masks and BVMs, bandages, diagnostic tools like stethoscopes and pulse oximeters, blood glucose meters, and on and on. But don’t feel like you have to – there’s a lot you can do with your brain, your five senses, and some basic first aid gear.
EMT vs. Whatever is Currently Cool
I want to talk just a bit about where the self-defense community is in regards to medical training. In a word, the community seems to be all for medical training and equipment…as long as it is geared toward treating gunshot wounds and arguing about the best tourniquet. It’s not a bad thing to be equipped, mentally and physically, to treat trauma. I think focusing on it exclusively is misplaced priority, though.
By the most liberal numbers I can find, approximately 313 people are shot every day in the United States. That’s a large number – no question. On the other hand about 2,205 people have a heart attack every day in the United States. Now, you may accuse me of a false equivalency here because most heart attacks happen at home, you and your family are in excellent health, etc. That’s OK because heart attack is just one example of dozens of non-gunshot problems you or your loved ones could suffer.
There are all sorts other things that can go wrong with you… or your parents, spouse, children, co-workers, etc. Are you prepared to deal with them? Do you know how to recognize a stroke? How about apply an AED or administer an Epi-Pen? Can you open an airway (of course, because you read our last Beyond #TQ! right?), or assess, understand, and deal with a diabetic emergency?
If part of your rationale for carrying a firearm and associated equipment is to protect those around you, you owe it to them to be prepared for a broader spectrum of problems than shooting problems. I could pontificate all day about why we’ve latched on to the Gospel of the Tourniquet, but I’ll save it for another article.
The Bottom Line
At this point it might sound like I’m bashing TCCC, TECC, and other care-under-fire programs. I’m not and those programs are incredibly important. I find great value in them and think more people should have that training. There are some huge gaps in care-under-fire medicine, things like CPR and stabilization of the cervical spine.
Both CPR and c-spine immobilization are omitted from care-under-fire curriculum both because they are impractical on the battlefield, and unlikely to be of much benefit (CPR won’t fix exsanguination and spinal injuries aren’t super common on the battlefield). They are hugely important in treating non-combat trauma, though. Even though these aren’t cool-guy skills, I think we should be striving for strong, well-rounded medical knowledge.
Becoming an EMT-B isn’t going to turn you into a doctor. It will, however, give you a much better understanding of the human body. It will teach you to assess a patient, recognize the signs and symptoms and various ailments and injuries, and understand the implications of your action or inaction. And it will train you to apply appropriate – and potentially life-saving – pre-hospital care in a broad range of circumstances that are probably massively more likely that a gunshot wound.
Ultimately, having the knowledge and skills of an EMT will make you a massively bigger asset. You will be a huge asset on a hike with friends, as a passenger on an airplane in flight, during a grid-down with your family, and yes, in a gunfight. I get it – sitting in class isn’t as fun as going to the range. But if you’re shooting a sub-2-second Bill Drill but all you know about emergency medicine is “tourniquet,” maybe think about expanding your skillset.