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More Paramedic School Stories: The First:

Years and years ago, before I left Da City’s employ as a medic, I had completed nursing school, written my boards, received my license and was living large. For certain values of “large”, that is.

I had been offered, and accepted , a position teaching pharmacology, part time, for the program that I had graduated from. The textbook we used (Nancy Caroline MD: “Emergency Care In The Streets”) was outstanding, and provided a clear template around which to build my lesson plans.

One of the innovations that I introduced, from my own nursing school days, was a particular format for drug cards. The point thereof was to have, on a 3 x 5 or 4 x 6 card, the names of the drug in question (trade and generic), the common dosing and route of administration of the subject drug, indications for using the drug, contra indications for using the drug, the mechanism of action of the drug, and the class (often, these last two overlap: a drug classified as a “Beta Blocker” worked by blocking beta agonism on the sympathetic nervous system. If you had mastered that point, you knew that the drug would serve to slow heart rate, mildly constrict arterial muscles (net effect of lowering blood pressure due to slower heart rate and decreased strength of contraction leading to diminished cardiac output), CONSTRICT bronchial muscles, and reduce intra ocular pressure. Or, you could write all that stuff out. For every beta blocker you encountered. Fun times. I simply earned what beta agonism tickled, and knew that blockade thereof reversed those effects.)

In addition, the cards noted nursing considerations (things the nurse, or paramedic, ought to have in his/her mind when employing this medication. Like, Beta blockers: check and recheck heart rate, blood pressure, and monitor the EKG, looking for slowing conduction of the elelctricity that controlled things).

Now, some of my students were first timers. They were folks who, as you might imagine, were taking paramedic classes for the first time.

In The Un-Named Flyover State, the licensing drill went something like this. You successfully completed the course, and took the exam. Pass it in one, bingo, license in hand, go out and fight disease and save lives.

If you failed the exam, then you got one chance to re take the test portion that you had failed.

If you failed the retest, you had to successfully complete a refresher course, whereupon you could re-test, again.

If you failed THIS test, you had to take the entire generic paramedic program, from step one, all over again.

As it happened, a couple of students had, indeed, found themselves taking the paramedic class, in order to qualify for a FOURTH retest.

So, TINS©, I laid out my expectations, had conjured up a 1,000 point, tow semester grading scheme, wherein around ½ of the grade (250 points each semester) would come from the midterm and final, combined. Another 25 points came from each quiz, administered each week in class. 16 weeks in a semester, no quiz on mid term or final weeks, and two other weeks off for review for the mid term and finals, 20 quizzes.

I announced at the beginning of each semester that I would consider extra credit in the event that any student came to me in advance, suggested something that would reflect additional pharmacologic study, and be pertinent to paramedic practice.

So, STORY NUMBER ONE: Somewhere around mid terms, one of the students rose in class, and delivered a pronouncement: Reltney, paramedics don’t need to know all this stuff. Nurses, yeah, I get that nurses need to know this stuff, but paramedics don’t!”

I invited him to hold that thought, and we could speak, in detail, after class. After the end of class, this fellow, along with a couple fo his work mates, all met with me, eager to set me straight.

As it happened, all of these folks were of the looking-at-a-fourth-retest group.

I invited my correspondent to state his case. He did so, as outlined above, with no new explicative material, no new rationale for his position.

I deliberated a moment, and fact checked myself. “So, you have taken the paramedic exam, correct?”


“And, you failed it, is that correct?”

“Uh, yeah…”

“Then, you took it again, did you not? And, failed it, again, am I correct?”


“And, again, after a refresher course, you took the paramedic exam, and, again, you failed it, is that also correct?”

(much more quietly) “yes…”

“So, I’m confused: you are not an RN, are you?”

“Uh, no…”

“So, let me see if I am understanding you: you are telling me, who has taken, and passed, the paramedic exam, and who is, also, an RN, that you are in a position to have an opinion that I ought to find persuasive, regarding what it takes to successfully take and pass the paramedic exam, based upon your experience in taking the exam, and failing it, what, three separate times?, did I hear you correctly?”

He mumbled something indistinct, and found somewhere else that he felt the need to be.

And, I did not hear THAT particular argument again.

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