Q&A with a Paramedic

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After a recent post on Instagram, I connected with Mike, and he graciously offered to answer some questions and add his insights into being a paramedic. It's a great option for getting patient care hours for PA school, but there's a lot involved and I am certainly not an expert, so I'm happy to share his firsthand experience with you. I learned a ton from his responses! On a side note, Mike just got his first interview invite, so send him all of your good vibes. 

What steps does it take to become a paramedic?

Becoming a paramedic is certainly not an easy task, but if you are willing to put in the time, it is extremely rewarding. 

Step one: Become an EMT- Basic. Many people under value their time as EMT-Basics. People tend to want to jump straight into becoming a paramedic because you get to administer medications and perform all types of procedures. A common phrase you will hear in the EMS world is “you can’t have good ALS (advance life support) without good BLS (basic life support).” My time as an EMT Basic was essential in properly learning how to assess and determine if a patient was sick or not sick.

Step two: Find a good program and enroll. A great deal of programs will be run by community colleges (which keeps the cost down) and vary in length. Typically, it takes 12 months to complete the certification program or 2 years to complete the Associates degree. During this time, you will meet anywhere from 2-4 days a week during the day or night. My program met twice a week for 8 hours a day. Classes will run for a full year, including winter and summer. On average you will take between 15-18 credit hours a semester, but do not fear, the classes tend to piggy back off each other (i.e. Medical Emergencies and Pharmacology will be taught together). While in class, you will also be responsible for scheduling multiple ride-along shifts. This will be done during your free time and is required by all programs. Ride along shifts can be equated to clerkship time found in PA school. It is time for you to put into practice the skills you are learning. You will be required to perform a set number of assessments and practical skills to be check off by your preceptor. It may seem intimidating, but it is probably the most exciting part of class. 

Step three: Take the National Registry. The National Registry Exam is the national certification exam for paramedics that is accepted by almost all states. This is a two-part exam which consists of a practical portion and written exam. Each phase of the exam is usually taken on separate days and your program director will need to approve you to take the test. 

Step four: Find a job/state licensure. Once you have passed both the written and practical exams you will be a Nationally Registered paramedic, but that does not mean you can practice just yet. To be able to practice, you must be affiliated with an agency or hospital. As a paramedic your certification or license will need to be tied to a Physician/Medical Director. Being affiliated means that the agency recognizes you as a provider and the Physician/Medical Director approves you to operate under their license. Essentially, you need to have a job to practice. 

Side note: Most states accept national registry certification alone, but there are others that require Registry and state licensure. This will require you to take an additional state specific protocol test. 

If someone wants to become a paramedic, what is the first thing they should do?

The absolute first thing a person should do is become an EMT basic. If you are already an EMT-B, reach out to your local paramedic program and find out what their program requires for admission. Typical prerequisites for a paramedic program are Anatomy & Physiology, and basic English and Math. Some programs used to require a certain amount of experience as a EMT Basic. Programs are starting to shy away from this due to the shortage of providers. Check locally to find out.

What is the difference between an EMT and a Paramedic?

In the field of EMS, there are multiple levels of care. The most basic level is called an EMT-B or Basic. This is what most people think of when they hear the word EMT. At the basic level, school typically is a couple months. What an EMT can do is usually determined by the state and or the Medical Director, but common practices are assessments, splinting, administration of low level medications (i.e. Tylenol, aspirin, glucose paste) and the assisting of already patient prescribed medications (i.e. nitroglycerin, albuterol inhaler). Again, this is a state/physician-based decision. A paramedic is typically the highest level of EMT care found out in the field. Paramedics carry a wide range of medications as well, and the portable monitor. Paramedics are trained to make differential diagnoses and follow protocols established by the medical director when treating patients. Paramedics can perform a wide range of skills such as; intubations, IVs/IO, Needle Decompression, Cardioversion, Defibrillation, Pacing etc. As a paramedic, I also carry a drug box and based on protocol and assessment, can administer a wide range of medications.

What does a typical day on the job look like for you?

