# 150 Hours?



## mikie (Oct 14, 2008)

So I'm sitting in class (Intro to EMS systems) and the prof. said that the ~100 hour EMT course is about to be 150 hours.  Has anyone heard of this?  Is this true?


*Let's not argue whether or not it is enough and whatnot ,rather the truth behind his claim and what will be added/elaborated upon.

Thanks!


----------



## Ridryder911 (Oct 14, 2008)

Most EMT courses are already 150 hours in length. Most are increasing to 200 hours to meet the required new EMT curriculum or what all other EMT's and EMT/I will have to take is a transitional course. 

R/r 911


----------



## mikie (Oct 14, 2008)

Ridryder911 said:


> Most EMT courses are already 150 hours in length. Most are increasing to 200 hours to meet the required new EMT curriculum or what all other EMT's and EMT/I will have to take is a transitional course.
> 
> R/r 911



So what will be added or changed in this "new" curriculum?


----------



## Ridryder911 (Oct 14, 2008)

Bill Brown wrote an article in this months _JEMS_ in regards to this. 

http://www.jems.com/news_and_articles/articles/jems/3309/from_fragmentation_to_unity.html


R/r911


----------



## ILemt (Oct 14, 2008)

Having read the article, it doesn't seem that Basics...ehem... "EMT's" will be doing anything different, aside from "possible changes in assessment"

So is the additional time spent on Assessment and Documentation?


----------



## Ridryder911 (Oct 14, 2008)

Actually there is an increase in the length of anatomy, more detailed assessment including more focus on medical assessments, and some additional knowledge in assisting Paramedics. 

R/r 911


----------



## ILemt (Oct 16, 2008)

With all due respect, what is the point in adding more detail to BLS medical assessments? We don't carry drugs, or monitor so what additional "good" is supposed to come from this?

Personally, I wish that basics were brought up to the old I-85 standard, but that won't happen in my lifetime.


----------



## wxduff (Oct 16, 2008)

ILemt said:


> With all due respect, what is the point in adding more detail to BLS medical assessments? We don't carry drugs, or monitor so what additional "good" is supposed to come from this?
> 
> Personally, I wish that basics were brought up to the old I-85 standard, but that won't happen in my lifetime.



That's not necessarily true. At least in New York, the EMT-B program has slowly been absorbing bits and pieces of the EMT-I program here.

If you didn't know, NYS has 4 Levels of EMT:
EMT-Basic
EMT-Intermediate
AEMT-Critical Care Technician
AEMT-Paramedic

I think that the state is trying to raise the level of the basic up to what is currently the intermediate. I don't think there are a lot of differences anyway, except that EMT-Intermediates can start IV's and few little things. So eliminating a level cleans things up.

If New York is doing away with EMT-I and integrating it with Basic then good for it. By doing that it's only the lowest level of care higher. And raising the bar is never a bad thing.


----------



## JPINFV (Oct 16, 2008)

ILemt said:


> With all due respect, what is the point in adding more detail to BLS medical assessments? We don't carry drugs, or monitor so what additional "good" is supposed to come from this?
> 
> Personally, I wish that basics were brought up to the old I-85 standard, but that won't happen in my lifetime.



Not in your area and not yet. Where I worked as an EMT-B, the only drug on an EMT-B ambulance was oxygen. Charcoal wasn't in the normal SOP for EMT-B per state statute and the county, at the very least since there was no written real written treatment protocol for basics and oral glucose wasn't required to be carried on a EMT-B unit, oral glucose was considered out of SOP for the county (to be harshly honest, if you need a protocol to know when to apply O2, you need a refund on your EMT-B class tuition). On the other hand, there are services and locations across the country that have their EMT-Bs administering CPAP, administering beta-2 agonists, performing 12-lead EKGs (even if they don't interpret it), using pulse oximetry, obtaining blood glucose levels, and probably a ton of other things that I can only imagine doing with 110 hours of training. 

