Would you like to be a Primary Care Paramedic?

[KELRAG]

To jrm818... Besides the obvious ami/cva/asthma pts you mentioned, look at ARDS net and surviving sepsis campaign. These are two that recognize the benefits of early interventions and suggested their role in prehospital care. When it comes to trauma, I don't fully agree with Bledsoe's recent stance on "the golden hour" which arrived from the controversial article dismissing the role of aeromedical services,it seems a little extreme but one of the underlying ideas was that a good portion of stabilization can occur on scene. Too often medics are falling back on the old standard of throwing the pt "in the back" and do all the interventions en route. This is an opinion held by many Pro-ems EM docs.

Addressing the commonly held belief by the international paramedics that pay attention; ems education in the us needs to be improved but it is heading in the right direction. At least in Texas, we now have the pathophys/a&p/bio etc... requirements. I went to a relatively well respected school that takes their science majors a little too seriously and did decently. To be honest, I don't think the years with test tubes, behind microscopes and buried in text books were overly helpful with being a medic. I know for sure my world lit hasn't done a damn thing. I work with medics that went to community college who are amazing! I can give u an exhaustive explanation on the multiple modulators of dopamine but the best medics know how to work on their feet. As hard as this may hurt. Our job isn't all the theoretically difficult. Common sense in a significant amount of situations will trump "extensive" knowledge of disease processes.

 

[Bieber]

I've been lurking here in the conversation and I've got to say, Veneficus and medicRob, you hit the nail straight on the head. It's the sad unfortunate truth that you're right, a trained EMT-B who knows how to do the skills could do my job. My protocols are literally step by step cookbook medicine, and what's even sadder is that this rigid structure still persists even in my state where paramedic requires an Associate's degree.

18g, I get what you're saying, but you've got to recognize that Veneficus is right, there's nothing about paramedics that is special as long as are protocols are rigid step-by-step instructions that tell us what to do, as opposed to guidelines that suggest the standard of care to be deviated from per our own discretion and clinical judgment. As long as you can do a basic assessment and are trained in the skills, you don't even hardly need to be an EMT--a first responder could do what we do. It's sad to admit it, and I think that's where you're coming from, but it degrades the paramedic and waters it down to nothing but a skill monkey (see, warm body).

And that is exactly why we absolutely HAVE to increase educational standards. I'm right there with medicRob, an Associate's HAS to be the MINIMUM. And I'll tell you, as an Associate's paramedic, I still don't feel like I know jack :censored::censored::censored::censored:. I'll be getting the shiny degree this spring, and let me tell you, I struggle every day to try and feel like I am capable of caring for patients. So how in the world is a six month paramedic mill graduate going to be competent to take care of critical patients?

There's three basic steps to making paramedic something valuable: step 1, increase educational standards (i.e. make us a true recognized profession), step 2, lobby to change the medicare scheduling so we can bill for service as opposed to transport (BLS, ALS 1, ALS 2, etc), and step 3, convince the physician community that we know what the hell we're doing (as evidenced by step 1), and get them to toss the cookbook protocols in the trash and give us clinical guidelines.

Until we can do step 1 and 3, we're nothing but EMTs with a couple of cool tricks, and until we can do step 2, you might as well kiss the dream of community paramedicine goodbye.

I want to be a great paramedic, I'm not one yet. I want to be able to use my clinical judgment and really be able make a difference for my patients and be able to provide them with a unique service that nobody but a paramedic could offer, but I can't yet. And it sucks to admit it, but it's the sad, unfortunate truth of American EMS. There's something very noble about EMS, I think, but we've got a long way to go before we can really step into the role we all so desperately want to play.

Instead of fighting against the truth, we need to be working to make this dream a reality. Call up your board of EMS today, and DEMAND that they raise educational standards. DEMAND that they pursue higher level education for paramedics as the standard and that they provide options for increasing your education in EMS besides more alphabet certs. THAT's going to do a lot more for EMS than arguing the reality with people online.

 

[jrm818]

To jrm818... Besides the obvious ami/cva/asthma pts you mentioned, look at ARDS net and surviving sepsis campaign. These are two that recognize the benefits of early interventions and suggested their role in prehospital care.

