# Paramedic Degree



## Melclin (Jun 18, 2009)

I'm becoming increasingly interested in how paramedicine is taught given the unique nature of our field - that combination of highly academic medical knowledge with an almost paramilitary organization and role.

I have many ideas and theories developing on the way things should be taught but in this post I'm ganna just ask for your opinions on the basic idea, and structure of, my paramedic degree, or the "Bachelor of Emergency Health (P.med)". 

Do you agree with the idea of university based paramedic education (keeping in mind that we don't have EMTs; here, its paramedics backed up by intensive care medics [who have grad dips, or masters degrees])? The buzz word in the field at the moment is "Education. NOT training" but it seems to me that a balance needs to be struck. Is there a danger of churning out academically brilliant medics who can't treat patients? That's been happening here in Victoria recently. It used to be that students didn't do any paramedic related subjects for a whole year. While I agree with the degree system, it clearly needs some fundamental tweaking. Thoughts?

So here's the lay out of my degree as it stands now. What are your opinions?

http://www.scribd.com/doc/16538751/BEH-Course-Structure09


----------



## hrmeeks (Jun 18, 2009)

Melclin said:


> "Education. NOT training"
> http://www.scribd.com/doc/16538751/BEH-Course-Structure09




Education with Training plus Experience should be the example 
just my opinion



Melclin said:


> Is there a danger of churning out academically brilliant medics who can't treat patients? That's been happening here in Victoria recently.
> 
> http://www.scribd.com/doc/16538751/BEH-Course-Structure09



we call those guys residents in the hospital or patches (b/c of the little orange patch on their shoulder


http://www.scribd.com/doc/16538751/BEH-Course-Structure09[/QUOTE]


----------



## VentMedic (Jun 18, 2009)

A well structured program should be able to get at least 1000 hours of clinicals during the course the a two or 4 year degree just as other health care professions do. Some programs require the sciences to be done prior to admission to a program. That ensures even more time that can be alloted to clinicals. 

Right now, many of the U.S. Paramedic programs only average between 300 and 500 hours of clinicals and ride time. The program length in total averages 600 - 1050 hours. The EMT-B is 120 hours total with usually no more than 20 hours included in those hours of ambulance and ED time. 

Our problem in the U.S. is lack of educators to properly educate in the classroom and oversee students to ensure they are getting the most out of their clinical experience. Coffee rounds in the nursing break room at the ED and ALS engine sleepovers just don't make the grade. So when some complain about education and experience, they may not have had the best possible use of their time in either the education or clinical areas.


----------



## Melclin (Jun 18, 2009)

VentMedic said:


> A well structured program should be able to get at least 1000 hours of clinicals during the course the a two or 4 year degree just as other health care professions do. Some programs require the sciences to be done prior to admission to a program. That ensures even more time that can be alloted to clinicals.
> 
> Right now, many of the U.S. Paramedic programs only average between 300 and 500 hours of clinicals and ride time. The program length in total averages 600 - 1050 hours. The EMT-B is 120 hours total with usually no more than 20 hours included in those hours of ambulance and ED time.
> 
> Our problem in the U.S. is lack of educators to properly educate in the classroom and oversee students to ensure they are getting the most out of their clinical experience. Coffee rounds in the nursing break room at the ED and ALS engine sleepovers just don't make the grade. So when some complain about education and experience, they may not have had the best possible use of their time in either the education or clinical areas.



I'm a little sketchy on how much ride time we get exactly. A few days in the first year, in second, we get around 4 weeks, and in 3rd year around 8 weeks, four of which are cycles through the ED, psych, ICU and I think maternity wards. Probably something in the order of 550-600 hours, and you get progressively more involved as you move through. In the third year placements, you have effectively the same authority to practice as the medics, given the supervision and approval of the medics you're with. That said, we don't graduate as fully fledged paramedics, we have 1-2 years of internship, spent one on one with a clinical instructor (in theory), taught while you work sort of stuff, in the style of a medical intern.


----------



## EMTrainer (Jun 19, 2009)

*I like the internship idea*

I like the idea of a year or two of internship before getting your paramedic license. We don't have that here and the amount of supervised field training after passing the National Registry test (not all states are Registry states, some have their own testing requirements) varies widely from service to service.


