Education levels

[Aidey]

Maybe no one else splits it into BLS and ALS, but traditionally there have always been people trained at a lower level to assist the provider. In an ED for example there are doctors, RNs, techs etc etc etc. The doctor doesn't perform every single task himself, certain tasks and procedures are done by the other people.

While the choice of ALS and BLS may not be the best terms in the world, I see no problem with there being 2 levels of pre-hospital care.

 

[AJ Hidell]

While the choice of ALS and BLS may not be the best terms in the world, I see no problem with there being 2 levels of pre-hospital care.

I don't either, so long as only the top level is allowed on ambulances. Anything less is appropriate only in a first responder role. People call for EMS because they need help. They do not expect you to show up and have to call yet someone else for help. Although many of our patients require only basic supportive care, the purpose of EMS is to be prepared for the worst case. And those who need that advanced care are the last people we need to be making wait for an intercept. Providing anything less is a failure to observe the meaning of the E in EMS.

The problem with the less than ideal terminology is that it serves only to fracture and confuse both the clinical and educational processes. Too many people are mistakenly using BLS and ALS as synonyms for EMT and Paramedic, which they are not. ALS and BLS refer to types of care rendered, not to a level of care provider. And EMTs often provide ALS care, just as Paramedics often provide BLS care. Consequently, the labels are meaningless and divisive, and need to go away for the good of the profession.

 

[Aidey]

I don't either, so long as only the top level is allowed on ambulances. Anything less is appropriate only in a first responder role.

See, here is where I disagree. I think that EMTs (as the lower level in this discussion) do belong on ambulances. Yes, it is silly when someone calls 911 to have an ambulance show up only to have that ambulance have to call another ambulance. But that isn't a fault of the level of care, that is a fault in the tiered response system (which is a system I dislike).

I'm perfectly ok with a 2 man ambulance crew having 1 paramedic and 1 EMT. I don't think that 2 paramedics are needed. The second person is going to be assisting on scene and then driving, and I think the EMT role is acceptable for that position.

I also don't have a problem with an EMT only IFT ambulance. Someone does not need a parmedic assessment when they are being transfered from St. Sent-Here-To-Die's care facility to the local hospital to have their skin rash re-assessed. Especially when the only reason they are going by ambulance because they can't sit up on their own, so the wheel chair transport won't take them. Or because they have mild dimentia and need to be watched, or any other number of the approved medicare reasons for ambulance transport.

 

[AJ Hidell]

But that isn't a fault of the level of care, that is a fault in the tiered response system (which is a system I dislike).

But the current allowance of EMTs on ambulances is what perpetuates that flawed system. Take away the option and you take away the problem.

I'm perfectly ok with a 2 man ambulance crew having 1 paramedic and 1 EMT. I don't think that 2 paramedics are needed. The second person is going to be assisting on scene and then driving, and I think the EMT role is acceptable for that position.

How long have you been a paramedic? Do you know one of the primary reasons that medics stay in EMS for such short careers? Burn-out. Do you know one of the number one reasons for paramedic burn-out? The overwhelming stress associated with having 100 percent of the responsibility for 100 percent of the patients you pick up every shift. When you have no partner (an EMT is not a partner. It's just a helper.), you have no one to share responsibilities with, and you burn out twice as fast. Studies show that medics in dual-medic systems have significantly longer longevity than those in mixed systems.

I also don't have a problem with an EMT only IFT ambulance. Someone does not need a parmedic assessment when they are being transfered from St. Sent-Here-To-Die's care facility to the local hospital to have their skin rash re-assessed. Especially when the only reason they are going by ambulance because they can't sit up on their own, so the wheel chair transport won't take them. Or because they have mild dimentia and need to be watched, or any other number of the approved medicare reasons for ambulance transport.

I completely agree. In fact, I don't believe that non-emergency transfer ambulances should be required to have ANY medically trained personnel on board. If anything, they need nurses aide training, not EMT training. But that isn't EMS, so it's not even relevant to this discussion.

 

[daedalus]

I completely agree. In fact, I don't believe that non-emergency transfer ambulances should be required to have ANY medically trained personnel on board. If anything, they need nurses aide training, not EMT training. But that isn't EMS, so it's not even relevant to this discussion.