I didn't mean to suggest that EMS is worthless or that there is no benefit whatsoever of advanced prehospital care. I was trying to agree with the other criticisms of the idea that "ALS" (as currently practiced in the US) is a justified healthcare expense because of all the cool skills that paramedics can perform that basics cannot.

As far as adding to the list: as far as I'm aware (correct me if I'm wrong), there is not yet any good evidence that starting early goal directed therapy in the field or that implementing ARDS care in the field improves outcomes. It may well prove to be an area of great potential, however it also may turn out that it doesn't matter if we dump fluids into septic patients 15 minutes early.

If we want EMS to grow we can't keep hanging our hat on a short list of specific conditions that benefit from early intervention: the list is short, and unskilled poorly paid cookbook providers can perform interventions just as well. There needs to be increased value in the form of educated providers who can address the needs of a wide variety of patients in a meaningful way.

ARDSnet and Surviving Sepsis are really great (for patients, and maybe for EMS), and may be a push in the right direction: since there's no prehospital tests for recognizing ARDS or Sepsis, diagnosis might require a bit of clinical understanding and good history/physical skills. Honestly, I'm not certain a lot of the paramedics I see would do very well at this; I'm not certain that I've been educated well enough myself.

When it comes to trauma, I don't fully agree with Bledsoe's recent stance on "the golden hour" which arrived from the controversial article dismissing the role of aeromedical services,it seems a little extreme but one of the underlying ideas was that a good portion of stabilization can occur on scene. Too often medics are falling back on the old standard of throwing the pt "in the back" and do all the interventions en route. This is an opinion held by many Pro-ems EM docs.

I haven't read any comment by Bledsoe, but are you referring to this article?: http://www.ncbi.nlm.nih.gov.ezproxy.uvm.edu/pubmed/19783323

Addressing the commonly held belief by the international paramedics that pay attention; ems education in the us needs to be improved but it is heading in the right direction. At least in Texas, we now have the pathophys/a&p/bio etc... requirements. I went to a relatively well respected school that takes their science majors a little too seriously and did decently. To be honest, I don't think the years with test tubes, behind microscopes and buried in text books were overly helpful with being a medic. I know for sure my world lit hasn't done a damn thing. I work with medics that went to community college who are amazing! I can give u an exhaustive explanation on the multiple modulators of dopamine but the best medics know how to work on their feet. As hard as this may hurt. Our job isn't all the theoretically difficult. Common sense in a significant amount of situations will trump "extensive" knowledge of disease processes.

I obviously don't know you, so I can't speak for your experience, but I can say I'm skeptical that you haven't been aided by more education. I think if I asked most medics I know about "sepsis" "early goal directed therapy" "ARDS" or anything like that I'd get blank stares, some reference to protocols, or "we're not doctors." You seem to have a rather different view, and I can't help but wonder if your education has something to do with it.

As someone else said: in he US, there is no difference in practice between well educated and poorly educated providers. In most jurisdictions, both versions of "paramedic" practice the same algorithmic approach, which certianly does not require the sorts of thinking skills you practiced in school. I have no doubt that even most medic mill paramedics are capable of hanging a bag of dopamine according to the recipe. In the current practice environment it indeed doesn't matter that you understand how it works and they don't.

That's my point really: I think the sort of education you completed has the potential to increase the value of EMS given the right practice models. I think this potential is far more than the potential gain in "value" from adding some cooler skills or doing some studies to prove that we can improve outcomes for 6 specific conditions instead of 4.

That's what I want: I don't want to be in a field that challenges me by seeing how many recipes I can memorize and how long I can spend working long hours for poor pay. I want to be in a field which challenges me by requiring critical thinking and judgment, gives me tools to meet the needs of my patients, and respects me as a professional. As Beiber notes, I doubt I'm even qualified to ask for those things, and that's a problem.


And, a defense of lit (I did a lit minor just for fun so I may be a bit biased): Lit is great for making you cultured and working on writing skills so you can sound wicked smart, but that's not even the real value. Analyzing literature (perhaps not in your specific class, there are many crappy lit classes, but in general) requires looking closely at a text, evaluating the authors perspective, biases, and goals, comparing and weighing different bits of information, and ultimately making a judgment about "so, what does this mean?" The critical thinking skills you practice can be applied to a wide range of environments, including *gasp* EMS: dealing with patients and co-workers, evaluating research or practice advisories, etc.