----------



## TransportJockey (Jun 19, 2009)

EMTrainer said:


> I like the idea of a year or two of internship before getting your paramedic license. We don't have that here and the amount of supervised field training after passing the National Registry test (not all states are Registry states, some have their own testing requirements) varies widely from service to service.



The whole state to state differences are one of the main things holding EMS back from becoming something other than the red-headed stepchild of medicine. We need fully standardized levels like all the other medical fields do


----------



## Melclin (Jun 20, 2009)

jtpaintball70 said:


> The whole state to state differences are one of the main things holding EMS back from becoming something other than the red-headed stepchild of medicine. We need fully standardized levels like all the other medical fields do



I'd agree with that. States here still have alot of differences but universities in all states now offer a degree. Some places still offer in house training although its just as long as a degree, its not a formal qualification and its being phased out as far as I know. 

With the degree you can also take it and use it to find employment with anybody who requires non specific university employment (in the same sense that a BA helps in general), and because theres a very general health focus in the first year we can get into health-care administration too, with a little bit of post-graduate work. It just generally helps to have it as a universally recognized bachelors degree rather than a "paramedic license" (we don't have any form of liscensure here, the alternative to the degree was in house training or a diploma style technical school type thing).

The multiple services thing you guys have still confuses me. We have one state run service. In my head joining the ambulance service is like joining the army. You don't get your soldier license and then go and work for whatever army employs you (not making a paramilitary comparison to paramedic practice its just the first example that popped into my head). So I get a bit confused about all the different types of private services and ALS/BLS, 911/IFT, fire brigade/ambulance (the idea that the fireries can also be medics is so weird to me).


----------



## TransportJockey (Jun 20, 2009)

Melclin said:


> I'd agree with that. States here still have alot of differences but universities in all states now offer a degree. Some places still offer in house training although its just as long as a degree, its not a formal qualification and its being phased out as far as I know.
> 
> With the degree you can also take it and use it to find employment with anybody who requires non specific university employment (in the same sense that a BA helps in general), and because theres a very general health focus in the first year we can get into health-care administration too, with a little bit of post-graduate work. It just generally helps to have it as a universally recognized bachelors degree rather than a "paramedic license" (we don't have any form of liscensure here, the alternative to the degree was in house training or a diploma style technical school type thing).
> 
> The multiple services thing you guys have still confuses me. We have one state run service. In my head joining the ambulance service is like joining the army. You don't get your soldier license and then go and work for whatever army employs you (not making a paramilitary comparison to paramedic practice its just the first example that popped into my head). So I get a bit confused about all the different types of private services and ALS/BLS, 911/IFT, fire brigade/ambulance (the idea that the fireries can also be medics is so weird to me).



That's one of the main reasons I'm getting my AAS (associates) in Paramedicine. My school is leading the way here in NM to try and get paramedic to require at least the Associates degree to practice. 

And as for being confused... I've been living in this city for almost two years and I still get confused sometimes about the ways they run the system here and in neighboring counties


----------



## EMTrainer (Jun 20, 2009)

*Confusing*

The confusion is less in states that accept National Registry standards. You can still have services that are Fire Service, Hospital, or Community based, professional or volunteer, or Privately Owned, but if you are a registry state you must meet the registry requirements for the level of service you provide. A community-based, volunteer ALS ambulance is held to the same standard as a hospital-based, professional ALS service.

Note: When I say "professional" I am referring to personnel who are making their living in EMS. I do not intend to imply that the care provided by volunteer services is less professional than on a paid service. I got my start on a volunteer community ambulance service and I would put many of the volunteer EMT-Bs we had up against any EMT-B from a full-time, paid service.


----------



## Ridryder911 (Jun 20, 2009)

EMTrainer said:


> The confusion is less in states that accept National Registry standards. You can still have services that are Fire Service, Hospital, or Community based, professional or volunteer, or Privately Owned, but if you are a registry state you must meet the registry requirements for the level of service you provide. A community-based, volunteer ALS ambulance is held to the same standard as a hospital-based, professional ALS service.
> 
> Note: When I say "professional" I am referring to personnel who are making their living in EMS. I do not intend to imply that the care provided by volunteer services is less professional than on a paid service. I got my start on a volunteer community ambulance service and I would put many of the volunteer EMT-Bs we had up against any EMT-B from a full-time, paid service.



