Delete American paramedics.

[Tigger]

By follow ups do you mean "the doctor said to come back if anything changes, and it did," or "the doctor told me to come back so he could check me out on this date and time?"

 

[Veneficus]

"the doctor told me to come back so he could check me out on this date and time?"

this

 

[Tigger]

this

I figured that's what you meant, I was asking RocketMedic that. Forgot to hit that quite button.

 

[mycrofft]

During my brief ER orientation and probation, we had people come in for f/up's...all were street people.

The current system will continue because the crushing deficits caused by sinkholes the money goes down is not a real one, it is an imbalance of profits (not inflated claims of amortization) being made from billing for care, then applied to non-care, such as buying adjacent real estate, building a "pavilion" for fundraising, better executive compensation, increasing stockholder profits, etc. You simply suck each needy pt.'s savings and insurance dry, then go to another; they/we are a renewable resource, and incapable of collectively responding because once they go through the wringer, they are poor, maybe homeless, maybe dead.

 

[mycrofft]

So, the answer is go faster on the current path, per the poll.

Ok..........

 

[Hunter]

I say empower Medics, however we wanna be empowered but don't hold ourselves to a higher standard. If we wanna be "empowered" then we need to behave like professionals in ALL branches of EMS, Fire/Rescue departments, Private (Not just 911, but even the [lizard slingers,transport jockey] IFT Ambulance transports.) These act like just because they don't work for a 911 system their job doesn't matter, and the ones that do work for 911 seem to have the same attitude towards them. Hospital based (i don't think there's too many of these left.)

 

[TatuICU]

Start requiring at the very least an AAS to get on a truck and get rid of these idiotic 2 week RN to Paramedic programs.

 

[mycrofft]

So paramedic is the epitome of PEMS?

 

[ah2388]

The consensus that I am developing from this thread, is that more or less it's time for American Paramedics, and American EMS in general to either step up, or step off.

I am hopeful that it is only a matter of time before we "step up."

 

[TatuICU]

The consensus that I am developing from this thread, is that more or less it's time for American Paramedics, and American EMS in general to either step up, or step off.

I am hopeful that it is only a matter of time before we "step up."

I agree with this sentiment. Everyone wants the money and credibility of being a healthcare professional but a lot of people don't want to put in the work. EMS has to start requiring a degree if it stands a chance. Sadly, in our area probably 5/10 medics do have at least one degree but still top out at about $11 an hour. Its very very sad but honestly if EMS did require a degree we'd lose half of our people and we can't afford that in this area. Double-edged sword. What doesn't help is our local paramedic training school's vehement arguments to state legislators (who don't really give a :censored::censored::censored::censored: anyway) that EMS training should not require a degree to protect their bottom line.

 

[TatuICU]

Isn't it commonly agreed upon that less than 10% of 911 call volume truly requires ALS-level skills (ignoring simple cannulation/fluid administration), or at least can honestly be billed for as ALS-2?

I would agree with this. In fact I wouldn't argue against the number being closer to 5%

 

[TatuICU]

That doesn't address the issue of RN having both AS and BS level degrees. Seems a little bizarre of someone could be an RN with an AS but only an EMT B with an AS.

An EMT-B should not require an AS, just as a CNA or LPN does not receive an AS. Both are certificate programs and should remain that way.

As an aside, in my experience its best to have the BSN or BS in something relevant (cell biology, chemistry, etc) if you want serious recommendation for hire these days as a nurse, especially in the critical care arena. I will say though that frankly, a BSN program's contents do not in any way better prepare a nurse to handle critical patients.

 

[TatuICU]

The power does not lie in the piece of paper, but rather in what was required to obtain it. A degree has a set of requirements that must be fulfilled by all that wish to get it, military service or prior experience guarantee nothing to employers.

My point is that a degree guarantees a depth of knowledge, something that our current system can't do. Some Paramedics need to learn A+P before they graduate, some don't, but both end up with the same patch even though one paramedic might have a greater appreciation and understanding of what is taking place with their patient.

You might laugh at anyone demanding appropriate pay for their level of education, but it is simple economics. If every paramedic had to get a degree to keep their cert, I promise there will be a lot less paramedics, and those paramedics that can get a BS will get to tell employers what their pay rate will be. Simple supply and demand.

Wow, someone here has an actual grasp of supply side economics.

 

[mycrofft]

EMT's, and that DOES include paramedics as defined by NHTSA who fathered them, were intended to be a low-price, widely disseminated technical group. Interfacility transfer was not even planned on, injury by car crash was their primary objective of preparation.

Do we strip rural and frontier areas of their EMS because vollies and certified (versus degreed) techs are downgraded and degree-prepared techs mandatory but not a realistic option out there (unless paid for by federal grants)?,

Do we artificially limit the supply? Many (mostly young) people want to be heroes, and this is one avenue, so the supply of cheap young labor is very large. Also, with low entry thresholds to certification and employment, PEMS offers a means to get a decently paying job, sort-of.

Do we prune off all the superfluous varieties of tech which various states and etc. have created since the inception?

And who is "We"? Who will bell this cat?

 

[triemal04]

EMT's, and that DOES include paramedics as defined by NHTSA who fathered them, were intended to be a low-price, widely disseminated technical group. Interfacility transfer was not even planned on, injury by car crash was their primary objective of preparation.
But medicine changes; that's just the nature of the beast. Just because something was initially designed as one thing does not mean that it shouldn't change to fit the current needs. Look at nursing now compared to what it used to be (don't anyone take that as an endorsement of what's happening in nursing please).

