Delete American paramedics.

[mycrofft]

How about cutting to the chase and abolishing paramedics and replacing them with physician assistants and maybe nurse practitioners? Keep the much lesser-trained EMT-B and first responder for areas which need a filler between first-aid and ACLS and won't otherwise get some, but in other areas go right to a really well-educated and qualified partitioner who is cheaper than a doc and oriented/indoctrinated for prehospital situations? Darned good step into the field of emergency medicine for an aspiring full-on MD too, if they stay long enough "on the street" to learn about it before they dive back into the ivory towers.

Our Australian and New Zealand associates may be saying "Just give the paramedics more power; works here!".

Let's toss it around!

 

[BEorP]

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

 

[Veneficus]

I support the European idea of using a physician (particulary an anesthesiologist) but I think that empowering paramedics is a reasonable alternative.

 

[EpiEMS]

Isn't Load and Go vs. Stay and Play the primary distinction between the American and European (e.g. SAMU in France) models? High level practitioners on scene may be more inclined to stay and play, even though they don't have the same level of equipment that they would in a hospital, no?

 

[Aidey]

Well, considering I think that having both PA and NP in this country is an absurdity I can't really pick one. I'm personally a fan of the Oz/Nz systems, and of all the options I think those would be the most feasible to adapt to the current US system.

 

[Veneficus]

Isn't Load and Go vs. Stay and Play the primary distinction between the American and European (e.g. SAMU in France) models? High level practitioners on scene may be more inclined to stay and play, even though they don't have the same level of equipment that they would in a hospital, no?

I would wager you don't know what kind of equipment those types of units carry. I have seen European units with scrub sinks, a full complement of surgical tools, and every medication used in emergency medicine. (all neatly packed away on a Mercedes sprinter)

As well, I have not witnessed a "stay and play mentality," rather a treat and release or stabilize and transfer.

"The load and go" mentality, I would think came more from the US EMS origin of needing to rapidly train and field providers to work out of hospital, as the US medical establishment purposefully limits the number of physicians it trains or accepts to manipulate market forces.

If you design an imperfect system, propaganda is the perfect way to justify it.

What is quite puzzling to me is since US Emergency Medicine docs are proud of their ability to decide who needs to be admitted vs. who can be treated and released, it seems more appropriate for them to increase their numbers and get involved in EMS prevention, treat and release, etc, then actually work in an emergency room.

After all, when a really sick patient comes to the ED, it is surgery or one of the intensive medicine disciplines that are called to handle those "critical" patients.

Unless you count the glorified paramedic role of hyperoxygenation and fluid resuscitation.

 

[medicdan]

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?

 

[Smash]

Unless you count the glorified paramedic role of hyperoxygenation and fluid resuscitation.

Hey now! What patient doesn't benefit from an absence of clotting factors and a PaO2 of 400, I ask you!

 

[Hunter]

How about cutting to the chase and abolishing paramedics and replacing them with physician assistants and maybe nurse practitioners? Keep the much lesser-trained EMT-B and first responder for areas which need a filler between first-aid and ACLS and won't otherwise get some, but in other areas go right to a really well-educated and qualified partitioner who is cheaper than a doc and oriented/indoctrinated for prehospital situations? Darned good step into the field of emergency medicine for an aspiring full-on MD too, if they stay long enough "on the street" to learn about it before they dive back into the ivory towers.

Our Australian and New Zealand associates may be saying "Just give the paramedics more power; works here!".

Let's toss it around!

How about PAs get paid about $30-40/hour and medics barely get half of that in some areas, if you think people complain about how much we get paid/charge them now imagine if they were paying for PA's and LPN

 

[usalsfyre]

Actually it's usually closer to $70-80hr...

The point is the cost savings of not taking everyone to the ungodly high cost center of the ED would more than make up the difference. I imagine ambulance RVUs would be worth a good deal less than ED RVUs.

 

[BF2BC EMT]

NP no, PA yes or increase the paramedic education degree only.

and cut the cord between fire and EMS

 

[EpiEMS]

I would wager you don't know what kind of equipment those types of units carry. I have seen European units with scrub sinks, a full complement of surgical tools, and every medication used in emergency medicine. (all neatly packed away on a Mercedes sprinter)

True, I honestly don't know — I just, I dunno, one ER doc can't nearly do the job of a trauma team. I'm curious about this. Maybe there's some good research about trauma survival rates in US vs. Europe. I founds some stuff on scoop and go in the US trauma setting. Cool natural experiment in this article: "Prehospital procedures before emergency department thoracotomy: 'scoop and run' saves lives" (http://www.ncbi.nlm.nih.gov/pubmed/17622878).
Another interesting one: http://www.anesthesiologie.nl/uploads/150/635/mmt_les.Siegers__Frassdorf.pdf

I would just love love love to run controlled experiments instead of natural ones. Take ten cities, make them set up several levels of care and see what happens.

and cut the cord between fire and EMS

In the area where I am, it's EMS and Police, with Fire on its own. I can't shake the feeling that EMS/Police combo makes just as much (or more) sense

 

[Medic Tim]

How about PAs get paid about $30-40/hour and medics barely get half of that in some areas, if you think people complain about how much we get paid/charge them now imagine if they were paying for PA's and LPN

That is the medic pay range most places in Canada.

 

[EpiEMS]

That is the medic pay range most places in Canada.

Canadian $ or US$?

 

[rescue1]

Canadian and US dollars are basically worth the same these days. I think there's like a .5 cent difference right now.

EDIT: In fact, as it stands, the Canadian dollar is worth more

 

[Medic Tim]

Canadian $ or US$?

Cdn but the exchange is only a few cents on the dollar

 

[EpiEMS]

Maybe a new class of practitioner could be added. Or, say, let PAs supervise medics?

What with all the "degree creep" that there is these days, why not just make EMT-B an associate degree level, paramedics a baccalaureate level? That'd keep it in line with PAs being masters level and physicians being, well, doctorate-level.

 

[Aidey]

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.

 

[EpiEMS]

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.

I remember reading somewhere about a proposal to make RN require a baccalaureate degree. All equivalent professions, like PT and OT require at the very minimum a bachelor's degree, and PT is now, for example, at the doctoral level for practice, so I've read.

 

[Martyn]

Absolutely NOTHING would be achieved by the United States of America towards having a nationally recognised 'paramedical doctor' until the United States of America actually became the United States of America. With each state having it's own certification and licensure etc this will never happen. Even the National Registry is not really national. There are still some states that don't recognise it. Coming to the USA from the UK it wasn't until I had lived here for a while that I realised just how screwy this country really is. On a smaller scale it would be like each county in the UK advocating for its own licensure etc. It would not be a viable option. Until ALL of the states learn to pull together and adopt a national recognition program something like this would never be accomplished. The overall state of health care in the USA is, without a doubt, world class, however, the actual provision of this healthcare to the masses is absolutely ridiculous. One of the main problems that I have seen is that there are way too many big money companies involved. Something has to change, something is going to break but until the big medical companies are reined in nothing will get done. OPEN MESSAGE TO THE UNITED STATES OF AMERICA: STOP FAILING YOUR PEOPLE AND PULL TOGETHER.