At least for me, it's kinda of hard to justify giving an unsupervised provider (and, yes, EMS is rarely under direct physician supervision and radio contact doesn't really come close) the power to administer drugs and perform interventions if they can not explain why the patient needs it and how that intervention is going to change their patient to gain the desired change. 2 hours of A/P (per current NHTSA National Standard Curriculum) does not come close to providing providers the education needed to achieve that goal. Furthermore, how can anyone justify giving basics more interventions if the education that they have on A/P is rivaled by that which is received by a student taking high school biology? To be honest, the status quo doesn't take 110 hours of training either. I can train anyone to slap on a NRB at 15LPM, call medics, and haul butt to the hospital if the patient looks sick in a few hours if we really don't need to know any of that fancy scientific thingamajig.


----------



## bstone (Oct 19, 2008)

Interesting. I-99s are getting a free ride to medic. My Intermediate course was about 80% that of I-99, but fell short from it totally. We know and were trained greatly above and beyond I-85 but we had to test for it, so I am an I-85 Intermediate with training closer to that of an I-99. It's a shame, really, as I wouldn't mind a free ride (just a class) to medic.


----------



## bstone (Oct 19, 2008)

bstone said:


> Interesting. I-99s are getting a free ride to medic. My Intermediate course was about 80% that of I-99, but fell short from it totally. We know and were trained greatly above and beyond I-85 but we had to test for it, so I am an I-85 Intermediate with training closer to that of an I-99. It's a shame, really, as I wouldn't mind a free ride (just a class) to medic.



In addition, I know that with another semester of classes (140 hours or so) I could easily bridge the knowledge gap to I-99 (we used the I-99 book and had to read all the sections and be tested on them, even tho we were being certified only as I-85). In this class I could forsee that we could also do the medic transition, tho that might be a bit of a leap. Minimially we can do the full I-99 transition.


----------



## triemal04 (Oct 19, 2008)

bstone said:


> Interesting. I-99s are getting a free ride to medic. My Intermediate course was about 80% that of I-99, but fell short from it totally. We know and were trained greatly above and beyond I-85 but we had to test for it, so I am an I-85 Intermediate with training closer to that of an I-99. *It's a shame, really, as I wouldn't mind a free ride (just a class) to medic.*





bstone said:


> In addition, I know that with another semester of classes (140 hours or so) I could easily bridge the knowledge gap to I-99 (we used the I-99 book and had to read all the sections and be tested on them, even tho we were being certified only as I-85). *In this class I could forsee that we could also do the medic transition*, tho that might be a bit of a leap. Minimially we can do the full I-99 transition.


Welcome to yet another installation of the classic series, "why EMS is being held back in America."

If you want to be a paramedic, take a real, quality paramedic course.  If you want the skills, treatement options, knowledge, etc, see the above.  Don't take some halfassed "upgrade;" it won't be worth the paper your cert if printed on.

So much for any improvements in certification standards happening anytime soon.


----------



## bstone (Oct 19, 2008)

triemal04 said:


> Welcome to yet another installation of the classic series, "why EMS is being held back in America."
> 
> If you want to be a paramedic, take a real, quality paramedic course.  If you want the skills, treatement options, knowledge, etc, see the above.  Don't take some halfassed "upgrade;" it won't be worth the paper your cert if printed on.
> 
> So much for any improvements in certification standards happening anytime soon.



Seemingly, the NREMT disagrees with you.

And nurses have all sorts of upgrade/transition classes.


----------



## EMT-P633 (Oct 19, 2008)

bstone said:


> Seemingly, the NREMT disagrees with you.
> 
> And nurses have all sorts of upgrade/transition classes.



Take a look at alot of the NREMT medics, alot of them are not worth the ink it took to print thier certs.  Not all of them. but alot.  Yes NREMT is finally making correct progress to unite EMS so our benifits / pay can be more on par for the amount of care we are able to provide to our patients. Let alone the amount of responsibility that comes with that big "P" on the shoulder

Now look at alot of nurses. same goes for them. and many of them can not make a the treatment decision with out a doctors prior assessment and authorization. Yet medics do it everyday. This is refering mostly to average run of the mill nurses. Not the specialized nursing fields.