Okay, not to be tacky but you label yourself as "EMTrainer" and represent you know very little about EMS. You yet do not know that the National Registry has *NO* such standards as you descrube. They do NOT develop standards for different divisions or levels of service! 

Now, with that stated we can hence see where part of the problem arises. EMS Instructors are not well educated enough within their own profession. How are we suppose to take one serious if they don't even know who writes and enforces the curriculum they supposedly teach from? Do we honestly suppose to take one serious enough to respect their opinion or any of their statements in regards to anything else? 

R/r 911


----------



## GonnaBeEMT (Jun 21, 2009)

*Huh?*



Ridryder911 said:


> Okay, not to be tacky but you label yourself as "EMTrainer" and represent you know very little about EMS. You yet do not know that the National Registry has *NO* such standards as you descrube. They do NOT develop standards for different divisions or levels of service!
> 
> Now, with that stated we can hence see where part of the problem arises. EMS Instructors are not well educated enough within their own profession. How are we suppose to take one serious if they don't even know who writes and enforces the curriculum they supposedly teach from? Do we honestly suppose to take one serious enough to respect their opinion or any of their statements in regards to anything else?
> 
> R/r 911



Say what Willis?


----------



## marineman (Jun 21, 2009)

GonnaBeEMT said:


> Say what Willis?



What part don't you get?


----------



## Ridryder911 (Jun 21, 2009)

GonnaBeEMT said:


> Say what Willis?



EMS 101: 

Short & simple, the National Registry of EMT's has *NO* such thing as a curriculum, Standards, etc. for states, divisions of EMS albeit private, fire, third party, etc. Never have or never will. Period. 

It is a testing agency that develops a test that is highly accredited and weighed for professional standards. These tests are offered to States that want to participate. Many opt due to the ease and costs. These tests are based on the current National EMT to Paramedic curriculum's. As well due to ever changing cardiac care, it is revised with current cardiac standards as set out by the Emergency Cardiac Committee which standard is recommended by the American Heart Association. 

The National Highway Safety Administration (NHTSA) (formerly known as Department of Transportation) is and has always been responsible for developing the National Standards for EMT's through Paramedics. States can choose not to participate, but by doing so risk the chance of loosing millions of Federal funding and programs. States can add to and develop additional levels but must use at least the minimum level. 

Each State is responsible for the development of EMS within their own state. They are charged to develop upon what is best for their own citizens. Most develop an oversee agency within the State that operate either independently or as many through such agencies as State Health Departments, etc.  

Some may even go further and allow cities or counties to place requirements. Not as popular as in the beginning and as most found very restrictive and costly. 

The current curriculum will soon expire. It is reviewed and contracted out for revision about every 10-15 years. The curriculum will be changed, and placed into a Scope. Attempts to allow EMS to mature has been slow for various reasons and many of these are the lack of having well educated persons teaching and governing the profession. 

The new scope was written under the guidance of the National Association of EMS Educators. The new curriculum will no longer have "objectives" as previously before. Emphasis will be placed upon educators to make "teaching lesson plans" alike those with true educational system and standards. A drastic and bold movement considering most of those that teach EMS are not truly educators but rather are "instructors" that train. A different method with different expectations. 

The NREMT has been working for the improvement of EMS in multiple ways for several decades. True they have some influence as per suggestions by revealing data from tests and scientific research. One of the major changes is that of their suggestion that those that teach Paramedic programs be Nationally Accredited (all other healthcare professions require such, except EMS). This is not new as many have thought, as it was introduced decades ago but a final date was announced recently. 

Again, each educator of EMS should already have a great knowledge of this to teach to their students. Each student should know their profession well enough to be able to know who is responsible for educational development and locally who has legal and legislative authority. As well, each student should know more than just local protocols but state codes and laws that over see EMS. Failure to do so, demonstrates lack of knowledge of being an EMT or Paramedic just as much as not knowing patient care. 

R/r 911


----------



## terrible one (Jun 22, 2009)

Ridryder911 said:


> EMS 101:



when do you think a new curriculum would be available and implemented? and what other changes do you forsee besides the changes in instructing the course?

just curious if you know of anything, as I am looking forward to some changes in the EMS education/instruction


----------



## Ridryder911 (Jun 22, 2009)

Actually the new scope is out. It is to be official this fall but doubtful that most publishers will be ready. Some are attempting to have new texts out by this fall. 

