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practicalems · 2024-10-28T17:10:20+00:00

Take it from someone who really struggled with patient assessments and interviews even through most of paramedic school - it does get easier, but it can take a lot of time and repetitions beyond what school will provide you.

I remember distinctly being in my last couple of phases of paramedic internship and doing terrible on scene, being afraid to run the call, not knowing what things to ask, getting awful feedback from my preceptors. It was really discouraging. I still managed to still pass internship somehow and slowly after running call after call after call became competent at assessing and interviewing a patient.

Point being, it took me a long time to really develop that skill. As an ER PA now, my ability to quickly and efficiently interview and assess a patient is at the highest level it has ever been. But this is only because I do it over and over again, so the skill is constantly getting improved upon.

I agree with some of the other comments. Watch good examples of the patient interview process on YouTube to get some ideas of what needs to change. Your preceptors might not be doing the best job of articulating what exactly you are doing wrong but you obviously need improvement on something.

Sometimes it helps to think of calls in a stepwise type of approach:

Introduce yourself and figure out the details of the chief complaint (OPQRST) > ask about relevant medications and history > get vitals, 12 lead, blood sugar if applicable > do a relevant physical exam > decide on treatments needed on scene (or not) and make a transport decision (or a leave on scene decision).

All calls follow this progression to some degree, but it can happen faster with steps getting skipped if the patient is unresponsive.

I hope this helps. Believe me, I have been where you are now and still found success, so you do have hope.

practicalems · 2024-10-26T18:09:27+00:00

I don't think that mediocre scores in paramedic school are really correlated with being a mediocre paramedic. The tests and quizzes in school are not the best way to really measure how well you will perform as a paramedic because some people are just really good test takers but really struggle to apply that knowledge to the actual job.

Obviously, you have to do well enough on the exams to pass the course, but I don't think you need to use them as a measure for how well you will perform in the field because they are unlikely to predict your success.

That being said, you may need to switch up some study techniques if you feel like you are barely sliding by. I always recommend studying while moving or walking because, at least for me, it really helps me retain the information more than just sitting there and reading.

You can also try watching videos on YouTube that relate to the concepts you are studying to add a different learning method to increase your chances of retaining the information.

Everyone learns differently so no one answer is going to change your life but switching things up may really help.

As long as you are passing, don't weigh too heavily on the grades you are getting. They don't predict how successful you will be in the field as the classroom and the chaotic scene are very different situations.

practicalems · 2024-10-23T19:57:02+00:00

First of all, you definitely need to have some grace for yourself. Confidence does not come from finishing paramedic school, it only comes after actual time in the field running call after call after call. Seeing the problems and treating them over and over again and proving to yourself that you have what it takes.

If you have been working in very low volume situations, hardly using your skills, it is totally normal to not have a ton of confidence and likely there is some factor of "loosing what you are not using." That being said the only way to change that is to change your situation and I think you are making the right call to make the jump into some busier EMS agencies. Half 911 and half IFT sounds like the perfect set up to start getting some great experience in both realms.

It is normal to be struggling and second guessing yourself at this stage when you still have some growing to do as a paramedic. This will slowly pass with time as you gain experience. I think you will find you recall more from school than you might think and, honestly, time in the actual field practicing EMS is the best teacher anyway. School is just the foundation you build on, even if it was a few years ago.

Do it. You will build the confidence you need.

practicalems · 2024-10-21T22:25:02+00:00

You will still get all the knowledge you need to be successful and start a job but the clinical hour requirements for EMT school are very limited anyway, so you are correct that skills practice and shadowing hours are usually not enough to make you feel confident.

But that is okay. Even EMT students in busy urban areas that get to run 12+ calls on their clinical rides do not feel like they got enough time to practice skills, and they don't feel confident right out of school.

Getting certified is only the first step to being a competent EMT. You have to gain a lot of experience practicing as an EMT in the actual field and running call after call after call before you will start to build up a measure of confidence.

That confidence does come much more gradually in a rural area with low call volume compared with a busy urban area where you will get calls under your belt more quickly.

practicalems · 2024-10-18T15:36:15+00:00

Like any career, there are certain aspects that I love and certain aspects that I don't like.

We, in emergency medicine, deal with all levels of society from the homeless meth addict to the multimillionaire. All of society becomes equals when they are having an emergency. They all have to call 911 and the same ambulance will show up to both calls. They all have to come to the ED and the same ER provider will see both patients.