----------



## Code 3 (Oct 19, 2008)

EMT-P633 said:


> Take a look at alot of the NREMT medics, alot of them are not worth the ink it took to print thier certs.  Not all of them. but alot.



I'm not sure I follow this statement. As far as I know, NREMT isn't a medic school. If you are running into "poor" medics that have a NREMT-P cert, then blame needs to placed on the individual and the program they attended. I'm not sure how you can say the majority of NREMT-P's are poor when all the NREMT does is _testing_ and not _schooling_.



> Now look at alot of nurses. same goes for them. and many of them can not make a the treatment decision with out a doctors prior assessment and authorization. Yet medics do it everyday.



This is comparing apples to oranges. You can't compare hospital care to pre-hospital care because they do not have the same staffing system or procedures. If your unit consisted of an EMT-B, EMT-P, and MD/RN then I'm pretty sure you would take a backseat to the MD/RN and they would perform the initial assessment.

Please understand, this is not meant to be a personal attack by any means. I'm just trying to fully understand what you're saying.


----------



## triemal04 (Oct 19, 2008)

bstone said:


> Seemingly, the NREMT disagrees with you.
> 
> And nurses have all sorts of upgrade/transition classes.


1.  NREMT mean's squat; it'd be nice if it meant more, and maybe someday it will, but as it stands now...means nothing.

2.  The national registry standards are very, very lax, and that is reflected in the quality of the NR test...so easy my dead grandma could pass it.

3.  Did you really make a comparison between RN's and paramedics?  For this situation?  Good lord but that was just silly.  And ridiculous.  An intermediate being "upgraded" to a paramedic is not the same as an RN who decides to specialize in anesthesia...completely different.  Someone who is a lower level than an RN (like a CNA or LPN) does not take an upgrade to become an RN...they take the actual courses that are required.  

You want to have people call you a paramedic?  Take the time to become one, don't look for some backdoor way just to make yourself feel better.  (That was a generic you.  Unless that applies to YOU, in which case it wasn't.  :wacko: )


----------



## bstone (Oct 19, 2008)

triemal04 said:


> 1.  NREMT mean's squat; it'd be nice if it meant more, and maybe someday it will, but as it stands now...means nothing.
> 
> 2.  The national registry standards are very, very lax, and that is reflected in the quality of the NR test...so easy my dead grandma could pass it.
> 
> ...



1 & 2. I think people will take issue with your characterization of the NREMT. Their tests are difficult and not everyone passes on the first or even second try. Plus they are doing a lot in order to make becoming a medic more demanding- such as requiring accreditation for programs in a few years.

3. There are indeed "upgrade" or "transition" courses for CNA to LPN and LPN to RN. I have seen them and a good search can reveal many of them. Gosh, I even found this online LPN to RN program: http://www.rncentral.com/nursing-programs/lpn-rn-transition

4. I am happy to go through the education required to become a medic, but I'll just become a physician instead. I'm your next medical director.


----------



## Ridryder911 (Oct 19, 2008)

I'll solve this argument. EMT I-99 will be a thing of the past. NREMT will no longer even recognize or test them beginning next year. As they seen a trend of many used in lieu of Paramedics as well as a "cheap way to have a pseudo Paramedic". 

Also beginning next year or when the new standards are officially installed .. 
the title of the Paramedic will *NO BE LONGER BE EMT-P*! (YEAH!!!!!) It will be simply be *PARAMEDIC*.. no mention of EMT anywhere, notta, nope.. not there.