Perhaps it is relevant to our discussion only because so many enter EMT school hoping to get a career in EMS, and instead end up on a BLS IFT rig. It is not totally the fault of the EMT that she has to endure such a cruddy education and work a dead end job bringing grandpa home from the hospital, being spit on by everyone including other medical providers and the public. The budding EMT student may have a passion to enter EMS, and we do that student a great disservice by allowing EMTs to work IFTs. Instead, anyone with a real drive to work in EMS should be welcomed into our fold, because we need people like that, and be made to endure a proper education (paramedic school). I agree with your assessments, CNAs with lifting/moving and gurney education should work IFTs. We lose many good potential EMS providers who burn out in these jobs, I see it every week at my service. Some of the brightest and coolest guys I have ever known, who would have made amazing paramedics, instead have gone to nursing, physical therapy, etc. They are going to make amazing RNs and PTs, but we also need a slice of that amazing individual pie in EMS too. We are hemorrhaging our best human capital because of medicare fraud committing greedy private IFT ambulance providers who burn them out of EMS in a period of a few years.

 

[AJ Hidell]

Perhaps it is relevant to our discussion only because so many enter EMT school hoping to get a career in EMS, and instead end up on a BLS IFT rig. It is not totally the fault of the EMT that she has to endure such a cruddy education and work a dead end job bringing grandpa home from the hospital, being spit on by everyone including other medical providers and the public.

Again we mostly agree. But I do believe that it IS their fault. Anyone who jumps into something without first doing an intelligent job market analysis is responsible for the disappointing results. Going to EMT school to be a hero in an area where there are no EMS jobs is simply not smart. In fact, it is an epic fail that clearly illustrates a serious lack of common sense, so I'm not at all sorry that those people don't end up responsible for human lives.

 

[daedalus]

Again we mostly agree. But I do believe that it IS their fault. Anyone who jumps into something without first doing an intelligent job market analysis is responsible for the disappointing results. Going to EMT school to be a hero in an area where there are no EMS jobs is simply not smart. In fact, it is an epic fail that clearly illustrates a serious lack of common sense, so I'm not at all sorry that those people don't end up responsible for human lives.

Touche. It just breaks me to see my friends burn out and leave for greener pastures. Its actually a coincidence I got employed at a transport company at all. While volunteering at a free clinic, it was recommended by my physician mentor that I complete the semester long course so I would have a foundation in vital signs and simple auscultation so that he could allow me to examine his patients with him. After the course, the ice cream store I worked for closed down, so I applied to a private ambulance in the San Fernando valley and got initially bit by the EMS bug, but than depressed by the work I was doing. Now, hopefully, I will continue my EMS education and than education as a physician or PA and continue to advocate for EMS. Not all EMTs in this area are fails, but certainly a lot are.

 

[marineman]

Again we mostly agree. But I do believe that it IS their fault. Anyone who jumps into something without first doing an intelligent job market analysis is responsible for the disappointing results. Going to EMT school to be a hero in an area where there are no EMS jobs is simply not smart. In fact, it is an epic fail that clearly illustrates a serious lack of common sense, so I'm not at all sorry that those people don't end up responsible for human lives.

If we ever meet I'm going to buy you a drink.

Now back to your regularly scheduled education argument...

 

[Aidey]

But the current allowance of EMTs on ambulances is what perpetuates that flawed system. Take away the option and you take away the problem.

You can't blame the EMTs for the system. When a politician or some fear-mongering anti-tax nazi convinces everyone that having a tiered system is really better, that isn't the fault of the EMTs.

How long have you been a paramedic? Do you know one of the primary reasons that medics stay in EMS for such short careers? Burn-out. Do you know one of the number one reasons for paramedic burn-out? The overwhelming stress associated with having 100 percent of the responsibility for 100 percent of the patients you pick up every shift. When you have no partner (an EMT is not a partner. It's just a helper.), you have no one to share responsibilities with, and you burn out twice as fast. Studies show that medics in dual-medic systems have significantly longer longevity than those in mixed systems.