 

[jrm818]

Numbers may not mean everything, but numbers talk. There is a reason the evolution of medicine relies so heavily on research. Also, as far as research being 'rigged', etc. Anyone with a proper education in research evaluation can spot a so called 'rigged' study from a mile away.

Tell that to the people who took Vioxx...

Sorry, agree with everything else, but have to take issue with this. There are well recognized problems with attempting to sort the wheat from the chaff in research: it's much harder than you suggest. There is a good amount of documentation about the failure of peer review to adequately control the quality of studies, the quality of post-publicaiton criticism, the role of buisness and advertising in literature, and the sheer volume of low quality studies that are published. The editor of the Lancet has said something to the tune of: "we've become nothing but an advertisement for drug companies," and several other editors have made similar statements.

For a EM perspective,from one of the editors of Annals (just to prove I'm not off my rocker): http://www.ncbi.nlm.nih.gov/pubmed/20702543

 

[Veneficus]

Tell that to the people who took Vioxx...

Sorry, agree with everything else, but have to take issue with this. There are well recognized problems with attempting to sort the wheat from the chaff in research: it's much harder than you suggest. There is a good amount of documentation about the failure of peer review to adequately control the quality of studies, the quality of post-publicaiton criticism, the role of buisness and advertising in literature, and the sheer volume of low quality studies that are published. The editor of the Lancet has said something to the tune of: "we've become nothing but an advertisement for drug companies," and several other editors have made similar statements.

For a EM perspective,from one of the editors of Annals (just to prove I'm not off my rocker): http://www.ncbi.nlm.nih.gov/pubmed/20702543

I think what medic rob is trying to say is that a provider must be skilled enough to evaluate the studies and evidence on their own.

Based not only in statistical analysis which is a must, but also with competent knowledge of known scientific theory as well as experience in clinical medicine.

I read many studies every day and I can agree, it takes me no time at all to recognize garbage when I see it.

 

[18G]

"It's the sad unfortunate truth that you're right, a trained EMT-B who knows how to do the skills could do my job. My protocols are literally step by step cookbook medicine..."

18g, I get what you're saying, but you've got to recognize that Veneficus is right, there's nothing about paramedics that is special as long as are protocols are rigid step-by-step instructions that tell us what to do, as opposed to guidelines that suggest the standard of care to be deviated from per our own discretion and clinical judgment. As long as you can do a basic assessment and are trained in the skills, you don't even hardly need to be an EMT--a first responder could do what we do. It's sad to admit it, and I think that's where you're coming from, but it degrades the paramedic and waters it down to nothing but a skill monkey (see, warm body).

I know I said I was done commenting but wanted to comment on this...

Unless you have some super EMT-Basics where your at (not a slam towards Basics) I would never want them performing high acuity ALS skills! That is way too scary. I recently helped out with a First Responder program and they had a hard enough time remembering their CPR sequence... so you really think a First Responder could learn much higher acuity skills?... ummm.. no.

Regardless of protocols, you always have discretion and the ability to deviate. Some protocols are much more strict in how you go about doing this, but you can easily do it by consulting with Medical Command. I follow protocols but I also treat my patient with my own clinical judgement. For example, a COPD exacerbation I had who was febrile with highly probable resp infection and dehydrated. Did my COPD/Asthma protocol mention about giving this patient a fluid bolus? No it didn't.... but its called treating your patient, common sense, and being a good practitioner! and no I didnt call MC... there was no need too. Just because something isn't explicity defined in medical protocol does not mean it can not be done. It sounds like I am more fortunate then you here in PA and actually have some decent protocols that treat Paramedics as though they are educated to make clinical decisions.

I have seen providers use the "its not in protocol" excuse and the too lazy to call command to get their patient what they need.

As someone else said: in he US, there is no difference in practice between well educated and poorly educated providers.

Strongly disagree. If a poorly educated provider is not able to formulate the proper general impression or diagnosis, then how are they going to be able to execute the appropriate treatment plan or institute the proper modalities under protocol? Why treat a severe pneumonia patient as CHF when we shouldn't be? So there is a huge difference between a educated and poorly educated provider. I been around long enough to know the difference.