R/r 911


----------



## bstone (Oct 19, 2008)

Ridryder911 said:


> I'll solve this argument. EMT I-99 will be a thing of the past. NREMT will no longer even recognize or test them beginning next year. As they seen a trend of many used in lieu of Paramedics as well as a "cheap way to have a pseudo Paramedic".
> 
> Also beginning next year or when the new standards are officially installed ..
> the title of the Paramedic will *NO BE LONGER BE EMT-P*! (YEAH!!!!!) It will be simply be *PARAMEDIC*.. no mention of EMT anywhere, notta, nope.. not there.
> ...



Rid, any idea how long the I-99 to Paramedic bridge course would be?


----------



## triemal04 (Oct 19, 2008)

bstone said:


> 1 & 2. I think people will take issue with your characterization of the NREMT. Their tests are difficult and not everyone passes on the first or even second try. Plus they are doing a lot in order to make becoming a medic more demanding- such as requiring accreditation for programs in a few years.
> 
> 3. There are indeed "upgrade" or "transition" courses for CNA to LPN and LPN to RN. I have seen them and a good search can reveal many of them. Gosh, I even found this online LPN to RN program: http://www.rncentral.com/nursing-programs/lpn-rn-transition
> 
> 4. I am happy to go through the education required to become a medic, but I'll just become a physician instead. I'm your next medical director.


This is an issue for another thread, so I'll leave it at this:  if people take issue with my assessment that the NR test is to easy...to bad.  It is.  While they may not be written in the best way, the tests are not a good gauge on the testee's knowledge level.  As well, the practical portion focuses far to much on the simple skills we have, and not our critical thinking and assessment abilities.

I do like NR requiring acreditation, that's great, and a step in the right direction.  Hopefully it'll help things, but as it is now, it may not; you still don't have to be certified with the National Registry.  Regardless of that, it still doesn't change the fact that the test is pretty lousy.

Did you notice that in all those programs (all the ones I looked at) there are multiple prereq's required before you enter the program?  Not just having your LPN?  It's almost like they want you to go through the same thing's as all the other RN's...minus a couple of classes.  

Paramedic education is allready bad enough without people wanting "a free ride" into it.  The course is allready short enough that a "transition" would be worthless.  Far to many people are getting a lousy education from the classes after taking the whole thing; why make it easier for someone to come out with even LESS knowledge?

I highly doubt that you'll be anyones medical director, but good luck with that anyway.  I am curious though...if at some point far, far, FAR in the future you got lucky enough to be in that position, would you still want uneducated people who got a "free ride" because they were grandfathered in or did a 100 hour transition working under your licensce?  Or would you only want highly educated, well trained personell?


----------



## Ridryder911 (Oct 19, 2008)

Don't know of any unless that school is offering one to complete the program. From what I understand is the NREMT will honor those that are currently under that certification as long as they keep it up and go through the transitional program. Apparently they believe that most will either go on through the program and finish Paramedic school or simply fade out. As I remember there is not that many that is left out there that is currently functioning at that level. 

Check into your local EMS programs and see if they are offering such bridge courses. 

R/r 911


----------



## bstone (Oct 19, 2008)

triemal04 said:


> This is an issue for another thread, so I'll leave it at this:  if people take issue with my assessment that the NR test is to easy...to bad.  It is.  While they may not be written in the best way, the tests are not a good gauge on the testee's knowledge level.  As well, the practical portion focuses far to much on the simple skills we have, and not our critical thinking and assessment abilities.
> 
> I do like NR requiring acreditation, that's great, and a step in the right direction.  Hopefully it'll help things, but as it is now, it may not; you still don't have to be certified with the National Registry.  Regardless of that, it still doesn't change the fact that the test is pretty lousy.
> 
> ...



As a future medical director it would be highly inappropriate if I began to second guess the credentials of those who have been trained in accredited facilities and certified by the NREMT. Should the same be done for someone who did an LPN to RN program? What about the physician who went to medical school in the Caribbean? As long as they passed their courses, attended an accredited school and passed the licensing exams then why should I second guess them? If they begin to behave poorly and are clearly incompetent then I'd yank their license- but that goes for anyone, with any certification, having graduated from any school. I know we can agree on that.