You can download the free scope through NAEMSE website. 

R/r911


----------



## Melclin (Jun 26, 2009)

Ridryder911 said:


> Actually the new scope is out. It is to be official this fall but doubtful that most publishers will be ready. Some are attempting to have new texts out by this fall.
> 
> You can download the free scope through NAEMSE website.
> 
> R/r911



I had a bit of a read through some of the documents there. I keep seeing references to medical oversight. This reliance on 'medical control' bugs me (if thats what they're talking about). We don't have it here, so maybe I don't understand it properly, but it seems like you're hardly going to be able to be considered professionals and clinical decision makers in your own right instead of just the eyes, ears and hands of a dr on the radio, without the underlying education. 

Another thing that irks me along the same lines is how RNs seem to be held in higher esteem and treated as having a greater medical knowledge over your way. Its the other way around here, and to me that makes more sense. Medics regularly make their own clinical decisions about courses of treatment and medications, often in life or death situations mostly without any back up and accordingly, we have the relevant education. None of which a nurse can do, and they constantly have medical backup (Our poor nurses cant even canulate without an extra qualification which is crap), and accordingly their education doesn't have the same focus on physiology and pharmacology. I'm not having a go at nurses, I just can't see why in the US it seems like medics are treated like they need to have less education than nurses, to do a job that needs more (physiology/pharmacology/Dx wise).


----------



## TransportJockey (Jun 26, 2009)

Melclin said:


> I'm not having a go at nurses, I just can't see why in the US it seems like medics are treated like they need to have less education than nurses, to do a job that needs more (physiology/pharmacology/Dx wise).



Part of it is the continued existence and demand for medic mills and other short programs so companies and FDs can have warm bodies. We had a long discussion about something like this in class and it seems like every time there were major proposed education increases, fire depts pitched a fit, because then they would have a harder time getting members, especially the volunteer depts. Although they could all go under and I wouldn't care too much. A professional EMS response would replace them soon enough


----------



## Melclin (Jun 26, 2009)

Interesting that you mention the FD thing. I find it hard to wrap my head around why people think its a good idea to mix the two. They involve two entirely different skills sets and education. Predominantly they go to different cases and they use entirely different equipment. I don't understand why there aren't separate ambulance services. It makes no sense and I hate the idea that EMS then becomes ancillary to fire fighting. Not to mention the fact that its just stupid to drive a great big friggen firetruck to an EMS call although I understand that alot of FD haves ambulances as well, but in that case, they may as well have a separate service. 

Here we have Police (coppers), Fire (water fairies) or Ambulance (Ambo's). You get a choice when you ring 000 (our 911). All three services work together, but they are distinctly separate entities with very different roles. Why it would be done any other way is beyond me.


----------



## downunderwunda (Jun 26, 2009)

Melclin,

I hope you are not suggesting that University Education in Australia is the ONLY way to achieve the knowledge to be an effective & highly skilled Paramedic. 

Let me quote some interesating stats for you. The average age now for people with a degree starting as a Paramedic is 24. They stay on average 8 years. 

The average age for a trades background to come into the profession is 34. The average stay is the balance of their working life. I fit the second category & resent the snotty nose little turds with their degree's trying to tell me after they have been on road for 2 minutes how to diagnose a patient. There are some good operators that come through the Uni ranks, & I am more than happy to work with them, but when I have a probationer trying to tell me when where & how I should give morphine, in front of the patient, I do take exception. 

My education, although not university based is more than comparable to the clinical knowledge you learn at University, but I also had street smarts before I joined this profession. Something that is lacking with most that hold the degree & the main cause of them burning out in a short space of time.


----------



## Melclin (Jun 26, 2009)

downunderwunda said:


> Melclin,
> 
> I hope you are not suggesting that University Education in Australia is the ONLY way to achieve the knowledge to be an effective & highly skilled Paramedic.
> 
> ...