I work in a fire-based EMS system in a major metropolitan area that borders the District of Columbia. That means my department is extremely busy! The best answer to this question would be there is no typical day. That is one of the exciting parts about being a paramedic. My department works a 24/72 schedule, meaning I work 24 hours on and then have 3 days off. Shift change is at 0700hrs, but it is customary to arrive at least 1 hour before. This ensures the crew coming off does not get stuck on a late call and gives you time to settle in and mentally prepare for the day. After dropping a pot of coffee, I head over to the Medic unit with my partner and begin our morning checks of the unit and equipment. During checks we replace any expired medications or damaged equipment, perform basic maintenance checks on the unit (oil, washer fluid, tire depth, lights, sirens), then finish up by ensuring the narcotics are locked up and signed over. 

Following morning checks we drink more coffee, have breakfast, and wait for the calls to start. On average my department as a whole, runs just under 500 calls a day. The average number of calls for a medic unit is around 8 a day. A long, detailed call will take me around 2 hours to complete and a simpler call can take as little as 30 minutes. 

How will your experience as a paramedic help you to become a PA?

I have heard that PA schools really value the patient care experience paramedics bring to the table. As a paramedic, you learn the basic steps to diagnosis and development of treatment plans. You also learn how to work as a team and think on the fly. I’d like to believe that PA school admissions respect the time and discipline it takes to become a Paramedic and believe that this will translate into your studies as a future PA. 

For me personally, when I think of this question, people will automatically assume the clinical aspect of being a paramedic is most important. While I do feel I have learned a lot clinically, I also have seen that there is so much I do not know. More importantly, my time as a paramedic has taught me life qualities that I believe will help me be successful in medicine and life. Here is my not so short list.

  • I have learned how to lead and how to follow. 
  • I have learned how to be humble and ask for help. 
  • I have gained confidence in myself and my decision making. 
  • I have learned how to work as a team
  • I have learned to do more with less and think on the fly
  • I have also learned the true meaning of empathy and compassion. 

What is the craziest thing you’ve seen?

In 2015, my partner and I were dispatched as the only advance life support unit to a single vehicle motorcycle accident in the parking lot of a strip mall. A rescue squad and a basic life support ambulance was dispatched with us to make a total of 7 providers. As we were approaching the scene, the officer on the rescue squad in a panicked voice asked for an alternate channel. When questioned why, the officer yelled to start an EMS Taskforce and give him the channel. A motorcycle attempted to run a red light when he was clipped by another vehicle. The motorcycle slid into a crowd of people including several children. There were multiple critical patients requiring advance life support intervention. My partner and I jumped off the rig and were directed by the basic crew to assess a young child that was fatally injured. I began to assess the patient and directed my partner to go quickly assess the condition of the other patients. Both my partner and I were brand new medics at the time (only 1 year of experience) just off our internship. Neither of us had experienced a mass casualty incident and as the highest level of care on scene, everyone was looking to us to make decisions. What a crazy and stressful experience. 

What is the hardest part of your job?

I think so far, other than very specific calls, the hardest part of my job has been telling someone that their mother, father, brother, sister, son, daughter or friend has died. I feel that never gets any easier to say the words. I will never forget the first time I had to tell a mother their child had died. It will be an experience you will never forget. I think that is why it is important to find balance while working in medicine. Find a healthy way to relieve stress and let work go for a bit. 

Where can people find you?

People can find me on instagram @ mike_jeffe or on facebook. Feel free to reach out if you have questions about becoming a Paramedic or what it is like to be a paramedic. I will also be providing updates on my journey from EMT-P-PAC and updates of my application process.


My name is Mike. I am a first-time applicant this year and currently in my last semester of undergrad. When complete, my degree will be a Bachelors of Science in Emergency Medical Care with an Administration focus. I have been working in emergency medicine for almost 8 years now. I first discovered medicine as a transporter in the hospital. I walked through the halls of the hospital, amazed by what I saw. I honestly felt like Harry Potter when he discovered the wizarding world. Everything was new and exciting to me. I was captivated by the amount of skill, knowledge, and selflessness that surrounded me. Over the years I worked my way from hospital transporter to EMT in the Emergency Department, finally landing in the fire department where I obtained my paramedic certification. I have been with the fire department for over 6 years, operating as a firefighter/paramedic for the last four.