----------



## triemal04 (Oct 19, 2008)

bstone said:


> As a future medical director it would be highly inappropriate if I began to second guess the credentials of those who have been trained in accredited facilities and certified by the NREMT. Should the same be done for someone who did an LPN to RN program? What about the physician who went to medical school in the Caribbean? As long as they passed their courses, attended an accredited school and passed the licensing exams then why should I second guess them? If they begin to behave poorly and are clearly incompetent then I'd yank their license- but that goes for anyone, with any certification, having graduated from any school. I know we can agree on that.


You're ducking the question a bit.  Like it or not, simply passing the NREMT test does not make someone a competant paramedic, it does not ensure that they know everything they need to, it does not ensure that they are able to perform their job; it tests people on the MINIMUM required knowledge...it only takes 70% to pass for :censored::censored::censored::censored:'s sake!  So to say that just because someone has their NREMT it's ok is intentionally deluding yourself and being disingenous.  And ducking the question.

Here it is again:  would you want someone who is uneducated and was never appropriately taught how to be a paramedic working under your license?  Like you would very likely get by grandfathering people in and allowing someone take a transition course instead of all the classes?

It's a yes or no question.  If yes, then let me know where you end up so I can stay away.  If no, then why would you advocate something that will increase the odds of this happening?  Hell, for someone who want's to be a medical director, shouldn't you (if you really want to advance paramedicine and get quality paramedics) be advocating increasing the educational requirements for paramedics and not decreasing them?

Edit:  And as far as the "second guessing of credentials" goes...absolutely that is appropriate, even your job as medical director.  Maybe you should focus more an first learning how to be a doctor, then find out exactly what a medical director does, and THEN decide if that is the appropriate position for you.


----------



## bstone (Oct 19, 2008)

triemal04 said:


> You're ducking the question a bit.  Like it or not, simply passing the NREMT test does not make someone a competant paramedic, it does not ensure that they know everything they need to, it does not ensure that they are able to perform their job; it tests people on the MINIMUM required knowledge...it only takes 70% to pass for :censored::censored::censored::censored:'s sake!  So to say that just because someone has their NREMT it's ok is intentionally deluding yourself and being disingenous.  And ducking the question.
> 
> Here it is again:  would you want someone who is uneducated and was never appropriately taught how to be a paramedic working under your license?  Like you would very likely get by grandfathering people in and allowing someone take a transition course instead of all the classes?
> 
> It's a yes or no question.  If yes, then let me know where you end up so I can stay away.  If no, then why would you advocate something that will increase the odds of this happening?  Hell, for someone who want's to be a medical director, shouldn't you (if you really want to advance paramedicine and get quality paramedics) be advocating increasing the educational requirements for paramedics and not decreasing them?



It's hardly ever that simple. However since you've decided to question my own competency by indicating you question my abilities as a medical director before I have even completed my MD and residency then I will end this conversation now. Come back when you can be a bit more civil.


----------



## Ridryder911 (Oct 19, 2008)

bstone said:


> As a future medical director it would be highly inappropriate if I began to second guess the credentials of those who have been trained in accredited facilities and certified by the NREMT. Should the same be done for someone who did an LPN to RN program? What about the physician who went to medical school in the Caribbean? As long as they passed their courses, attended an accredited school and passed the licensing exams then why should I second guess them? If they begin to behave poorly and are clearly incompetent then I'd yank their license- but that goes for anyone, with any certification, having graduated from any school. I know we can agree on that.




You don't think that they second guess anyone attending "off shore" medical schools? Your kidding, right? That is why one of the reasons medical residencies are filled with U.S. programs first and then the rest get the left overs. Look at where of most are employed at? Small rural towns that will open arms with anyone with a pulse.


Don't think that week end Docs are treated differently than those that attend the traditional US schools, you have not seen much of the interaction of physicians. Remember, some medical schools in foreign countries are only 4 years total in length, and yes they can still obtain a US medical license if they pass the test. So, does this prove anything? Again, look at Chief of Staff, Director of Departments, and even those that have to work at nighttime shifts.... Yep, still see it all the time. Some are more accepted than others.