Whether or not the education is uni based has nothing to do with the backgrounds. People with a trades background who are 34 still do uni degrees and people who are 24 still do other forms of training. Your poor experiences with uni grads don't make the system fundamentally flawed. Nor does your competence make the way you were educated fundamentally better. Also the length of their stay in the professional is not a reflection on their competence, nor the quality of their education. Many people move on to different careers, as you did. In short what you have told me says nothing substantial about university other than you have a grudge against it because you associate _some_ co-workers you haven't liked with the degree. If they're disrespectful wankas as individuals, it has nothing to do with the efficacy of university education vs Vocational education in influence on the greater direction of the profession. 

However, I do think its entirely possible to become a perfectly competent technician through other forms of training. But if we are to encourage pre-hospital specific research and higher levels of theoretical knowledge as well as achieving professional status amongst other health workers and dictating our own scopes of practice instead of being told what to do in simple steps by Dr.s, then yes, university is the only way to do that. If you want to attract the kinds of people who are predisposed to that sort of thing, in short if we wanna poach people who would have done medicine or science, then yes university is the only way to do that. 

Other than that, a degree is almost universally recognized. If I leave paramedicine, I still have a degree. It means I can do post grad education in other areas if I want to diversify, or change fields. A person with on the job training/vocational education has far fewer options in this regard.


----------



## downunderwunda (Jun 26, 2009)

> However, I do think its entirely possible to become a perfectly competent technician through other forms of training. But if we are to encourage pre-hospital specific research and higher levels of theoretical knowledge as well as achieving professional status amongst other health workers and dictating our own scopes of practice instead of being told what to do in simple steps by Dr.s, then yes, university is the only way to do that. If you want to attract the kinds of people who are predisposed to that sort of thing, in short if we wanna poach people who would have done medicine or science, then yes university is the only way to do that.



Then why are other professions, such as nursing looking at maintaining the degree, but putting more emphasis on vocational training that classroom? Where I work, I have the respect of Doctors, Nurses, & many of the other health related professions, put simply, Professional Status is not just a title, but a lot more. It encompasses a wide range of things & will require higher rates of pay. However, the maitenence of your status becomes YOUR responsibility, YOUR cost, YOUR problem. Currently the service you work for provides you with education, they assist with the maintenence of your skills, at a huge cost. It is estimated to cost in excess of $800000 to train (even with a uni degree) & maintain an officer for a period of 5 years. Are you prepared to wear that cost yourself, even with a professional wage as was offerred in South Australia recently?

My point about peoples age is not there just for length of service, but also demonstrates that if a person is older they have a lot more life experience, they have learned to cope with trauma, (both actual & psychological), & can communicate with people. I do not as you say, have a grudge with University trained officers. What I have a problem with is the attitude that is displayed by too many that join & work with me that they SHOULD be an ICP NOW not have to wait & prove themselves, as well as learning their coping methods.


----------



## Melclin (Jun 27, 2009)

We might have a misunderstanding when we're talking about vocational training. As it happens, I think the current system does put to much emphasis on education rather than training. 

To clear things up (because my last post was a bit combative): while I think the university system is the way to go, we do have a special profession and we can't just have a normal academic degree. As it stands now I feel the degree is getting much better and fast, but it still has many flaws. The degree _was_ atrocious and with so little clinical placement time, I can see graduates coming out of their final exams having aced them and thinking they're god's gift to paramedicine. My class and the ones coming after us have already had more placements than some graduates used, so we are quite aware of the differences between academic knowledge and and practical application and probably more importantly, how to respectfully suggest pt care issues and not to get your head bitten off when interacting with older medics, a lot of whom do have a big grudge against us (sorry if I misjudged you).* I think the answer lies not in going back to the old system, but in adjusting the new one - because it has so much to offer if we can work out the kinks.*

Nursing is moving more towards vocational education in the sense that they do more placements, but on the job experience and university are not mutually exclusive, as I said above.

There's a difference between paying to achieve the qualification you need to get a job and paying to maintain training with in the employer's organisation. Do I have a probelm paying for my degree? NO. Do I have a problem paying for my MICA grad dip in 5-10yrs time or doing an ECP course and leaving AV to work in primary health care? NO. Achieving qualifications to improve yourself professionally at your own expense is what the rest of the professional world does, why should we be different? However, would I have a problem with paying for training on a new defib that AV is introducing? Yep. For a professional development day on the introduction of a new drug to the AV CPGs. Yep. But again I feel that's a fundamentally different issue than the original education. If we want to focus on that sort of employer mandated training how are we supposed to assert ourselves as autonomous medical practitioners, and work and develop in an environment where, quite soon, practicing paramedicine will not be exclusive to Ambulance service employees (paramedic practioners, ECPs, PAs, health admin).