And I have to ask the question, if nobody believes in ALS then what are you even doing here? Why are you even working as a Medic? With your attitudes, your the last people I would want taking care of someone I know and surely aren't people I would want to work with in the field.

There is validity to some of what has been said but its not the extreme that is being portrayed.

 

[Veneficus]

And I have to ask the question, if nobody believes in ALS then what are you even doing here? Why are you even working as a Medic? With your attitudes, your the last people I would want taking care of someone I know and surely aren't people I would want to work with in the field.

In many instances in history, the reluctant participant often makes a greater diiference for the better than the zealot.

 

[MrBrown]

As someone else said: in the US, there is no difference in practice between well educated and poorly educated providers.

There is no discernible difference on the outside, and that is how the Fire Service and all the barely homeotasasing loser Parathinktheyare's with poor cerebral perfusion who carry round a cookbook for retarded idiots get away with it.

 

[SeeNoMore]

I am sorry you are offended 18G, I think there are certainly very good paramedics and I agree with you that some of what Paramedics do makes a differene and I think your point about relaving suffering being a wothy goal in and of itself is valid.

I really do think there should be Paramedics, just less and more focused. But I don't hold much hope for EMS improving, mainly because few seem to expect it.


I was working a code today at an ER and the person came in with the ET tube misplaced with here distended belly rising with every bvm squeeze. I don't know the medic in question, and I am not saying they were not good overall, but in this case it seemed like quite an oversight as even I , not the brightest bulb nor having ever done an intubation could see the belly rising and how distended it was.

I was talking to folks after in the ER and they did not seem that bothered, the general impression seemed to be that this sort of thing just happend when medics intubated. Its troubling that we are regarded as barely compent in many areas, and even worse that many in EMS se generally unconcerned with making things bette, even if it means drastic changes.

 

[18G]

It's cool... I'm not offended. I just don't totally believe all that is being said from three voices out of a million. The situation in EMS needs improvement and that has already been recognized on a National level with changes being made as we type.

It's not appropriate that only one side of an issue gets heard and stated as absolute. Hopefully, others are able to understand that the EMS system is not as severely broken as is portrayed on this forum and realize that we have many, many great pre-hospital practitioners in our Country that provide very professional, competent, and high quality care everyday. EMS, and ALS specifically, does make a difference and there will always be a desire to have and need Advanced Life Support care in our Communities.

I support the initiative to raise the educational standards very much and am all for it. In fact I am a huge supporter of it. But at the same time do not belittle the majority of EMS professionals that take their role very serious and provide great care every single day and who already have a solid educational and clinical background.

Having RN, MSN, and whatever else behind your name doesn't automatically make you the best person for the job either. Education is vital but isn't the end-all of what makes a great EMS provider.

So take both sides into consideration and think of your own field experience and formulate your own opinion. I highly encourage ALL regardless of cert level to always strive to learn more and prove to certain people in the world that you aren't a bunch of idiots and are very capable and do in fact provide awesome EMS care.

 

[Veneficus]

Hopefully, others are able to understand that the EMS system is not as severely broken as is portrayed on this forum and realize that we have many, many great pre-hospital practitioners in our Country that provide very professional, competent, and high quality care everyday.

If there were so many great providers being a paramedic would be a reputable healthcare profession that could stand on its own.

Not a bunch of protocol driven laborers who have held EMS back in the stone ages with their saving lives lights and sirens response time matters mentality while the rest of the world advanced.

If that is the measure of great, we could all do without it.

Have a look at a majority of protocols and practicioners around the country.

Congratulations on a job not done hero.

 

[18G]

If there were so many great providers being a paramedic would be a reputable healthcare profession that could stand on its own.

Not a bunch of protocol driven laborers who have held EMS back in the stone ages with their saving lives lights and sirens response time matters mentality while the rest of the world advanced.

If that is the measure of great, we could all do without it.

Have a look at a majority of protocols and practicioners around the country.

Congratulations on a job not done hero.