You have alluded to LPN to RN programs. Most of those programs are the same that has the Paramedic to RN as well. (Kinda makes you think of what they consider the Paramedic level to be). One usually has to have years experience as well and pass advanced standing tests to be able to enter a year and a half program. So in reality one only saves 8 weeks in most of those accelerated programs by the time the complete the pre-req nursing courses. 

EMT I-99 was a bad idea as it was only a way to get pseudo Paramedics that could work for peanuts. Bad for the system, the medics and the patient. Personally glad they finally are abolishing it as many EMS management wanted a cheaper version of Paramedics (due to the shortage and pay increasing) and they can still bill for the same rate.. what a deal! (low salary, high return!). 

R/r 911


----------



## triemal04 (Oct 19, 2008)

bstone said:


> It's hardly ever that simple. However since you've decided to question my own competency by indicating you question my abilities as a medical director before I have even completed my MD and residency then I will end this conversation now. Come back when you can be a bit more civil.


Competancy?  No, what I'm questioning is why you would feel this way; it's actually a bit mind boggling.  And (since you may have missed the edit) I am questioning exactly how much you understand what a medical director is supposed to do and what their role is.  Like it or not, it seems you don't have a good idea yet.  Far as questioning your abilities...what abilities?  You don't have any, you aren't there yet!  Seriously, focus on becoming a doc first.  Leave the rest of this till later when you've got a better grip on it.  

If this is upsetting to you...sorry.  Didn't really intend it that way, but facts is facts homey!

And yes, it is that simple.  Educated, competant paramedics, or uneducated incompetant paramedics?  Which do you like?


----------



## EMT-P633 (Oct 19, 2008)

Code 3 said:


> I'm not sure I follow this statement. As far as I know, NREMT isn't a medic school. If you are running into "poor" medics that have a NREMT-P cert, then blame needs to placed on the individual and the program they attended. I'm not sure how you can say the majority of NREMT-P's are poor when all the NREMT does is _testing_ and not _schooling_.
> 
> 
> 
> ...




Sorry, wrote this half asleep, and didnt clarify what i was trying to say very well.......:wacko:.
What i was trying to say about the NREMT is. in my experience most of but not all of the medics who carry the NREMT cert are just that "cert collectors", and basically do little more then the required minimums.  

The  NREMT program is testing and not actually schooling.  But on a national  level it is the program / organization that is attempting to bring all of EMS together under 1 roof so to speak.  Its my opinion that If they are trying to accomplish this they need to up thier standards.  Currently to be a member of the NREMT you need to pay your Fees and complete an additional 40 hours of training. I do not feel this is near high enough for what we do.  If NREMT is going to change all state levels of care and "unite" us so to speak. they need to also raise thier standards of care.

As for the nurses comment i made. Im not sure exactly where I was going with that. please ommit that.:unsure:


----------



## Ridryder911 (Oct 19, 2008)

EMT-P633 said:


> The  NREMT program is testing and not actually schooling.  But on a national  level it is the program / organization that is attempting to bring all of EMS together under 1 roof so to speak.  Its my opinion that If they are trying to accomplish this they need to up thier standards.  Currently to be a member of the NREMT you need to pay your Fees and complete an additional 40 hours of training. I do not feel this is near high enough for what we do.  If NREMT is going to change all state levels of care and "unite" us so to speak. they need to also raise thier standards of care.


You are about 1/8 right. What surprises me the most is how uneducated Paramedics are about their own profession. 

As you described NREMT is a testing agency. Now, to take an additional 40 hrs for what? As long as one completes the NHTSA EMT levels of EMS training one can take the NREMT test. If one has to take an additional 40 hours I question their State standards as being  enough to be competent or not, since again the NREMT uses the national standard level, anything below would be sub standard (as it already is). 