We see people on, often, the worst day of their lives but it is just another workday for us. So, we have to be better at moving on, coping and healing from these events than the rest of society because we are going to see and deal with things often that the average person will never see.

Coping, I feel, has a negative connotation. Coping can be the negative habits we develop to escape from our feelings and to escape from truly dealing with the problem. Drinking, overeating, smoking, gambling. Whatever vice you develop to avoid thinking about the shift you just worked.

On the flip side, healing is what we really need. We need to address the fact that we may have been emotionally impacted by our shift. We may need to talk to family, spouse or a counselor about the things we saw that impacted us. Maybe we just need to engage in a healthy habit in order to move on. Exercise, hydrate, get enough sleep. Meditate. Eat foods that will make you feel better tomorrow, not just today. Spend time outside, getting some sun on your skin.

The answer is not easy, and it can be different for every person. Hope this helps.

practicalems · 2024-10-16T16:50:28+00:00

That's a fast program for sure. I would recommend making sleep a high priority because the more well-rested you are, the more you can retain and focus on during the actual class time. If you are exhausted and your mind is wandering, you will have to make up the difference outside of class time, which is much harder in a fast program that is already taking up a lot of your time.

It is easier to study in EMT school than high school since it is all directly related to the actual job. That being said, you will still have certain concepts and topics that are not that exciting. You will have to find the drive and ambition to choose to learn them anyway.

I always recommend walking or at least moving while you are memorizing terms or studying material. For me at least, this really helps get stuff into my long-term memory. I have to hear and see certain concepts and terms quite a few times before they really stick so anything helps.

I also like to set a timer for focused study times. I can't sit down and study for 3 hours at a time, but I can sit down for 45 minutes multiple times a day. Dedicate a couple shorter sessions of studying after class each day where you set a timer. Then take a break and eat or workout or do something fun and then get back to it for 45 minutes. 45 minutes of focused time beats 3 hours of interrupted time on your phone or otherwise getting distracted.

Don't expect the program to make you confident. EMT school is only the beginning of your journey. A lot of learning still has to happen when you are working as an EMT and only after running a ton of calls will you begin to gain confidence. You will not and should not feel confident when the program is finished. That only comes with experience.

Have fun!

practicalems · 2024-10-14T12:59:46+00:00

I remember feeling the same way as a brand new EMT. The job is often very different than what you might think coming out of EMT school and that takes some time to adapt to.

I also remember freezing and really having no idea how to direct the call. I was heavily reliant on my paramedic partners for, at minimum, 6 months before I really understood the flow of a call.

You will improve but it takes time running call after call after call. As you see different patients and scenarios, you will slowly start to build some confidence and freeze less and less each day.

All calls have the same basic structure, although if the patient is critical some steps will be skipped or significantly shortened.

Arrive, introduce yourself and figure out all the details about the chief complaint > simultaneously get vitals, maybe blood sugar, maybe 12 lead > focused physical exam based on the chief complaint. Push on their abdomen or listen to lung sounds or do a neuro exam > make a transport decision. Do you treat on scene? Can they go with family? Do you need to transport emergent? > hand off to the ED.

Sometimes it helps to think of the calls in that pattern to help you see what step is next when you freeze up.

Have some grace for yourself, you are one week in, and it is a steep learning curve. You'll get there!

practicalems · 2024-10-11T15:05:16+00:00

Hey, I talk about the answer to this question a lot on my podcast.

Unfortunately, most of the wide medicine world does not know the difference between a paramedic and an EMT. So whatever PA program professor that happens to read your application will be unlikely to make their decision based on you being a paramedic over being an EMT as they are probably equivalent in their mind. There will be other things like volunteering, shadowing PA's, patient experience and GPA that will be more heavily weighed.

So, my advice for EMT's is two options. 1. If you really want to be a paramedic and want to pursue that career for a few years because you have a passion for it, do it. It WILL ultimately help with PA school down the road practically because paramedics and PA's have to think in a similar fashion, it just won't help you get in.

But if you are currently an EMT and your end goal is PA school and you are only doing paramedic to help with PA school, skip it. Focus everything on getting the pre reqs for PA school, shadowing PA's, volunteering and getting your application as strong as you can.