Now your task is to make your face known and make your statements in a very public forum, in person Nationally. If you have all the answers and have this thing figured out and everyone else is wrong then step up and let it be known. I mean if millions of people who have much more experience then you who actually are doctors are all wrong, then please... be our EMS savior and get us out of this horrible, horrible mess. Please save us all from these thousands of horrendous monsters called Paramedics.

Write for JEMS, EMS World, and other Publications and let the world know your position and how you can solve the problem. You will be lauded as a real hero then. As I already stated I never claimed to have all the answers and am a willing participant to make the system better. Your obviously not. So get out and stop complaining since you obviously lost the desire.

It's quite easy with anonymity to put down a group of people. You already admitted you say what you do because your jaded. Your biased which is obvious.

 

[boingo]

I remember an RRT that had a similar outlook....

 

[18G]

Vene and VentMedic would make a great couple...lol.

 

[8jimi8]

Now your task is to make your face known and make your statements in a very public forum, in person Nationally. If you have all the answers and have this thing figured out and everyone else is wrong then step up and let it be known. I mean if millions of people who have much more experience then you who actually are doctors are all wrong, then please... be our EMS savior and get us out of this horrible, horrible mess. Please save us all from these thousands of horrendous monsters called Paramedics.

Write for JEMS, EMS World, and other Publications and let the world know your position and how you can solve the problem. You will be lauded as a real hero then. As I already stated I never claimed to have all the answers and am a willing participant to make the system better. Your obviously not. So get out and stop complaining since you obviously lost the desire.

It's quite easy with anonymity to put down a group of people. You already admitted you say what you do because your jaded. Your biased which is obvious.

You haven't been reading close enough obviously. Every Week he posts part of the solution to the problems in EMS. Part of that is recognizing the weaknesses.

You keep shouting about how great care paramedics are providing, when you don't realize that. the Paramedic "INITIATES" care. Vene is trying to get you to realize the potential of "DEFINITIVE" care.

Get off your high horse and help him.

 

[18G]

You haven't been reading close enough obviously. Every Week he posts part of the solution to the problems in EMS. Part of that is recognizing the weaknesses.

You keep shouting about how great care paramedics are providing, when you don't realize that. the Paramedic "INITIATES" care. Vene is trying to get you to realize the potential of "DEFINITIVE" care.

Get off your high horse and help him.

I more then get it.

Paramedics providing definitive care was never the intention of EMS which makes it not appropriate to be slamming Paramedicine for performing its original mission. A new and expanded role for the Paramedic is certainly a great thing and an area I see great potential as well. But again, don't portray what Paramedics currently do as falsely as possible in hopes of achieving the new expanded role more quickly.

An expanded role is a whole NEW territory. So why expect it to happen over night? Your gonna get much better response and initiative of providers by encouraging and supporting current Paramedics then you will by belittling them and filling them with animosity which naturally leads to resistance. That's what I'm saying.

By its very nature field care is "initial" care and is a very important phase to dedicate ones self too. Your mentioning "initial" care as if its of lesser importance.

And during this entire thread I haven't heard anyone else offer suggestions. All I have heard is that all Paramedics suck and are worthless pretty much.

 

[8jimi8]

I more then get it.

Paramedics providing definitive care was never the intention of EMS which makes it not appropriate to be slamming Paramedicine for performing its original mission. A new and expanded role for the Paramedic is certainly a great thing and an area I see great potential as well. But again, don't portray what Paramedics currently do as falsely as possible in hopes of achieving the new expanded role more quickly.

An expanded role is a whole NEW territory. So why expect it to happen over night? Your gonna get much better response and initiative of providers by encouraging and supporting current Paramedics then you will by belittling them and filling them with animosity which naturally leads to resistance. That's what I'm saying.

By its very nature field care is "initial" care and is a very important phase to dedicate ones self too. Your mentioning "initial" care as if its of lesser importance.

And during this entire thread I haven't heard anyone else offer suggestions. All I have heard is that all Paramedics suck and are worthless pretty much.

I haven't seen anyone say paramedics suck. quit acting all butthurt and step up and drag the industry forward. Quit crying about yesteryear's mission. The mission is evolving. Sorry i really have no more to add to this. i'm checking out.