This may be true for high volume systems where an individual ambulance consistently runs 12 or 15 calls in a 12 hour shift, and in that case it does make sense to have a dual paramedic car. In slower systems were an individual ambulance works 6 or 8 runs in a 12 hour shift only one paramedic is needed IMO. In those 2 examples, the paramedics are all running about the same number of calls due to the variance in run volume.

I've run into a number of medics have big egos and get into this mindset that "oh any call where death isn't imminent is beneath me" and I think attitudes like that contribute to burn out significantly also.

 

[subliminal1284]

I have an idea, why not just make all paramedics go to med school.

 

[daedalus]

I have an idea, why not just make all paramedics go to med school.

No need. Paramedics educated in the basic sciences (a strong prerequisite foundation taking at least two full time semesters) and than an optimal paramedic program (ie not a medic mill, but a year long program not measured in hours but in competencies) leading to an A.S. degree, with graduates required to take an pass the national registry in all states, would be at a adequate level of competency without medical school.

Wishful thinking.

 

[subliminal1284]

I was being sarcastic

 

[VFFforpeople]

Re-reading, I see what you were saying now more clearly. I agree with what you are saying, and see what point you were making. Removing a 2level system would help cut down on the "ego" or the down talking, making it more fluid and easier running.

 

[Aidey]

Gah, we should not need to eliminate a 2 level system just to get rid of big egos and bad attitudes.

 

[mperkel]

hmmm

I definitely clicked the yes button.

Personally, I am one of those "users of the EMT certificate" I have plans for medical school and am currently working on my bachelor's of science degree.
I could not fathom a career in EMS, mainly because of the many flaws of the system.

Obviously, it would be a long process, and you must start from the ground up to change a broken system.

Here's just some of my idea I have thought about:

If there is a total revamp of the EMS system, many current EMT-B's and paramedics will expect themselves to be "grandfathered" into the new system.
This obviously would not work, because their level of training would be inadequate for the new positions.

To fix this, the following should happen;
-EMT-B's should become the level of First Responder, functioning in the same capacity as before.
-EMT-Paramedics should be allowed to function as EMT's with a required "transition course", enabling them to function in their current positions.
These changes would allow current EMTs to keep their jobs, and current pay levels.

For new EMTs, wanting to enter the EMS career, they would have to do the following.
-To be an EMT, you must go to a community college and receive an AS degree in "Emergency Medical Technician". This would include specialized courses, first year being basic science, mathematics, and english courses. Second year being more specific to medicine, with pharmacology, skill sets, clinical hours, ride-along, and testing. Much to the functioning of our current EMT-Paramedic level. These EMT's will be paid current paramedic salaries and function in the capacity of a paramedic.
-Those wanting a "simple" Emergency Medical quick course should take the a First Responder course, which would be about 150 hours of specific training like current EMT-Basic courses. They would receive wages similar to current EMT-Basic pay. They can function in the current capacity like an EMT-B.
-To become a Paramedic, a decent paying career, would be similar to nursing training. You would be require to take the Paramedic major, and get a degree preferably in Bachelor's of Science. You would go though basic undergraduate courses: math, science, anatomy, english, psychology, humanities, etc. Your last two years would consist of emergency pharmacology, specialized skills, internships, clinicals, field tests, and ride-alongs. All very similar to doing an ASN for 2 years and attending nursing school after. They will be paid similar to standard nurse's salary, and function in the field.

Overall, there would be 3 levels in EMS:
>EMR- Emergency Medical Responder, working on IFTs, driving ambulance, helping out. Ideal for someone wanting entry-level experience in an EMS job.
>EMT- Emergency Medical Technicians, working on ambulances, doing 911, standbys, events, etc. Limited drug education-similar to current Paramedics. Follows protocols, or direction of EP/Medical Director.
>EP, Emergency Paramedics (or something else), working on ambulances, called in for true Emergencies (911), obviously less positions than EMTs. Would have advanced medical knowledge, similar to Nurses, but specific to Emergency Medicine. Could make clinical judgements on patient care and confers with Medical Director.