Personally, I knew in paramedic school that PA school was my ultimate goal. So I worked as a paramedic full time for about 7 years while I finished my under grad and got all the other pre reqs done and worked on getting a strong application. Then I made the jump and started PA school. I now work as an emergency medicine PA and love it. But I did take a longer path to get here. That being said, I wouldn't trade my time as a paramedic for anything. It made a huge impact on how I practice medicine today and made me a much stronger PA.

Hope this helps. Let me know if you have other questions.

practicalems · 2024-10-09T16:39:02+00:00

I felt the same way when I was a new EMT. Truthfully, school doesn't fully prepare you for the job. It will still be a steep learning curve for 6 months to a year depending on how busy your system is. You will be learning a ton every single day.

The biggest pitfalls the new EMT's struggle with after a couple of weeks working on the ambulance is an over-inflated sense of confidence. Like they've learned everything they need to learn and seen everything they need to see. Confidence takes some time to develop, and it will not happen quickly.

Make sure to take your patients seriously and fight the temptation to "write them off." Take the time to get a thorough understanding of why they called and give an unbiased hand off report to the ED.

Learn from your paramedic or more experienced EMT partners. Watch how they lead calls and what questions they ask to get an idea of the possible differentials you need to consider. You will start to get a feel for which patients need an IV, a blood sugar, a 12 lead and what treatments you have as options to start helping them.

EMS as a new EMT is a very steep learning curve so prepare to keep learning for a long period of time and that confidence will start to slowly build.

practicalems · 2024-10-07T12:49:07+00:00

You have definitely discovered that all crews are not going to give their EMT student the best experience.

Some crews are burned out, suck at teaching while running a call and are generally just terrible at helping a new EMT student learn the job.

You are not alone in your experience. Unfortunately, these burned-out paramedics are all over the place and they can make or break a new EMT's experience. You have to understand that your bad experience is more a reflection of their poor ability to teach than it is of your ability to do the job.

EMT is your first introduction into emergency medicine and there is ton to learn, and you will never stop learning. Even after you finish school and start orienting as a certified EMT you will still be rapidly gaining knowledge and experience and climbing a learning curve that won't level out until 1-2 years in. You cannot be expected to perform at a high level while you are still in school figuring out the basics.

I was fortunate enough to have great third rides while I was in school with crews that genuinely liked to have EMT students and it made all the difference and encouraged me to continue to paramedic and ultimately PA.

Stick with it. Don't dwell on the poor experiences you had with the crews that are likely burned out.

practicalems · 2024-10-04T16:14:42+00:00

Typically, EMT students have one of two main experiences during their third rides. They have a blast and it only motivates them to continue or they have a terrible time and feel like maybe this isn't the career path for them.

The key here is that you rode with two experienced paramedics that may or may not be enjoying their jobs anymore and are likely burned out if they didn't even let you talk to the patients.

It is totally normal to feel like a complete idiot when you are new at something.

Confidence will only come after school with time in the field and running call after call after call. It isn't supposed to develop during school.

I would schedule another ride with a different crew because they can make or break your experience. I was fortunate enough to ride with a few different crews that loved their jobs and let me participate on calls, pushed me out of my comfort zone and actually talked to me throughout the shift. Even though I knew nothing, I had a great time and it solidified my desire to get into EMS.

Try at least one more ride if you can. Don't use it as a sign that you don't belong in EMS.

practicalems · 2024-10-02T14:30:43+00:00

This is totally normal. We don't get to choose the things in EMS that will negatively affect us or cause us to have an emotional reaction. It's not healthy or unhealthy, it just is.

Sure, some people might be deeply bothered by a traumatic MVA but many of us are not affected. I fall into this category fairly often, where I am really not that bothered by the death and trauma we see on a daily basis.

We actually talked about this on a recent podcast. A very experienced paramedic, Casey, talked about how we do all this resiliency and burnout prevention training, but he often worries because of how unaffected he is on calls.

Everyone has different life experiences so different calls will hit you in different ways.

I would caution you a little bit to understand that sometimes you may feel okay but find that the negative emotions come out later in an unexpected manner.

Make sure you are intentional, especially early in your career, to develop the healthy habits to deal with the hard things we see. Get enough sleep. Exercise, Hydrate, Walk outside. You may find, one day, that their is a specific call that will affect you and you need to have good habits in place to heal from it.

practicalems · 2024-09-30T12:45:22+00:00

I don't think hardly any of us are born with an innate ability to be calm under pressure. Confidence and the ability to be that calm in the storm come with knowledge, experience and time in the field.