 

[usalsfyre]

Paramedics providing definitive care was never the intention of EMS which makes it not appropriate to be slamming Paramedicine for performing its original mission.

But it is appropriate to slam EMS for not recognizing or being willing to step up and take care of the need at hand.

A new and expanded role for the Paramedic is certainly a great thing and an area I see great potential as well. But again, don't portray what Paramedics currently do as falsely as possible in hopes of achieving the new expanded role more quickly.

You, I and probably most others on this forum understand the absence of evidence does not equal the evidence of absence. Unfortunately, this isn't an easy sell to legislators who allocate the money. At some point, these people are going to start asking some very uncomfortable, hard to answer questions about what their money is getting them. Without evidence, it's not going to be easy to sell our role.

An expanded role is a whole NEW territory. So why expect it to happen over night? Your gonna get much better response and initiative of providers by encouraging and supporting current Paramedics then you will by belittling them and filling them with animosity which naturally leads to resistance. That's what I'm saying.

I don't disagree with you here BUT....any mention of requiring paramedics in my area to do more education is met with screaming, threats, calls for the union to get involved where applicable, ect. This is not a few lo level providers, this is from most providers, and a lot of the service administrators here.

By its very nature field care is "initial" care and is a very important phase to dedicate ones self too. Your mentioning "initial" care as if its of lesser importance.

It's initial but never definitive. It's expensive, and refers patients to a more expensive area of medicine because we've decided we can't trust providers. Expensive=bad in the current healthcare environment.

And during this entire thread I haven't heard anyone else offer suggestions. All I have heard is that all Paramedics suck and are worthless pretty much.

Honestly, I'm more and more getting to the attitude that most paramedics DO suck. Because they refuse to get with the program and realize they can offer a lot more to the average patient. They suck because they want more money to do what is right by most patients. They suck because they don't realize how limited their knowledge really is. I'm not referring to most of the paramedics who read and post here regularly, I'm talking about the "just average" guy at your service. I'm sick of hearing the complaining and the desire for respect without wanting to do the work to achieve it. I'm sick of hearing paramedics tell patient's "we're not a taxi" despite having nothing more to offer than transport in the majority of cases.

There's alot of leaders on here who could lead EMS out of the dark age it's in. But the low to average level providers are liable to lynch them first.

 

[Veneficus]

Now your task is to make your face known and make your statements in a very public forum, in person Nationally. If you have all the answers and have this thing figured out and everyone else is wrong then step up and let it be known.

It is not that I have all the answers and everyone else is wrong.

I have my own perspective on what the answers are and what is wrong.

Do you really think that my opinion that EMS needs not only more education but to diversify hasn't been said by anyone else for the last 20 years?

Do you think Industry leaders in Places like Wake County haven't figured it out?

Even the current writers for many of your esteemed industry magazines have said the exact same thing. If I thought adding my name to it would help, I would do so. But all it would buy is "Who the hell is he to say these things?"

Even titles are not respected. There is a medical director in Naples Florida who is a real doctor who tried to do what he feels is best for patients by EMS. Did you follow how far that worked out?

I have signed my name to some direct accusations to some internationally recognized doctors in EMS that it was their neglect and impotence that allowed this to happen.

You know the response?

"We are impotent because services we demand more of have us replaced by somebody more willing to play ball."

That is a direct statement demnstrating it is providers holding it back. Not physicans.

You are doing the samething every mediocre parathinkyaare around the nation is doing. Claiming to be good enough and making excuses to not actually do anything for yourself.

Your life saving ability doesn't even qualify you to work on a truck in any other modern nation. You have simply effectively sold your snake oil to the American public and politicians.

I mean if millions of people who have much more experience then you who actually are doctors are all wrong,

Are you suggesting that millions of doctors are actually advocating what the modern US EMS system is vs. simply making it that way because they are not currently capable of more?

Are you suggesting that protocols are not written for the least common denominator of practicioner?

Are you suggesting that EMS effectiveness is measured in response times because doctors who know think it should be?

Do you think high flow o2 as protocol saves lives because an EMS director signed off on it. Because in the first days of medical school we were told that was poor medicine. If doctors are teaching future doctors things like this, why are the great life saving EMS providers still doing it?

