Future of EMS,,In your opinion

[Emt512]

Based upon the posts I got from the the last thread I started today makes me want to ask the more experienced members these questions...

With health care changes and reform coming what do you forsee for the future role of EMS?

Do you feel that the Community paramedic is a good idea? And why wouldnt RN's or PA's who are NREMT-P certified not be more suitable for the job?

Do fire/EMS combo services overall provide better services than private EMS ran companies?

 

[ExpatMedic0]

I think its pretty obvious that parts of america are lagging seriously behind. Paramedic level in the USA compared to every other western country in the world is lagging seriously behind. I think(hope) that it will only be a matter of time until we catch up to the rest of the world.

I support the community paramedic concept and it has been a success in country's like Australia and the UK from what I have read and discussed with co-workers from those country's,

 

[mycrofft]

Nice boots nd lights on vehicle, no knives except shanks.

 

[Melclin]

I think the biggest change and challenge will be moving to a culture of educated paramedics working in systems where clinical practice is evidence based and that evidence base comes at least in part from paramedics themselves. We have an increasing culture of paramedic lead change in clinical practice. We do not simply have doctors changing protocols that we have to strictly adhere too. We have an ever increasing level of flexibility to follow evidence based changes in the standard of care and adjust our own practice accordingly, even to the extent where that means directly contravening the guidelines. We also have facilities by which we can use the evidence base to drive official change in guidelines. Its not all rainbows and puppies (far from it) but especially for such a large service we do alright and we are certainly not the best or most progressive system in the country. To be honest I feel at the moment our biggest obstacles are to do with the administrative culture and finances. We have the infrastructure, education and culture to institute sweeping progressive changes, but we simply can't afford them.

I think the community paramedic idea is a great idea.

Its been a while since I was read in on the topic, but my understanding is that the literature out of the UK showed it to reduce ED utilisation, increase pt satisfaction and that it is cost effective & safe.

The problem with that model in the US is the level of education.

Here a bachelors degree is the entry level requirement for both nurses and paramedics. At most universities nurses, paramedics and other HCPs like OTs, midwives etc share the first same year's worth of subjects. The paramedic departments of most universities offer post graduate qualifications in various disciplines. Most commonly intensive care practice, much the same as nurses complete post grad studies to become crit care qualified. Both paramedics and nurses can and do pursue higher degrees including PhDs.

From there it is not such a big leap to design a "Primary care paramedic" or "Paramedic practice" masters course. Now compare that to the US that has almost no consistent academic framework on which to superimpose a system of education and research in such a discipline. Add to that intitutions that seem pretty keen on EMS no progressing (FD assosciation etc).

I think increased education is the future but we've all got a lot of work to do to get there.

 

[mycrofft]

Melclin

Prehospital EMS was originated in the US by the transportation department and continues to be run by it. Medcial conglomerates are moving to gather services under single roofs, and local counties are divesting themselves of their clinics.

Since we are a "rescue" oriented society, it will have to collapse and require rescue before any real improvement occurs.

 

[Joe]

Its just going to be a bunch of whiney kids who do nothing but complain amd expect handouts for easy work. The whole system needs to be demolished. And alot of our pts need to realize the sniffles are not a reason to call 911. Also separate 911 and ift's. Either you runn 911 or you domt.

 

[NYMedic828]

As I've said many times in the past, the only way EMS will survive, is to die a slow painful death and rise from the ashes under different architecture.

 

[Bullets]

the future of EMS in most states is a giant brick wall, because that is where we are hurtling uncontrollably towards.

The systems need to recognize who is doing things well and what works, not just here in the US but overseas. I find the NJ experience interesting because at the local level many would say that the system is too messed up to be fixed. With the DOH having no political strength and the NJSFAC being a politicians nightmare, the squads are a zoo. Yet at the state level, the NJEMSTF is incorporating many of the things that will eventually lead to change in the system. Physician fly cars, incident advance teams, security plans for ports, bridges, tunnels and rail, and most importantly, interagency operations and EMACs. i have to say we have done a great job developing a strong relationship with FDNY EMS, who is not known for playing nice with others.

Realistically the state DOHs need to step in and establish a base licence for EMS operations.

 

[Tigger]

Its just going to be a bunch of whiney kids who do nothing but complain amd expect handouts for easy work. The whole system needs to be demolished. And alot of our pts need to realize the sniffles are not a reason to call 911. Also separate 911 and ift's. Either you runn 911 or you domt.

Got salt?

Sorry we can't all dedicate our lives to EMS, or aren't willing or fortunate enough to work exclusively in a 911 system. I do just fine switching from the renal roundup to taking a call for our 911 contract or backup for the city, I guess I don't see your point.

 

[Bullets]

Got salt?

Sorry we can't all dedicate our lives to EMS, or aren't willing or fortunate enough to work exclusively in a 911 system. I do just fine switching from the renal roundup to taking a call for our 911 contract or backup for the city, I guess I don't see your point.

You may find it easy, but much like medics, the skills deteriorate if they arent used. An EMT who only does IFT and isnt using the full assessment skills and techniques ill see some decay when it comes time to apply them. With a heavy healthcare industry in my town, we commonly have an IFT truck on scene of MVCs prior to 911 arrival. Very rarely have i found those EMTs treating or have a report to give to me. The EMT cirriculum is not an ideal course of education for someone who is going to do IFT on a daily basis.

There needs to be some type of education focused on the IFT worker. Something that highlights the chronic illnesses they are more likely to face on a daily basis, something that allows for the IFT to better understand their patient and what they are experiencing.

 

[NYMedic828]

Seriously what skills are you maintaining?