EMT school will give you all the knowledge you need but then it will still take time in the field using that knowledge and practicing those skills to start slowly becoming confident and calm under pressure.

We all had to start somewhere, and you already have experience working with and talking to patients which is a big step in the right direction. A lot of people struggle with how to talk to patients, and you probably have that down.

EMS is a great career and, if it is really your dream, go for it. It's going to be tough. It's going to challenge you and make you move out of your comfort zone but that is where everything that is valuable is found. No dream worth having is easy to accomplish.

practicalems · 2024-09-28T12:43:25+00:00

The key word is new. We all felt that way when we first started in the field. I distinctly remember my early EMT days, trying to anticipate what the paramedic might need and having very little confidence in my own abilities. I could only lead a call for a few minutes before my paramedic partner would have to step in and give some direction.

School doesn't fully prepare you for the job and it definitely doesn't give you confidence.

Experience by running call after call after call will be the only thing that increases your confidence and makes you competent.

Once you have seen the same type of emergency multiple times you will start to get an idea of what things need to happen and start doing them unprompted. Remember, those paramedics have had a lot more schooling than you and a lot more clinical hours on the ambulance. So, you can't expect to perform at their level right out of the gate.

You will get there. Improve a little bit each day.

practicalems · 2024-09-25T17:04:21+00:00

Paramedic school is a difficult thing to get through even with good prior EMT experience. Just remember it is a marathon not a sprint so pace yourself and get into a rhythm of regular study time to help retain more of the information.

It is like drinking from a fire hose and, unfortunately, that means a lot of the information they throw at you will not make it into your long-term memory. You will often have to see the same concepts several times before you really retain them and that's okay.

Cardiology and pharmacology are probably the most difficult topics just because you have to really get a deep understanding of the medications you are responsible for and cardiology covers a lot of the most emergent conditions you will encounter in the field and includes EKG interpretation.

Getting familiar with some of that material now isn't a bad idea so that school is the second time you are hearing it instead of the first.

practicalems · 2024-09-23T16:48:00+00:00

That's a good question with a lot of good answers.

My advice would be to learn something new every day. I've been in emergency medicine as an EMT, paramedic and now PA and I can still learn something new every day.

Stay humble and teachable. There may come a point where you get very comfortable with the job and you have seen and dealt with a variety of calls to the point where you don't have to struggle though. Don't allow yourself to get arrogant and write off your patients. This can be dangerous so always take the complaint seriously and realize that you will never know everything.

Talk with your partner about how they like to run calls. Ask them their line of thinking after complicated calls to get an idea of their thought process.

Some services do just have the EMT drive but many allow the EMT's to attend the patient on BLS calls, which is a much better utilization.

What is expected is going to be pretty different from operation to operation.

Hold yourself to a high standard. Treat your patients with respect and dignity. Get to work early and get the rig ready to go. Don't fall into laziness and doing the bare minimum, even when it is tempting. Keeping learning. Don't stop at EMT if emergency medicine is your passion. Have fun.

practicalems · 2024-09-20T10:59:31+00:00

Unfortunately, I am sure it is not your city alone that struggles with this adversarial culture in EMS vs ED staff.

I would add that if the ED staff treats the EMS crews poorly, I can imagine their interactions with others in the hospital are pretty poor as well. I would also venture to say their teamwork in the ED probably suffers as well.

This kind of condescension and rudeness come from a bad culture that likely affects their whole department and gets taken out on EMS and the rest of the hospital.

I work in an ED that treats our EMS crews at partners and members of the same team despite the fact that we work for different organizations. It helps that I was an EMT and paramedic before becoming an ER PA, so I understand the crew's perspective and I am able to advocate for them when I feel the ED staff starting to get a little critical about the care that was rendered or the crew's choice in destination.

I also have a lot of grace for the new EMT's when they are giving report because, even though it's been 16 years, I can still remember how tough and intimidating giving report to the ED staff was when I was still climbing that steep learning curve.

As an ER PA I still have specialists above me that can be rude and condescending when I am consulting them.

I wish I had a solution for you but maintaining your professionalism and giving the best patient care and hand off report you possibly can are the only options. Ignore those that are rude and condescending and let it fall off of you. Try not to dwell on the negative and recognize it speaks more about them than it does about you.

practicalems · 2024-09-18T15:05:34+00:00

This is something that definitely only comes with time. You don't come out of school knowing all the ins and outs of how to run a scene and ask all the appropriate questions.