Why does every doctor which much more knowledge and experience than I may ever hope to possess tell me to quit wasting time with EMS?

Becuase it is effective?

You may have helped a handful of patients in your career simply because you were better than nothing, but it certainly doesn't make it great.

then please... be our EMS savior and get us out of this horrible, horrible mess. Please save us all from these thousands of horrendous monsters called Paramedics.

Write for JEMS, EMS World, and other Publications and let the world know your position and how you can solve the problem.

First off, I would never write for that utter trash of a magazine called JEMS. I would be forever contaminated.

One of the editors of EMS world posts here, if he wanted an article, he has but to ask.

You will be lauded as a real hero then.

Like every other person who has said similar things in different ways?

Pearls before swine...

As I already stated I never claimed to have all the answers and am a willing participant to make the system better. Your obviously not. So get out and stop complaining since you obviously lost the desire.

If you are willing to make the system better, why instead of actually doing some research to provide something concrete, or lobbying to make a degree a requirement to be a "life saving paramedic," do you simply supply anecdotes of when you are valuable? Especially when those make up probably 5% of your total work load.

What if paramedics were only paid when their care made a demonstratable difference in outcome?

If you haven't noticed, in the US, there is a growing effort to only pay for medicine that actually makes a demonstratable difference at all levels.

It's quite easy with anonymity to put down a group of people. You already admitted you say what you do because your jaded. Your biased which is obvious.

Am I any more biased than you are?

Despite having no demonstratable evidence to your effectiveness, despite not being qualified to touch a patient in any other modern country. Despite all your treatments end with "transport to the ED." Despite the fact there are major published studies demonstrating EMS is not cost effective. Despite a plethora of studies demonstrating paramedics have trouble with everything from intubation to destination selection based on out dated concepts, you seem to think paramedics are worth what they are paid because they save lives, occasionally, when the patient falls into your treatment algorythm, not because they have the tools and knowledge to select what is best.

Tell me, if paramedics are so smart and capable, keeping in mind that I not only worked as a medic but teach them also:

Why do they have to be told to take trauma patients to a trauma center?

Why do they have to be told to take cardiac patients to a cardiac center?

Why do they have to be told to take stroke patients to a neuro center?

Why are those things not only in education but written into protocols?

Why do paramedics tell people how great the local hospital is by saying it is a level I? Level one what? Trauma center? Because if I was having an MI, or a CVA, or even COPD exacerbation, I wouldn't give a crap what kind of trauma service a place had.

Incidentally, if being a paramedic is so effective, why do all the upper end ones seem to move on to other healthcare fields? How many doctors, nurses, RTs, etc are simply using that profession as a stepping stone?

Why does the average EMS provider quit after 5 years?

 

[18G]

I'm not gonna buy into the stance that every US Paramedic is a complete idiot and moron with no sense about them and who cannot manage patients effectively and appropriately.

Take a bunch of RN's and put em in the field and your still gonna need a framework of policies, directives, and protocols. Perhaps a bit different then what is written now, but its not gonna be unlimited practice and decision making.

Unfortunately, I have to work full and part-time and will be going back to school next semester to finish some classes and also have kids, so I don't have the time or energy to lead a charge for EMS reform. Put the changes in place and I'm there. Force of hand is probably what its going to take. EMS providers will step up or move over... Union or no Union. Sometimes that is what it takes. States or perhaps the EMS movement in the Federal government is gonna have to say this is the way its gonna be, this is the new stage for EMS... learn the lines or get off the stage and allow the pieces to fall into place from there.

I don't like the excuses anymore then the next person but at the same time I don't dismiss and overlook the many Paramedics who do a great job everyday.

It's been a nice discussion but I'm gonna have to agree to disagree. Vene, you do pose some valid question and point out issues that need attention and I do agree with those. But the overall tone is what I am disagreeing with. Paramedics as a whole are not worthless... some, definitely... but not the majority. I appreciate you (and everyone else) taking the time to share your position and I do respect your knowledge and experiences that seem to be considerable and certainly more then my own. I am a hard headed person and am passionate about my field and believe in what we do (obviously, right?). So naturally I am going to pull from my almost two decades of EMS service and oppose insults to my profession and peers when they are unwarranted.