Too Much Information For a Paramedic?

This is a coordinated post by our friends Greg Friese and Steve Whitehead.

– Greg’s post on this topic can be found at:

– Steve’s post on this topic was originally found at his blog, The EMT spot… unfortunately that blog has gone to the great blogosphere in the sky. 

Hey guys? Guys? Hello?


“They Don’t Know What They Don’t Know.”

It’s an established fact that 60% of fatalities within confined spaces are would-be rescuers. They see someone down in a confined space, enter the space, and are overcome by the conditions that took down the initial victim. The process sometimes repeats itself, with multiple would-be rescuers entering the space and falling victim themselves. It’s tragic really, but the cold, hard fact is that these people are victims of their own ignorance. They don’t know what they don’t know. They don’t recognize that there is a fatal set of conditions within the space, and they don’t know that whatever it is that killed the first victim, or subsequent victims, will kill them as well. It’s a well documented phenomenon that plays on the compassion of the would-be rescuers and ends up getting them killed.

They simply don’t know what they don’t know.

So when I was approached by our friend Greg Friese from the other day regarding a comment he received on one of his training articles, I was interested in doing a co-post with him. He also has contacted our friend Steve Whitehead from (Sorry folks, that post’s gone!) and together we’re tri-posting on this issue. Their links will follow below and are just great as always.

The comment that followed this online training article was written presumably by a paramedic. It was a critique of the article that simply stated “too much information for a paramedic.” I read that, and immediately thought of confined space incidents, where ignorance can get a person killed. Lots of situations fit that scenario and it’s not always the rescuers who get killed. EMS providers who “don’t know what they don’t know” can and do kill patients. More often, they don’t provide the best possible care.

There’s this thing that we have made it our business to know how to repair. It’s called the “Human Body” and if you’re reading this article, the chances are good that you possess one. The human body is VASTLY complex. It’s the most complex machine we humans know about and we are still learning about it to this day. There are some amazingly smart people out there who have dedicated their lives to studying these meat machines that our brains pilot around and they still haven’t figured everything out yet. We can help set it back on course to heal itself in a lot of cases but we can’t construct a new one. We don’t know about all the minutia, the microscopic works inside of it that make it do all of the amazing things that it does. The levels of systems within systems that function seamlessly within still other systems are numerous and fascinating. I learn something new about it all the time, and still there are people who know vast amounts more about the inner workings of it and about the huge number of things that can affect its operating effectiveness than I do. The human body is remarkably complex yet elegant and perfect in its design.

C’mon. Don’t be a wuss.

And we who call ourselves “medical professionals” are well advised to study every possible aspect of it. Consider it your life’s work. If your job is to fix and support the end users of the human body, you darn well better know everything you can about it.

“But”, you say, “There are people out there who are supposed to know much more about the human body than we are. They’re called Physicians, and they get paid a whole lot more than we do. We’re just paramedics. (or EMTs).” And you’d be right for saying that, of course. Physicians have the ultimate responsibility for knowing the human body. It’s their life’s work as well. Their patients live and die based upon their knowledge, skills, and talents they have for examining the human body and being able to figure out what’s going on. Their whole practice is based upon their knowledge, skill, and talent. The more they know when they’re working there, the better provider they are.

It’s that simple, and it’s exactly the same for us EMS people. The more we know, the better we are. Nobody is better served by dumbing us down. Nothing is gained by denying yourself knowledge. Not a single patient is better served by you not knowing everything you can know about what is going wrong with them and it’s your duty to learn as much as you can about what you’re supposed to know about.

What is the line for how much paramedics “need to know?” Is everything that we need to know covered by our initial training course? Is that everything we need to get out there in the world and start slinging IVs and Meds all willy nilly?

I look at the paramedic license as a “learner’s permit.” It’s the baseline knowledge level needed to function at that level under supervision. It’s a jumping off point from which the provider should immerse themselves in knowledge. I can certainly say that I’ve learned volumes past my initial certification and that the “extra” knowledge has saved lives. Did you know that Fentanyl can cause chest muscle tetany when administered too rapidly? Or how about that lasix, when pushed too rapidly can cause hearing loss? Do you know that ST depression in the high V leads can signify a posterior MI? What about differentiating an acetabulum fracture from a “pulled groin?” Can you reliably predict the patients whose blood pressure is going to crash after Nitroglycerine administration by reading a 12-lead EKG? What about the clinical presentation of a non-ST elevation MI? Do you know the MEND stroke screen? What about the different neurological exams to find an intracranial bleed?

Etcetera, etcetera… The point is, there isn’t a cut off. The final exam we take for our licensures prepares us with the baseline knowledge to get out there and learn what it takes to make us truly great EMS providers. The true professional will learn this, and constantly seek the knowledge he or she needs. The average to sub-average provider will comment that they “don’t need to know” something.