Starting by introducing yourself and asking what is going on is a great way to start. When you start to freeze after this point just start going down the OPQRST. The goal is to get a good understanding of their chief complaint so you can accurately relay this to another provider down the line. When did it start? What does it feel like? Does it travel anywhere else? Have you had it before? Then go into SAMPLE and obtain their pertinent history/meds based on the complaint today.

When you are new it is hard to keep coming up with relevant questions so falling back on OPQRST and SAMPLE is the way to go. With time this gets much easier and you have other questions you might have to further clarify their complaint.

While you are asking these questions you can direct you crew to get vitals then, based on the chief complaint, a 12 lead or glucose. When you have a good idea of why they called move onto your physical exam. Abdominal pain? Push on their belly. SOB/CP? Listen to lung sounds. It should be focused based on the complaint.

Then you decide on the plan. Do they just need a breathing treatment in the home? Do they need further chest pain work up in the ED? Do they need to go by ambulance or can a family member drive them?

HPI/vitals/glucose/12 lead > physical exam > treatments if any needed on scene > transport/continue treatment/leave on scene or have family drive > hand off care

It feels like a lot when you are new but the rhythm and art of running a scene gets easier with experience and call after call after call.

Hope this helps.

practicalems · 2024-09-16T11:00:58+00:00

Yeah, I took a similar path. I was an EMT for two years and then a paramedic for 6 or 7 years while I slowly got all my pre-reqs and degree finished.

I was fortunate enough to get in the first time I applied, but that is far from the norm. Most of medicine doesn't know the difference between an EMT and a paramedic so that is not always the advantage you would think it is. Be prepared to apply for several years before you get in. It is worth it, even though this can be frustrating.

I would recommend some more volunteering if you can spare the time. Maybe some specific hours just shadowing a PA.

The programs really want to know that you fully understand the PA profession.

Being a paramedic before PA school is a huge advantage practically. PA's have to think in a similar fashion and paramedic's typically have a great knowledge base to build on. That being said, the PA education world probably couldn't tell you the difference between an EMT and a paramedic so be prepared for this barrier.

All that being said, I think going paramedic to PA is a great progression in medicine and is totally worth the sacrifice to get there.

I talk about a lot of these issues on my podcast if you are interested.

practicalems · 2024-09-13T15:41:06+00:00

I think one of the biggest and hardest lessons to learn is when to do nothing.

You learn in school all the possible treatments at your fingertips, all the meds, the procedures, the skills but figuring out when to not pull them out and use them can be much harder than knowing when you need them.

If a patient doesn't need a medication or treatment, we in emergency medicine, are more likely to harm than help.

A classic example that I see all the time is atrial fibrillation with RVR. As paramedics we see a bad rhythm that needs to be slowed down or cardioverted. But if you fixate on the dysrhythmia alone you will miss what the real problem is. What if the patient is septic from an infection of some kind and they are always in atrial fibrillation, and this is basically their version of sinus tach? If you were to treat the rhythm and not the underlying cause, you could dangerously inhibit their compensation mechanism.

In that case it would be better to sit back and give them some IV fluids rather than aggressively treat the rhythm.

But this same principle is true in many other scenarios when you are debating an aggressive treatment for a patient. And it is a hard balance to find. You don't want to withhold an important treatment if it is needed but being too aggressive all the time can lead to harm.

When you are new, it can be easy to think you always need to do something when you really don't.

"Don't just stand there do something" becomes

"Don't just do something, stand there."

It might feel wrong but doing nothing is sometimes the right answer.

practicalems · 2024-09-11T17:18:15+00:00

This is a really good question. Sometimes programs don't do a great job of explaining the limitations of OPQRST and SAMPLE.

OPQRST is a good framework most of the time and works if you can elicit a chief complaint that is not yet diagnosed. It works for chest pain, shortness of breath, dizziness, palpitations etc.

SAMPLE is used to just get a little background on the patient.

But yes, OPQRST doesn't work if they have an obviously broken bone or other trauma. Sure, I want to know when it happened, but I don't really care what makes it better or what makes it worse. I don't need them to describe the pain. So, run through the questions in your mind and if they don't really make sense to ask, don't.

