# Opinion: Should states limit entry into EMT B/Paramedic courses?



## ethomas4 (Jan 26, 2012)

Wondering what you all think. 

Should states limit EMT and Paramedic course entry? 

Pretty much, anyone willing to pay can get into EMT B and Paramedic school. (obviously the school, states etc want the money). But this just FLOODS the job market and makes it extremely difficult for people to get hired. 

In many EMT programs in CA, they have lowered the passing rate to 75%...and I know for a fact that at one junior college they lowered the acceptable passing rate to 69%!!!!!!!!!!!!!!!!!!! (I know because I was a volunteer instructor there, and I was against the policy)

If they did this, there would be fewer EMTs and PArmedics, thus giving those that do graduate from these courses a much better chance at finding employment. Unfortunately, most of my EMT and Paramedic friends/colleagues spend money, time and put forward many emotions to become an EMT or Paramedic yet they find NO JOBS!!!! HOW SAD. 

Should it be more like law enforcement? where you are only trained if they have decided to hire you (for the most part).

Any ideas on how to fix current lack of employment in EMS?

Thank you for your opinions.


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## pa132399 (Jan 26, 2012)

i would say no on restricting the number of people because usually the testing process will weed some people out and in the case of EMT-B it is difficult to get a job because we are a dime a dozen medics on the other hand its a lot of schooling and usually the people willing to do it have a job in the field and in my case i have a job in ems and when i finish school i will have a medic slot at my current company.  

Also in medic school we started with 40 and we are down to 28 we are only just under halfway through so its has its own attrition and weeds out the people who would be flooding the field. its all a matter of how much you want the 9 extra letters or in PA the orange.


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## ethomas4 (Jan 26, 2012)

great response.

however, i have seen in recent years that testing no longer weeds anyone out. I will never forget the day that I heard an EMT B instructor, on final testing day, say "dont worry, we will not fail anyone, do you guys know what it would do to our reputation if we had a low passing rate? no one would go through our course."  

I would like testing to be a bit harder and actually weed people out...maybe it is like that in pennsylvania, which would be a good thing. I think that NREMT should be more demanding of EMTbs. 

so maybe the answer is no to limiting but yes to actually making people learn things.

thanks


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## pa132399 (Jan 26, 2012)

i agree on the learning portion of it and PA when i took mine two years ago and i think still has its own state test which was decently difficult and people from my class of only 8 still managed to fail it but im currently in luzerne county community colleges paramedic program and its tough and the tests are an absolute mind**** but it makes me learn the material.

we shall see though i have heard rumor that with the new national standard that you will have to achieve each level from emr , emt, aemt, and then medic. but who knows it will be interesting


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## Chief Complaint (Jan 26, 2012)

I dont see why they would.  What does the state stand to gain by limiting the number of students?


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## DesertMedic66 (Jan 26, 2012)

It's kind of hard to limit a class that anyone can get into. I believe that the colleges that teach EMT and Medic programs should be limited. I'll bite the bullet and say that in my personal beliefs Fire departments should not have any kind of EMT or Medic programs (just personal beliefs based on EMTs I've seen with only Fire department EMT programs). 

Testing still does weed out the students. Normal rates for my school is 46 students per one of the three classes. After day one it usually drops to 40. Then midterms will drop it down to 25 or less. 

And then again with the personal beliefs but I think Medic schools should have a prerequisite of working as an EMT for at least 6 months. Not trying to start an argument just my beliefs.


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## pa132399 (Jan 26, 2012)

i agree with cc on it the number coming in can only benefit the state and many emts generally in PA are running with volunteer community ambulances


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## ethomas4 (Jan 26, 2012)

the state gains nothing by limiting space......just a very interesting question to me


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## pa132399 (Jan 26, 2012)

firefite i agree with the minimum requirement to be accepted into medic school i was shocked at how many people in my class have only been emt's for less than a year. i still think that you should have a decent dose of field expierience befor you devote a year of your life to something you dont know if its for you.