NREMT is NOT changing the EMT levels per say as per standards, the *NHTSA which is developed by the NAEMSE is * so please leave the NREMT out of it. Again, they only test what is taught. 

So many are not even aware what is going on in EMS. Standards are changing, but it takes time. The standards that are changing have been under scrutiny & review and debated by (guess who .. yep volunteers and Fire Services) for the past 13 years. There are many others out there hoping to make it through but again so many special interest groups is fighting to keep curriculum's and educational levels down. 

Even now, the rumors even here is poorly understood. NREMT is not changing any standards, nor do they have the power to do so. They are requiring those that are testing for the Paramedic level have graduated from a accredited program. NOT any other levels (Basic, Advanced (the term Intermediate will be removed) and so on.) Yet, there are those that are even fighting this acclaiming it will cause undue hardship on programs, increase the shortage... yadda, yadda.. doo doo. All B.S. because they want Paramedic mils and cook book medics. Remember, those with an education will demand more money and want the system to become a profession.. Gasp!

Before arguing and making suggestions, spouting off "what should be or this or that" do a little research on the matter. Look at  NHTSA, Advocates for EMS, NAMESE, NAMESP, State EMS Directors Association web sites. They all have posts that discuss current changes and proposed changes .. the real ones. Other wise posting should have .. could'a .. is all yap. 

R/r 911


----------



## EMT-P633 (Oct 19, 2008)

i stand corrected.


----------



## Ridryder911 (Oct 19, 2008)

bstone said:


> It's hardly ever that simple. However since you've decided to question my own competency by indicating you question my abilities as a medical director before I have even completed my MD and residency then I will end this conversation now. Come back when you can be a bit more civil.



I agree with some, you fail to see what the real world is like. Most medical directors are now bought. The EMS pays a fee and you get what you pay for. Majority are "paper medical directors" only. Many EMS administrators want that and again they decide who and whom is the medical director. In other words, they want the ones to sign here and here. I would to say, over 80% would not know the difference between a Basic and Intermediate level and maybe what a Paramedic is allowed to or not. Most states do NOT require any requirements on EMS Medical Control other than to be an licensed physician. Even there, is the irony. Many of them are not definitely EMS (residency EMS director trained) nor even ER physicians. They are GP, Ortho's, etc.. what ever the EMS can find, or as I have seen "the least involved committee". 

Right now you inform us upon how and what. I realize your intentions are honorable and I hope you will pursue and carry through with them; but I also know the facts and the real world. I have personal friends and former Paramedic peers and students that are EMS Medical Directors. Most were in the field more than 15 years before becoming a physician, so they do know the problems. They are active as much as they can be... now, that is not always enough. Yet, that is life. One works 12 hours a night for three shifts, go to medical records to sign charts, deal with the spouse, attend the "partners" meetings and parties, kiss the administrations arse, and yes then there the is the EMS. For a whopping $15,000 a year or so.. to review Paramedics charts that can't hardly be read or procedures that are so routine and simplistic as a step by step ... Get the drift, one hurries through to get home to get some sleep for that all nighter. 

Even if one wants to do something, (as I have seen) what can they do? Attempt to restrict a Paramedic (if FD the Union will be on your tail) and Administration will be asking you how are you going to get more reimbursement for them. As I am now seeing, more and more EMS shopping for the Medical Director of their choice, not always the best one. 

Remember, it is a business. 

This is not just in small areas. I have such action on one area that the Medical Director is over two cities with one having a million people and the other about half a million. He/She is also over the FD, Police, Sheriff, and yes the EMS as well. Talk about meetings, reviews, education, and having to be politically correct... wow! 

Look at the current changing of the guards. Austin,for example.. many are holding their breath to see what changes are going to occur.. Great protocols, great system, that all can be changed with a dot from the ink pen. Who knows... will the new medical director be pro- or be a bureaucratic one? .. 

Again, not saying you can't or you won't.. I hope you pursue.. I just realize it is hard, as I have heard the same statements from those that have been there and attempt to do it. 

R/r 911


----------