I take your point about age, and I agree with it, but again it doesn't really have to do with university. 

"Younger people have trouble coping/dealing/communicating" is not followed logically by "the degree is flawed", it just means the people doing the degree are not the right ones. 

If you want to argue that you should only be allowed to start the degree when you're 25 or 30 then that's fine (I don't agree with mandatory age limits as it happens, but I do think more thought should be put into preparing us for the nasty things). However, that's a separate issue to the overall efficacy of the degree (unless you are arguing about curriculum change like I am).


----------



## Ridryder911 (Jun 27, 2009)

It's nice to see that not only those in U.S. disagree about the education method. I do say though, it is unique to see that one would complain that they are too educated? Then want to apply more of a vocational angle and skills? This can't be done while in the University setting? 

We have the total opposite here. All the emphasis is placed upon the skills and very little on the knowledge. So you may have those that are very proficient in applying the skills, it is they just don't know why and when to do them. 


R/r 911


----------



## Melclin (Jun 27, 2009)

Ridryder911 said:


> This can't be done while in the University setting?
> 
> 
> R/r 911



Well thats my point is that it can be. 

When the change occurred from vocational to university training, I feel they went a little far, and we ended up churning out medics who knew the text book backwards but couldn't do anything in the real world, but were still keen on telling their partner how to do everything. I had a convo with MelbMICA about it recently. Our state service is having quit a bit of trouble with this at the moment, amongst other things.

*But I don't think its a problem with the university model itself*. It just needs to be tweaked. There were always ganna be hiccups making such a change. The medics coming through now, have much more on the job experience and the curriculum has been tweaked to improve our ability to apply our skills. And its only getting better. Of course it would be better if we all had street smarts as well, but there's already a shortage, and imagine all the good medics and experience time we'd loose if there was a mandatory entrance age of ~30. 

I've seen you have the opposite problem over their, and I don't want us to move backwards, which we would be doing if we went back to un-regulated, in-house training with the ambulance services with the focus on "how" rather than "why".


----------



## downunderwunda (Jun 27, 2009)

Melclin, I would like to clarify something here.



> I take your point about age, and I agree with it, but again it doesn't really have to do with university



Who is attending uni, generalisation, I know but school leavers.

I dont know where you got



> "Younger people have trouble coping/dealing/communicating" is not followed logically by "the degree is flawed", it just means the people doing the degree are not the right ones.



I did not at any point say that. 

I think you need to read what I wrote before you try to justify this



> If you want to argue that you should only be allowed to start the degree when you're 25 or 30 then that's fine (I don't agree with mandatory age limits as it happens, but I do think more thought should be put into preparing us for the nasty things). However, that's a separate issue to the overall efficacy of the degree (unless you are arguing about curriculum change like I am).



I *did not*suggest at any time an age limit on starting the degree, however I quoted some statistics on duration of employment. I also said that this is not always the case, there are exceptions. 

I would also like to point out, & I am sure all of those who have worked in this field for any period would agree, you cannot teach how to



> preparing us for the nasty things



This is something that you learn on the job, with training officers, with peer support, and then you will learn to cope. 

One of my biggest problems is that there is too much "I wnna be a ICP NOW". Too many young, inexperienced highly educated people that want all the responsibility, when they have seen a small snapshot of what is done in a probationary period. 

Having the education is great, knowing when to use it is better. I can adapt the saying you can train a monkey to hold a hose to You can train a monkey to insert a tube, but you cant teach him to know when to do it appropriatley.

I believe that with the systems in place in Aussieland, (no offence intended to our american friends) our skill levels are more highly appropriate than in the US, with base levels pushing the boundaries of ICP anyway, there should be less of a rush to achieve that until appropriate experience is achieved. We are on similar lines, but looking from different perspectives. 