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## ethomas4 (Jan 26, 2012)

I also agree with the comment that FDs should have nothing, or very little, to do with EMS


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## ethomas4 (Jan 26, 2012)

im sorry, I meant that they should not have EMT or Medic programs. my mistake


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## ethomas4 (Jan 26, 2012)

i meant, they should have little to do with paramedic programs...sorry


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## pa132399 (Jan 26, 2012)

tu tu tu day junior .. jk but i agree a medic program should be run by a college or a hospital based education program unless the fire dept runs both fire/ems


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## Handsome Robb (Jan 26, 2012)

pa132399 said:


> firefite i agree with the minimum requirement to be accepted into medic school i was shocked at how many people in my class have only been emt's for less than a year. i still think that you should have a decent dose of field expierience befor you devote a year of your life to something you dont know if its for you.



Meh, I did it and I love my job. I was hired as an Intermediate after starting medic school. Everyone is entitled the their own opinion.

I don't think programs should be limited just because of availability of jobs. There's a limited of availability of jobs in many fields, engineering or nursing come to mind. 

I will agree with the statement about fire department programs, however stand alone programs aren't all bad. My school is run by the local EMS agency and I have heard plenty of bad things about the CC program as well as heard many grads from the CC say they wish they went to my school.


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## pa132399 (Jan 26, 2012)

nvrob how is school going for you so far


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## Mountain Res-Q (Jan 26, 2012)

I am doing my part and failing students every time I skills test college students.  Unlike many of the other proctors, if you try to insert an NPA in the mouth, I fail you... I know... I am mean...  :blink:


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## Handsome Robb (Jan 26, 2012)

pa132399 said:


> nvrob how is school going for you so far



Going well man, going well managed to pull a 95% overall for didactic. Not sure how I did that one. We just started clinicals. How about yourself?


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## pa132399 (Jan 26, 2012)

our program is split into three semester so far its going well we just got back into the second semester on the 17th and we are starting itls and then next month acls. we do clinical all throughout and then after april 22nd we start our als internship and need to get 50 team lead calls.

tests are ridiculous and im lucky to be one of 3 out of 28 who have passed every test on the first shot so its going good we are doing iv's now so ive actually just got back from clincal today now sitting at work putting them into our clincal website


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## pa132399 (Jan 26, 2012)

Mountain Res-Q said:


> I am doing my part and failing students every time I skills test college students.  Unlike many of the other proctors, if you try to insert an NPA in the mouth, I fail you... I know... I am mean...  :blink:



bahahaha roflmao


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## SanDiegoEmt7 (Jan 26, 2012)

What they should do is require greater education, which would in turn result in great levels of care for its citizens.

It would self limit cause it wouldn't be 4 unit or 2 week emt program, or shake n bake medic program.  

Your desired economic outcomes would follow (less workers, better matched to job demand) 

But you don't just limit the amount of slots and let the standards remain so low


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## Bullets (Jan 26, 2012)

Must be an EMT for 3 years before you can apply to medic program.

Must pass a general intelligence test to enter EMT class, must get an 80% or better

Must get 80% or better on EMT certification test to get cert

Must pass general EMT test with 80% or better to enter Medic school

Must pass medic boards with 80% or better to get license

Deal with it


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## WhiskeySix5 (Jan 26, 2012)

firefite said:


> I think Medic schools should have a prerequisite of working as an EMT for at least 6 months. .



I could not agree more, though I would say 12 months. I am amazed how many medic students we get for internship that do not know how to perform an assessment, or cannot communicate with a patient.


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## Veneficus (Jan 26, 2012)

ethomas4 said:


> Should states limit EMT and Paramedic course entry?



Only Clergy, Lawyers, and Doctors decide who can be one of them.

EMS persons cannot.

However, why would it benefit the state to limit the numbers? If quality was the true measure instead of quantity, wouldn't it make more sense to raise standards?



ethomas4 said:


> Pretty much, anyone willing to pay can get into EMT B and Paramedic school. (obviously the school, states etc want the money). But this just FLOODS the job market and makes it extremely difficult for people to get hired.



You are right, and it is designed that way. It gives people the opportunity to change or train for a career quickly. That has its own financial benefits.

In the US the state does not have the responsibility of providing jobs. That has been tried a few times before with rather unpleasant and economically unsustainable results.

The role of the state is to provide opportunity. If you went to EMT school and passed, you have an opportunity to get an EMS job.