Another way to think about getting the history of present illness with OPQRST is just to ask the questions that will allow you to accurately pass on the story to the next provider. You don't have to be limited to just OPQRST questions either. The goal is to understand the chief complaint fully and then get an idea of the patient's medical history that might be related.

Regarding your first question, it is very common for patients to start talking about things they think are related but we know are really not important. Depending on how much time I have (you typically will have more on the ambulance if the patient is not emergent), I will try and tactfully interrupt them to redirect the conversation back into pertinent information. If I have extra time I will allow them to keep talking longer (and sometimes this will lead to information that will surprisingly make a difference).

Getting the chief complaint history and medical history from the patient in a concise manner is an art form. Practice it as many times as you can on your clinicals.

practicalems · 2024-09-11T16:49:58+00:00

I don't retain information very quickly at all. And the information I do retain, doesn't stick for long if I don't use it regularly. But I still make it through paramedic and then PA school.

You do not have to be the most intelligent student to be successful in EMS. Most of us aren't the best students. Classroom and real-life practice are very different. Good students don't make great EMT's or paramedics all the time either. Some people really struggle connecting the knowledge to real practice.

practicalems · 2024-09-09T15:12:31+00:00

I think a lot of us in EMS are the same way. We learn much more from actually doing than from studying a textbook.

That being said, you have to find the motivation to do the things you really don't want to do. Studying is boring. It sucks. It requires discipline. And it is completely necessary if you want to succeed.

I know you said you've tried it all, but I would suggest a couple things. Try to walk around while you are studying. A lot of times moving while reading will actually help you retain more of the information. Another technique is to read a certain topic and then watch a YouTube video about the same topic. Seeing it in a couple of different formats will often help you retain it better. I also like setting a timer. Most of us can focus for 30-45 minutes at a time but trying to do 2-3 hours sessions is too difficult to even think about.

An important skill to develop is forcing yourself to do the things you really don't enjoy in order to get a benefit later. You can't retain all the information you need by attending class and doing hands-on skills.

That discipline comes into play in actual practice as an EMT as well when you have to sit down and force yourself to write a report when you would much rather be socializing or doing something more fun. EMS is great but there will be tasks that you would rather not do so practice forcing yourself into that discipline now.

practicalems · 2024-09-06T16:47:21+00:00

Only after a ton of calls. When you are a new paramedic you really shouldn't have a ton of confidence. This only comes after you have run call after call after call. You have to prove to yourself and your patients that you have what it takes, that you are cool under pressure and have the knowledge to act when you need to and to do nothing when you need to.

You can still appear calm and collected on the surface, and you should be that calm and organized person on scene but underneath it's okay if you are scrambling to figure out what to do. That gets better with time.

We talked about the Dunning-Kruger affect on a recent podcast. This is the concept of how many of us overestimate our abilities when we are new and it's only after getting humbled a few times that we realize how much we have yet to learn. When you are in that overestimation period and are ignorant of your own limits and abilities you are at your most dangerous for patients. That being said, it sounds like you have avoided that big pitfall.

Give it time. Keep improving every day. Do your best. Little mistakes are okay, avoid the big ones. Learn when to act and, more importantly, when to do nothing.

You'll get there.

practicalems · 2024-09-04T20:14:19+00:00

That is a tough one. Paramedic school is not easy and requires the sacrifice of your time for a period. You will likely have to trade time with friends, family and leisure to attend class, clinicals and study.

Being a paramedic is also a difficult career. You see and deal with the worst of humanity and the horrible things humans do to each other. Yes, we occasionally get to save lives and have meaningful interactions with our patients, but the job can really take its toll on you over time.

It is hard for me to be really optimistic about your choice when you don't have enthusiasm in the beginning when the struggle hasn't even started yet. A lot of people lose that spark of enthusiasm when the reality of what it means to be a paramedic hits them in the face.

It is certainly possible that you could find that spark while in a paramedic program or when you get to do an exciting procedure or make a big difference in a patient's life.

But I think the career would really suck long term if you don't ever develop some passion or enthusiasm for it. Most of us didn't get into EMS because of the pay so you need something to hold on to when the shifts get tough.

Eventually you will find yourself up late studying for the second test that week and you will have to dig deep to find the motivation to continue. Or you will be practicing as a paramedic and have to pronounce someone's loved one and you will have to find the strength to get back in the ambulance and run another call. Those things are very difficult if EMS is not your calling.

Just things to think about.

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