Where Should Your EMT Clinicals Really Happen?

I’m going to suggest something here that’s bound to make a few people upset with me. Upset like the way my wife gets upset when we’re having an argument and I make a really good point and she’s not quite sure what to say to rebut me. Like that frustrated, pouty, “I wish you hadn’t gone there” kind of upset. … So right here at the start, let me just say, I’m sorry.

I was listening to a recent episode of one of my favorite podcasts and a one of the dudes in the discussion, an EMS educator, made the point, “Why don’t we do EMT clinical rotations in nursing homes and detox centers?”

[Insert gasping sound from the crowd here ...]

To which I have to say, “Well, uh … good point.” Why don’t we? OK so before you click over to the next web site, never to return, let me state my case.

When I was an EMT student, I dutifully went and did my clinical time at the local ER. Two shifts and sixteen hours later (We had a very progressive program. Thank you very much.) I emerged ready to take on the EMS world.

When I started my first Job in EMS I found that I was spending far more time in nursing homes and psychiatric facilities and detox centers than I ever did in the ER. And when I did step foot in an ER the staff wasn’t often looking for me to take over the clinical care of the patient like in the other facilities.

Wouldn’t it have been far more helpful to know what a nursing home environment was like? Wouldn’t seeing and interacting with nursing care providers taught me more about what to expect for my job. How beneficial would it have been to spend several hours interacting with hospitalized psychiatric patients or drug addicts detoxing from various substances. It’s undeniable. That would have been an excellent learning experience.

I’m not saying that we should throw out the ER clinicals. There’s plenty of valuable things to learn in the ER. But I am saying that we should think about some alternative learning environments that may also prove equally valuable. Dare I say … more valuable?

My comments section is now working so – let the thrashing begin.


  1. Two words – Liability & HIPPA.

    I’m not saying you’re wrong, EMT clinicals should be held in real world situations. However, many hospitals & ERs aren’t allowing EMT clinicals anymore due to liability & HIPPA reasons. Nursing homes and detox centers would be great, but they have the same restrictions as the hospitals. You would not only have to get permission from the facility, but from every single patient you touch. I would love to see it happen, but I don’t think it will. It would take a unique training agreement betwwen the facility and the agency to make it happen.

    What you can do, and we’ve done it here, is do a “Health Fair” at the senior center. Potential EMTs end up sitting there and doing vital set after vital set for hours. They take what seems like a million pt histories. And they work with many pts dependent on nursing aides.

    If anyone else has additional ideas, I’d love to hear them. I’ve been looking for ways to expand both our initial training and our skill refreshers.

  2. Glad you are enjoying http://www.emsgarage. Have you been listening to http://www.emseducast.com? What do you think?

    Yesterday my crew had a paramedic ride along student. While we only had four calls she saw four patients all over the age of 75. The patients were at 1) senior focused apartments with shared meals and activities, 2) senoir living at home that needed home health or residential living, 3) senior at group home with limited healthcare (ie CNA) support, 4) senior at a nursing home receiving complex nursing care. I thought our student got a great perspective on everyday EMS.

  3. administrator says:

    Greg, both of the podcasts are great. I love listening and I enjoy talking about what you’re doing on my site. I know that putting quality, useful EMS info out on a regular basis is a lot of hard work and I hope you guys keep doing it. Thanks for the comments.

  4. administrator says:

    Terryn you make several good points. I think most agree that this would be a problematic thing to accomplish. But it would also be a worthwhile thing to accomplish. And you make a great point that there are other ways to make it happen.

  5. I am 100% behind you. I have been a CNA in nursing homes and have done home health for over 10 years. I learned more in the nursing homes than I did in my ER clinicals. During class I explained to many of my fellow students how to interact with the elderly and what to expect when they go in to the nursing homes.

  6. Ok, now for another opinion on the other spectrum, I am an emt in south texas and I had to have a whopping 84 hours of clinicals before I did registry, 4 shifts in the er, 2 in the icu, 1 OBGYN , 4 ride outs with the fire dept, and 1 private ambulance company rideout, I am also a firefighter and I see more trauma and od’s then anything else . The private companies tend to deal with the nursing homes and the transport. So in my eyes I learned a lot more from the actual er and icu then private. But every ems structure in every city tends to be different. If anyone would like to discuss thos further plz leave me an email.

  7. I think we should experience more places than a ride with the local FD and an ER rotation. Maybe instead of touching 10 people maybe 20 people and do an ICU rotation. After I starting to watch Intervention I think it would be a great idea to see an addiction clinic and get that real life experience and it will teach us to “ask the Patient” about addiction and get a better understanding of what they are going through and we can work on developing patient rapport with these sick people.

  8. Steve Whitehead says:

    @EPI, honestly, I can think of dozens of places that we should visit and experience. And it should be regionally specific. But one place I think almost everyone visits frequently is nursing homes.

  9. I agree. Is there anyway to change this? is the choice of rotation a SMFR thing or is it a state thing that we have to do one hospital and one FD ride?

  10. Spencer Gist says:

    I am about to start my EMT Basics this fall and I quite agree with you. I do believe I will be doing a little of all of which you have mentioned. So thank you very much for the help!(:

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