Your (in)ability to market yourself, provide a service worth more, distinguish yourself from your contemporaries, or move somewhere else for a job, is really of your making. 

It is not the fault of other students, the state, immigrants, or any other bogeyman you want to attribute this to. The state owes you nothing. 



ethomas4 said:


> In many EMT programs in CA, they have lowered the passing rate to 75%...and I know for a fact that at one junior college they lowered the acceptable passing rate to 69%!!!!!!!!!!!!!!!!!!! (I know because I was a volunteer instructor there, and I was against the policy)



So what? I have sat in classes much harder than paramedic class where passing was 44%. A grade of B was 49%, and you would be damn proud of a B in that class. Arbitrary percentages of passing mean nothing. You could know 100% of paramedic class and still know less than 1% of medicine.

Of course, as a "volunteer instructor" for a program that charges students tuition and I am willing to bet pays instructors, maybe you should ask for some money or quit doing work somebody else is being paid for for free.

To keep up your skills? You have no substantial skills. 




ethomas4 said:


> If they did this, there would be fewer EMTs and PArmedics, thus giving those that do graduate from these courses a much better chance at finding employment. Unfortunately, most of my EMT and Paramedic friends/colleagues spend money, time and put forward many emotions to become an EMT or Paramedic yet they find NO JOBS!!!! HOW SAD.



Let me be the first to tell you, students do this with all sorts of degree programs every day. The limited amount of jobs is because of market forces. How many people with degrees in advanced basket weaving (or other liberal art) find themselves with a job that didn't require a degree or no job at all?

How many doctors are out of work? How many engineers?

True not everyone can get into those jobs, but the reason they are paid what they are with the opportunity they have is because they are extremely valuable to society. 150 hours (or less) of first aid training, well... not so much.

In fact I'll be willing to bet the 1500 hours of training barber isn't complaining there are too many barbers.

It is the responsibility of student to research their career choices. It is the responsibility of said student to have a plan or ability to market themselves to employers after they acheive thier academic goals. 

Going to school gives the opportunity for a job, it does not promise one. Many paramedics and EMTs have an unrealistic expectation of the job market. It is not the responsibility of the State to make up for the FAILURE of the students to appreciate their prospects after school.

Why should The State be involved in covering for your failures and inability?  



ethomas4 said:


> Should it be more like law enforcement? where you are only trained if they have decided to hire you (for the most part).



This is not a universally true statement. In many places you are free to pay to go to a Police academy. You will even graduate. You are not promised a job. There are plenty of these people working security jobs at the mall and other places.



ethomas4 said:


> Any ideas on how to fix current lack of employment in EMS?



Absolutely,

Join the rest of the civilized world and make working on an ambulance a 4 year degree to start. Not only will it raise the caliber of provider, it will eliminate everyone trying to do a quick career change to healthcare or try to get a job requiring just a few weeks of training and a high school diploma which is an absolutely useless minimum in most modern societies.

Actually on the topic, we could probably eliminate US high schools totally and just send people right to university. After all, the passing criteria for high school in the US no longer meets the needs of US society.  (the quality is simply too low) 

Remove EMS from the fire service, this will allow market forces to influence not only the amount of providers, since they still will likely not be paid the pay and benefits of a government worker, but increase pay and demand for those who provide a higher quality of service. (especially in California)

Students could figure out that just about every EMS training program grossly over charges. If you divide the cost of the average EMT+ Paramedic program and lost wages by the hours you will have to work to recoup those costs at current salaries, it likely is going to be years of life. (aka not worth the investment, because you could have gotten more valuable training or education in another field)

A higher educated provider can provide services other than a glorified taxi ride. Services that can be charged for and recouped to offset the loss of providing emergency transport. Of course then they would have to do more than "true emergencies."

You know why I get paid $50/hour to teach ACLS class?  

Because I am worth it.

Use that same logic to figure out why you make what you do.

It is not the responsibility of The State, any state, to make up for the shortcomings of citizens who provide no value, or such little value they cannot attain the goals they desire.

While it is the responsibility of The State to provide assistance to its members who struggle to survive, there is a difference between surviving and having what you want.