In essence, a lot of people would be "downgraded", but keeping their current pay salaries and enhancing current Emergency Medicine.
Pre-hospital care would become respected and actually be another step to providing complete medical care.
Obviously, this would take a lot of time and reform to initiate.

Just my suggestions to take the professions of the EMS to the next level.
Comments and criticism welcomed!

 

[VFFforpeople]

Gah, we should not need to eliminate a 2 level system just to get rid of big egos and bad attitudes.

Not getting rid of lack of better term "BLS" or care like that. It is simply making people that want to do EMS work be top notch. I see it as a FF can't enter a house without Fire control 1,2,3. So, I am FC1-3, but my partner that maybe going with me is only FC1 or 1-2. Now we have a problem. It is like that in EMS, EMT is the lesser scope now how am I doing a full service to my community by being EMT? I am not , I am not the "best" I can be for them. That is really all it is about, what is best for the community, even if they only need a band-aid, never know what can happen in that time frame that could require a medic level.

 

[fortsmithman]

How exactly would a 4 year paramedic program be organized? Would it be organized along the same lines as the Bachleor degree program offered by Centennial College/University of Toronto, where the student only graduates as a Primary Care Paramedic / BLS level, or would the program be similar to the Bachleor degree program offered at Medicine Hat College, Alberta, where the student graduates as a Advanced Care Paramedic / ALS level?

As for an EMT/PCP/BLS program, I would like to see the same number of course hours of a 2 year program put into a 1 year program. I don't know about other areas, but the college programs at my area community college apparently don't spend enough hours in class, since they repeatedly trash the streets around the college during every drunken party. A few years ago they even had a homicide (a student was stabbed). Maybee if they were forced to spend more hours in their studies, they wouldn't wreck the neibourhood.

I checked the Centennial College web site and with that program after they graduate from the Centennial College portion they are eligible for licensing as primary care paramedics. I think after they complete the portion at U of T in Scarborough and get the Bachelor of Science in Paramedicine they may be eligible for advanced care paramedic licensing.

 

[HotelCo]

Geeze. I thought we were done with this thread.

 

[VentMedic]

Geeze. I thought we were done with this thread.

fortsmithman was responding to a question.

The Canadians take their discussions on education very seriously.

 

[Mzcr]

Just a little different perspective:

I have a BA, Business Mgmt. Got through part of my MBA years ago and decided I'd rather eat glass. I currently work in a senior professional level job in field related to my degree. I don't love it, but it pays the bills.

I've been interested in EMS for several years but couldn't afford the time/energy/money it would take to get the education required, minimal though it might be. I also cannot afford to quit my job to do EMS full time, now or probably ever.

But since I want to do something other than make decisions involving the specific gravities of Acrylobutilestyrene vs. polycarbonate/acrylobutilestyrene, I decided to go for it and get the education and do the job part time on the side. And I'm glad I did.

The training I took for a Basic certificate was two semesters at a Community College. Two and then three days a week, 4 hours class, and 72 hours of clinical rotations. I feel completely unprepared to do the job right now, but I'm not sure what else they could have taught me in school..I just need to do it.

Maybe its because I live in a rural area, but a big percentage of the people I know in EMS do it part time, volunteer, not as a full time job.

While I agree with the need for those in any profession at all to be able to string words together, and for EMS to understand how the human body works, if you are talking about adding one or two more A&P/Pharm/Biology type classes, no problem. If you're talking about adding the whole "Gen Ed" requirement, I don't agree. There's no way that taking a Fine Arts class is going to improve someone's EMS skills.

Why not just have a basic level of reading/writing/math and science that must be met to start a program? Those who do need the brush up will be required to get it. Those who can already do the basics can focus their limited time and energy on the subjects that really do matter.

EMS is a relatively low paying job in general, Basic especially so. If I'd been required to go through the whole AA/AS degree, there's no way I'd have done it and I think a lot of people would have made the same decision. It's just not worth it financially or time-wise for people who are working volunteer positions.

FWIW, I don't think my degree helps me in my day job either..it allowed me to get the job, but I learned next to nothing in 124 credit hours that I actually use. Most of what I know is based on experience. I have to think EMS will be the same way, except that the things I learned in class actually pertain to the job.