Do we strip rural and frontier areas of their EMS because vollies and certified (versus degreed) techs are downgraded and degree-prepared techs mandatory but not a realistic option out there (unless paid for by federal grants)?,
In a fashion, yes. A true rural area is different than what many people consider rural. And while I think a system should be put into place to allow all areas to have access to professional EMS services, even then a longer responce time would still be a reality. So...if volunteers were used to augment the system...that's acceptable. As long as they maintain the same standards and educational requirements as a professional service. If they can't do that or are unwilling...then tough. If you choose to live in a rural area there are things that you need to consider, and a lack of immediate medical care, police responce or fire responce are only some of those things.

Do we artificially limit the supply? Many (mostly young) people want to be heroes, and this is one avenue, so the supply of cheap young labor is very large. Also, with low entry thresholds to certification and employment, PEMS offers a means to get a decently paying job, sort-of.
Not artificially. If educational standards were raised the number of providers would initially decrease I think; not as many people would be willing to put the time in for the compensation. This is NOT a bad thing. I do think that as time went on, more people would start to move into the field again as the situation improved.

Sort of is a good way to put it as far as a decent paying job goes.

Do we prune off all the superfluous varieties of tech which various states and etc. have created since the inception?
Absolutely. One way to increase the amount of funding available is to increase the medicare reimbursement. This would be much easier to do if there were only 1 or 2, 3 at the absolute most, levels of providers. Of course it would also be easier to increase medicare reimbursement if the standards were raised, and different levels were only used when they were actually needed.

And who is "We"? Who will bell this cat?

"We" is people who are actually in this profession and vested in it. Unfortunately, getting "we" to speak with one voice and come up with, and then implement a coherent plan is likely next to impossible.

 

[EFDUnit823]

Why not just make paramedicine a real profession through education, which will lead to empowerment of paramedics?

There was a real attempt for this in Indiana only to be staunchly opposed (and eventually won) by the Nursing Union

 

[RocketMedic]

Job threat.

Another concern is how will this affect fire EMS? Many of us are firefighters or looking at becoming firefighters, and their priorities may differ.

 

[systemet]

Do we strip rural and frontier areas of their EMS because vollies and certified (versus degreed) techs are downgraded and degree-prepared techs mandatory but not a realistic option out there (unless paid for by federal grants)?

I think you have to grandfather in the currently certified providers, and provide some sort of distance-delivery upgrade program.

Nursing had to deal with this with the advent of the BScN (and is still dealing with it). There are lots of angry diploma-RNs who don't like that their upward mobility has been restricted by the advent of the BScN, but haven't upgraded to a higher level. There are also plenty of diploma-trained RNs who now have BScN or higher degrees.

To a certain extent, a new wave of more educated providers will drive the profession forwards and bring the rest of us with them. To the same degree, those currently operating in the field that aren't degree-educated will provide years of experience and mentorship and help develop these new paramedics. The learning should be a two-way street.

This was often my experience working as a new medic with some of the veterans. The guys that had trained in the 80's had had no initial exposure to 12-lead, for example, but had received piecemeal training over the last 10-15 years to catch up. There were instances there when even when I was a new medic, that I could help them. Just as working with someone who'd run a few hundred cardiac arrests greatly benefited me.

Do we artificially limit the supply? Many (mostly young) people want to be heroes, and this is one avenue, so the supply of cheap young labor is very large. Also, with low entry thresholds to certification and employment, PEMS offers a means to get a decently paying job, sort-of.

Yes. It can't continue to be acceptable to work on an ambulance and deal with life-threatening injury and illness on the basis of a few months of school.

Do we prune off all the superfluous varieties of tech which various states and etc. have created since the inception?

I think so. If you train an EMT for 2 years, they're going to have some sort of pharmacology/traditionally non-BLS skills anyway. So it's probably a net move towards increasing the "BLS" scope of practice.

And who is "We"? Who will bell this cat?

I don't know. How did the RNs do this? Or the RTs (they're definitely moving in this direction too). Even a lot of the lab tech / diagnostic imaging is moving this way.

 

[Tigger]

As an aside, in my experience its best to have the BSN or BS in something relevant (cell biology, chemistry, etc) if you want serious recommendation for hire these days as a nurse, especially in the critical care arena. I will say though that frankly, a BSN program's contents do not in any way better prepare a nurse to handle critical patients.

By the nature of nursing, it's initial degrees have to be very broad in their curriculum. A BSN is directly useful and needed in many areas of healthcare, a paramedic's certificate or degree is obviously not. EMS is lucky in that it is a bit of a "niche role" within in healthcare, meaning that the initial degree process can be quite specific and directly train providers for their role. This eliminates the myriad of add on course that are found in the nursing field and will hopefully make the transition process somewhat less painful when it comes.

 

[triemal04]

I don't know. How did the RNs do this? Or the RTs (they're definitely moving in this direction too). Even a lot of the lab tech / diagnostic imaging is moving this way.

Another concern is how will this affect fire EMS? Many of us are firefighters or looking at becoming firefighters, and their priorities may differ.

Unfortunately, that says it all right there. Not fire departments being involved in EMS, but people using their time and involvement in EMS just so they can move on to something else.

You don't see that with many other medical fields. A RN may choose to specialize in one thing or another, or only work in certain places, but they are still an RN. Same with an RT. Or PA, or radiology tech, or MD.

Not always the case with EMS.