Ask yourself: "Why do so many foreigners risk their lives to come to the US everyday and are happy earning wages so low US citizens would never consider working for such?"

Perhaps they have a more realistic understanding of what they are worth and the type of life that actually buys?


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## mycrofft (Jan 26, 2012)

Bullets is pretty good above.
How about copying the nursing NCLEX model, including steps to cut out interference with test results to make all pass. *

Adult education generally (and I include the ARC) is turning into a travesty. California passed laws last yeare to help cut some of the worst offenders out but enforcement is lax and the measures weak.

Try this: classes only offered through community or state colleges or a private college meeting similar standards. Testing is uniform nationally and run by one company or government entity, and secured/audited by another. A track record kept at State level of certificate holders being fired for cause or other certificate-lifting offenses, and track kept of which school's graduates are being cited, or who do not pass the standardized testing to get certified; if their per capita failure/citation rate reaches 5%, they are put on probation.

The point isn't to artificailly restrict the  supply of EMS workers, it is to assure the public that the ones reaching the job market are competent (in some cases _literate_) enough to do the job. If students want to learn to treat people at any level up to Wilderness EMT or Medical First Responder, they can go to Am Red Cross or a tech school or whatnot and get that certificate; however, they would not be hireable except at low level capabilities such as a pool or a school  until/unless they transitioned into an accredited program (maybe be able to test/challenge some stuff), then certified.

One side effect should be that the plethora of confusing different names and micky mouse subdivisions of EMT would be pruned. If I was in Kentucky and needed an EMT-B, I could hire one from Calif. and be sure of what I was getting (the original intent), and not hear from all the EMT-I, IV, R, W, 1, 2, MSNBC's out there.

*NURSING: when Calif passed mandatory nurse staffing ratio (like that worked!), hospitals got involved with some schools and turned them into mills. Lowered passing rates and even re-taking the finals if they failed was justified partly on the basis of language skills. No idea what their NCLEX passage rates were.


PS: many replies occurred before I submitted this. I didn't address them.
So far.


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## LifelongEMT (Jan 26, 2012)

I believe they should limit. Have the applicants take a pre exam to see what experience they have and how much they want to be there. I myself am a firefighter emt i had to pay my own way through all of it! and we had to do an application and write an essay about why we wanted to be ther then we had an interview and then found out if we made it into the course and had to maintain an 80 average or better to pass the course..


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## Veneficus (Jan 26, 2012)

LifelongEMT said:


> I believe they should limit. Have the applicants take a pre exam to see what experience they have and how much they want to be there.



So how do you grade a subjective exam? 

What objectives could you possibly put on an exam to select people out of highschool?




LifelongEMT said:


> I myself am a firefighter emt i had to pay my own way through all of it! and we had to do an application and write an essay about why we wanted to be ther then we had an interview and then found out if we made it into the course and had to maintain an 80 average or better to pass the course..



At the 2 places I taught at we stopped doing that.

First the spelling and grammar was painful. 

Second, it is a complete waste of time to read dozens of "woe is me I had a hard life and want to help people" stories.


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## STXmedic (Jan 26, 2012)

There sure seems to be a lot of entitlement associated with a 120hr tech course...

Should there be limitations put to entering into EMS training? Sure, by the means of increasing standards. Require more prerequisites prior to admission. Raise the standard of teaching and make the class work more in depth, instead of teaching the material as superficially as possible. Make it more difficult to get in and get through and you'll significantly decrease the number of people wanting to be EMTs, and increase the competency of providers.

As far as needing 1-3yrs EMT field experience before entering paramedic, that's ridiculous and pointless. I disagree 100%.


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## Veneficus (Jan 26, 2012)

PoeticInjustice said:


> As far as needing 1-3yrs EMT field experience before entering paramedic, that's ridiculous and pointless. I disagree 100%.



You say it so much nicer than I do.

But I agree. It is an outdated industrial age labor mentality. It has no place in the modern world.


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## Chief Complaint (Jan 26, 2012)

States dont need to have any control over the number of students.

Fire departments and EMS agencies control the numbers via the amount of job openings.