To back this up, I also believe that, in Aussieland we have an opportunity, in at least 3 states, QLD, NSW & Vic, to progress ALL staff to an ICP status very easily. I belive this should be a natural progression for all officers, regardless of Uni degrees. Not for the benefit of Ego, but for the benefit of our patients & their families.


----------



## Melclin (Jun 28, 2009)

*School Leavers*
Yeah it is mostly school leavers, but as you say, that's uni in general. It doesn't mean that it has to be that way for a paramedic degree, we already have more mature age students than most degrees. It doesn't make the uni framework wrong for paramedic education.

*Quoting You & Age Limits*
With the 'quoted' words I used, I wasn't actually quoting you, I was using the quotations to frame an idea conversationally. I was essentially paraphrasing you though. You posted in a thread about the efficacy of a uni degree, that older vocationally trained medics are more likely to stay in the job than younger uni trained ones. It's reasonable to assume you are making the point that the uni model precludes older people from joining the service. Which is what I was disagreeing with, because I see no reason why older people can't, or shouldn't have to go to uni.    

I didn't say you _specified_ an age limit, but I was assuming that in your statement about older medics being better suited to the job, that you were suggesting that the model should be focused in some way on older people.
Which was the point of the thread - discussing the efficacy of the uni model. You said you hoped I wasn't suggesting that uni was the only way, and proceeded to use the age issue as an example of why exclusive uni education was flawed. If you weren't suggesting the age issue as part of some argument regarding the model, why was it suggested?

After all this I still don't understand your point about age. Yes it would be better if we were all street smart first, its true of most professions, but we can't wait forever building st smarts before we start work. Other than some loose idea that 'young people go to uni', I don't see your point about why an education system housed within a university framework can't be equally suited to educating people of all ages. 

*Coping with Death & Misery*
On the topic of learning to cope with tough issues, I entirely disagree that you can't be _prepared_. That's different to being _ready_. I'd compare it to training for combat. You can train and train and train, do things a thousand times with live fire exercises, but it never makes you _ready_ to deal with combat. But you sure as hell wouldn't suggest that we don't at least try to _prepare_ soldiers not just to cope after combat but to work well in combat. 

As it stands now, no body even tries to prepare us for death and misery, because there is this attitude that its impossible so why even try. It's narrow minded and shows a distinct lack of understanding of the reality dealing with nasty situations for the first time. They all found that nothing prepared _them_ so they assumed that nothing could. 

I can say with some considerable certainty that 
-psychological strategies for dealing with circular thought patterns and guilt driven illogical thoughts (taught to me by my psychiatrist), helped a lot.
-knowing things like "the heart attack was going to happen with or without you, the fact that you were there can only have helped" 
-being aware of basic statistics about death that you might take for granted: "bugger all cardiac arrests survive to discharge" (We all start uni thinking VF is no big deal thanks to teli). 

I knew these things because I made it my business to know and because I was taught certain things (like with my shrink) in other aspects of my life.  Not because uni told me. So when I did my first arrest/fatality, I can honestly say that it was not an issue for me because of these things. *I'm not saying I have all the answers, but I am saying that its a cop out not to try*. I really feel that their are a number of things that could be added to curriculum for two purposes in this area: 1. preparing students to maintain their calm, and work effectively and retain their knowledge under pressure (just as the defense force does, although I'd question some of their methods). 2. To cope with ongoing emotional strain of the job.   

*Students & ICPs*
Now, continuing with my dissertation , on the issue of ICPs, its difficult for me to comment with any intellectual authority, with my lack of experience. But from what I hear, yes that is a problem.The problems you're describing are no different that what medical interns do, so I think with the ongoing guidance of their superiors, Ambo students can work through their initial arrogance. Part of the problem though, is that a lot of our 'superiors' are not well educated and practice a sort of gung-ho oldschool ambo first aid full of intuition and street smarts, and its hard to take their advice seriously, when they practice very differently from how we have been taught. Just as theory isn't everything, experience isn't everything either. Older ambos may have to accept that their is value in our education. It's hard to accept the criticism of being over educated and naieve from people who _seem_ under educated and burn't out. Now I know I'm making gross generalizations, but I'm just using hyperbole to provide the point of view from the student side. Once again though, I fail to see what exactly this has to do with the uni model in particular. If it doesn't, I'm happy to have a conversation about it all the same, I just want to know if I'm missing something.


----------