How to apply a NRB?

How to splint an arm?


IFT providers should be performing assessments and interacting with pateithe which are the only actual skills an EMT need perfect. The rest is common sense.

 

[Veneficus]

You may find it easy, but much like medics, the skills deteriorate if they arent used. An EMT who only does IFT and isnt using the full assessment skills and techniques ill see some decay when it comes time to apply them. With a heavy healthcare industry in my town, we commonly have an IFT truck on scene of MVCs prior to 911 arrival. Very rarely have i found those EMTs treating or have a report to give to me. The EMT cirriculum is not an ideal course of education for someone who is going to do IFT on a daily basis.

There needs to be some type of education focused on the IFT worker. Something that highlights the chronic illnesses they are more likely to face on a daily basis, something that allows for the IFT to better understand their patient and what they are experiencing.

Just pointing out with the exception of trauma, poisoning, and a handful of inflammatory processes, all 911 patients suffer from chronic disease.

You know what EMS does for trauma, poisoning, and inflammatory dysregulation?

They drive the patient to the hospital.

 

[Tigger]

You may find it easy, but much like medics, the skills deteriorate if they arent used. An EMT who only does IFT and isnt using the full assessment skills and techniques ill see some decay when it comes time to apply them. With a heavy healthcare industry in my town, we commonly have an IFT truck on scene of MVCs prior to 911 arrival. Very rarely have i found those EMTs treating or have a report to give to me. The EMT cirriculum is not an ideal course of education for someone who is going to do IFT on a daily basis.

There needs to be some type of education focused on the IFT worker. Something that highlights the chronic illnesses they are more likely to face on a daily basis, something that allows for the IFT to better understand their patient and what they are experiencing.

The only thing that is going to deteriorate is one's assessment skills, and there is no excuse not to assess every patient, IFT or not. As for "interventions," what is there to decay? We teach 14 year olds how to backboard someone in a pool, surely it can't be that hard. The actual interventions provided by EMTs are just not that complicated.

I agree that the EMT course does very little to educate those that do BLS IFT.

 

[Veneficus]

There is a possibility that the assessment skills of IFT are actually better.

They see the progression of disease processes over time.

They see the entire history.

The med lists are more accurate. They also usually say what the meds are for.

They also regularly deal with patients who are sicker than most 911 patients.

 

[Tigger]

There is a possibility that the assessment skills of IFT are actually better.

They see the progression of disease processes over time.

They see the entire history.

The med lists are more accurate. They also usually say what the meds are for.

They also regularly deal with patients who are sicker than most 911 patients.

But because I don't run 911 calls all the time, I am somehow an inferior provider based on the attitudes displayed in this thread. I didn't use my lights and sirens, so therefore I am not part of the club. Oh well. :sad:

 

[Veneficus]

But because I don't run 911 calls all the time, I am somehow an inferior provider based on the attitudes displayed in this thread. I didn't use my lights and sirens, so therefore I am not part of the club. Oh well. :sad:

Neither am I, we can start our own club.

 

[RocketMedic]

Neither am I, we can start our own club.

Can I join? I'm woefully underknowledgeable...

 

[Veneficus]

Can I join? I'm woefully underknowledgeable...

Of course. But our first by-law is that the new guy has to bring doughnuts.

Not those health conscience muffins either.

 

[VFlutter]

Education, Education, Education

Something to think about....

Kindergarten teachers require a 4 year bachelors degree to teach little kids how to color and count to 10 yet we allow paramedics to be taught by instructors who only hold associates degrees (Is that a requirement? I know most instructors I have seen have AAS but do some programs just have paramedics teaching?). What in a paramedic associates degree prepares them to be able to teach or to do anything more then flip through pre-made powerpoints distributed with the text books? Its like the blind leading the blind.

The educational standards for EMS need to drastically improve but that will be a long road. Start with increasing the requirements for instructors and hope that the quality of education will improve. Let someone who has actually understands the science behind what we do teach us.

Since I always compare everything to nursing... instructors are required to have their MSN to teach. Many are DNP/Phds. My patho instructor had his Phd in physiology.

And as Vene has said before, many of us that have gone through actual education have spent more time in lab then some paramedic courses. That is pretty pitiful

 

[NYMedic828]

Something to think about....

Kindergarten teachers require a 4 year bachelors degree to teach little kids how to color and count to 10 yet we allow paramedics to be taught by instructors who only hold associates degrees (Is that a requirement? I know most instructors I have seen have AAS but do some programs just have paramedics teaching?). What in a paramedic associates degree prepares them to be able to teach or to do anything more then flip through pre-made powerpoints distributed with the text books? Its like the blind leading the blind.

The educational standards for EMS need to drastically improve but that will be a long road. Start with increasing the requirements for instructors and hope that the quality of education will improve. Let someone who has actually understands the science behind what we do teach us.

Since I always compare everything to nursing... instructors are required to have their MSN to teach. Many are DNP/Phds. My patho instructor had his Phd in physiology.

And as Vene has said before, many of us that have gone through actual education have spent more time in lab then some paramedic courses. That is pretty pitiful

The biggest issue here in my opinion is that paramedic training institutions are about making money. It is cheap to hire and instructor that meets the minimum standards. I can pay a paramedic instructor the regular street rate and they won't fuss. How much more do you think someone wants to be paid when they are a DNP or Ph.D or even a doctor? It cuts greatly into the profits of the organization.

Until someone above the level of the organizations such as the state or federal government steps in and says "hey, lets get some actual instructors these guys are no longer adequate" nothing will change.

The dollar sign will always rule.