Get out there, get fascinated, and learn as much as you can. It will never be enough knowledge, but your mind is a sponge for a reason.

Study Hard. Know Your Stuff. No Excuses.


This is a coordinated post by our friends Greg Friese and Steve Whitehead. Be sure to read their posts on this

Greg’s post on this topic can be found at:

Steve’s post on this topic was great, but sadly Steve’s blog is gone… Drat how the passage of time ravages my backlinks.

  • I couldn’t agree more.

    “Get out there, get fascinated, and learn as much as you can. It will never be enough knowledge… but your mind is a sponge for a reason.”

    Fantastic post, CK, as always. 🙂

  • Great post Chris. Thanks for joining the conversation. Also thanks for tipping me off to the MEND. New to me so I used the Google and found

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  • Great post, Chris. A couple points stood out in particular for me…

    “Nobody is better served by dumbing us down. Nothing is gained by denying yourself knowledge.”—->EXACTLY. If one moment you’re complaining about the lack of respect–or the lack of parity in salary–in EMS, and then the next moment you’re claiming something is ‘too much information for a paramedic,’ you are not getting it. How can we elevate EMS as a profession if we are not willing to elevate ourselves as professionals?

    “I look at the paramedic license as a ‘learner’s permit’. It’s the baseline knowledge needed to function at that level under supervision.”—->This is exactly how I felt when I got my EMT-B cert. While I had already worked with and around EMS for ten years when I got it, I knew that from a patient care perspective, I had only just begun in my learning. And yes, you learn a lot from doing and observing, but you also learn from studying, in the field, in the classroom and on your own time. If you’re a patient (and sooner or later, we all are), don’t you want to know the medic caring for you also cared to learn as much as possible about how to do it well?

    Keeping a focus on knowledge and learning is one small way we can all be a part of EMS 2.0.

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  • Paulgeorgesilva

    One of the issues we run into in my state is what I call the “so what factor”. Usually it goes something like this:
    “Hey we should get capnography”
    “We will be able to get much better information on how the patient’s gas exchange is occurring”
    “So what? That won’t change anything. Still gonna give’em 15LPM by non-rebreather”
    “Well we should do 12 leads more often, we’ll get much better information on location of blockages”
    “So what? Chest pain protocol is the same no matter what and they never believe our 12 leads anyway”

    And so on. It’s infuriating!! Maybe I should post this up at my station and see if they get the message.

  • Thanks for writing this Chris! Great information and it made me think as always 🙂

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  • Thom Dick

    Promise ’em your best, each and every time, and be able to look ’em in the eye when you do it.
    You are the man, Chris!

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  • Chris,

    I couldn’t agree more. I’ve been nauseated by my local EMT school utilizing brand-new EMT’s as instructors (especially as skill instructors). So instead of sitting on the sidelines and complaining, I decided to do something about it. So I offered to help. I was told that I am “very intellegent (sic) and tend to talk over the students’ heads. This is simply not a good quality for an instructor.”
    My response? Are the students too dumb? Or do I make the rest of the instructors look bad?

    I hate it when I hear talk of CPAP “pushing fluid out of the lungs and replacing it with air”… There is SO much more involved. Taking shortcuts just to save time does EVERYONE (Students, Instructors, and PATIENTS) a huge disservice.

    When I see you talk about a cert as a “Learners Permit”, I couldn’t agree more. I remember telling some folks a few months back that it wasn’t until I was out of school and on my own as a medic that I really saw how little I knew. I enjoy learning, and I can’t understand why the folks in Massachusetts had to falsify their con-ed documentation. I know I have a huge advantage with my volunteer squad providing educational reimbursement, including sending me to the JEMS conference every other year or so. Why do I enjoy con-ed? Because I keep learning more and more. I find some of the most interesting discussions happen outside of the lectures, too, when you compare notes with folks from different places and backgrounds and find that they have an entirely different approach to the same problem you see. This fall, I’m enrolled in a CCEMT-P program at my own cost. I’m pushing myself, and loving every minute of it. Do I see myself using much of the CCEMT-P program in my practice as a street medic? Not as much. But I work part time doing transports – and that’s going to make a big difference.

  • massemt

    Jon – I agree with everything you’re saying.
    Just wanted to point out that the folks suspended in Mass were suspended for falsifying their refresher courses, not con-ed. The ones I know went above and beyond with new information, just didn’t take the refresher that teaches the basic course in 24 hours of lectures.

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  • DaveB

    To me, one of the issues is this: Initial training and protocols are designed for the “lowest common denominator”. In other words, the initial training and protocols flow from the “bottom up”, while innovations and advancing EMT knowledge and care flow from the “top down”. There is a huge gap there, which is represented by the inertia felt by those that want to do the very best we can.

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