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## mycrofft (Jan 26, 2012)

Nope. The number of trainees is governed by the number of classes and the number of potential customers in both the "total quality management" and the literal senses. There's been a glut of trainees and trained persons (says so right on this here piece of paper, "trained") ever since "EMERGENCY!" (Johnny and Roy on Squad 51) hit the TV. Just like every time they re-produce "101 Dalmations" there is a (temporary) blurp of Dalmations about.
Companies respond by hiring many part-timers; good for students and servicemen, not so good for people wanting to make a living at it.


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## Veneficus (Jan 26, 2012)

You know...

I think we have been looking at this from the wrong angle.

Rather than attack the number of students, let's reduce the number of instructors by requiring a Master's or above to teach.

or at the very least, weeding out instructors who teach only the curriculum of:

"So there I was locked in an epic batlle with death to snatch another helpless victim from his jaws... When all of a sudden, in a moment of EMS zen, I provided a cookbook treatment which magically saved the patient's life and the day..."

Yes, I think we should start there by laughing at them at every opportunity, not inviting them to professional functions, cutting their pay to zero, and perhaps tearing their patches off in front of an honour guard.

Or students could just quit going to the schools they teach at...


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## Bullets (Jan 26, 2012)

Veneficus said:


> So how do you grade a subjective exam?
> 
> What objectives could you possibly put on an exam to select people out of highschool?



How do private highs schools select people? they use entrance exams...civil service exams, SATs, ACTs, there are plenty of employment entrance exams

If you want to get really crazy, EMTs should need an Associates degree or 60 credits at a 4 Year college. Medics 4 years Bachelors

In NJ cops are required to have a Associates or better, but i know thats not common south of the Mason-Dixon


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## STXmedic (Jan 26, 2012)

Bullets said:


> How do private highs schools select people? they use entrance exams...civil service exams, SATs, ACTs, there are plenty of employment entrance exams


Those tests don't judge "experience", which is what he originally stated the purpose of the entrance exam should be. They test knowledge and comprehension.



> If you want to get really crazy, EMTs should need an Associates degree or 60 credits at a 4 Year college. Medics 4 years Bachelors


Now you're talking! Glad to see we're on the same page!


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## 281mustang (Jan 26, 2012)

Obviously there is a problem with the flooded market, but the solution isn't to get the state/government involved(as it pretty much never is), but to increase the standards, which the NR is starting to get around to doing.

If you were to drastically increase the standards to something taking longer than a semester to break into the field, the flooded market would be no more. Not to mention it would weed out a good portion of the half-asses.

My neighbor is an 18 year old Freshman in college that's EMT certified. His EMT-B course was offered in high school for free to anyone eligable that thought it might be interesting to take. What does that say about our profession when an EMT course is a high schooler's 4th period class?


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## Handsome Robb (Jan 26, 2012)

PoeticInjustice said:


> As far as needing 1-3yrs EMT field experience before entering paramedic, that's ridiculous and pointless. I disagree 100%.



I'm glad someone agrees with me. That's a ridiculous statement. Are nurses required to be LPNs for a certain amount of time before school? No. Are doctors required to be a mid level practitioner for a certain amount of time before school? No.


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## STXmedic (Jan 27, 2012)

NVRob said:


> I'm glad someone agrees with me. That's a ridiculous statement. Are nurses required to be LPNs for a certain amount of time before school? No. Are doctors required to be a mid level practitioner for a certain amount of time before school? No.



To be fair, getting some EMT-B experience before going to paramedic could really solidify some of the core practices of medicine: High-flow NRBs for everybody, large blouses of diesel, delay transport so paramedics can meet you on scene, and of course, my personal favorite, Tredelenburg...


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## Handsome Robb (Jan 27, 2012)

PoeticInjustice said:


> To be fair, getting some EMT-B experience before going to paramedic could really solidify some of the core practices of medicine: High-flow NRBs for everybody, large blouses of diesel, delay transport so paramedics can meet you on scene, and of course, my personal favorite, Tredelenburg...



That's how you save lives! Duh! :rofl:

Honestly the only thing I personally think helps is the operations experience. Not clinical experience, but that's just me.


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## DrParasite (Jan 27, 2012)

PoeticInjustice said:


> To be fair, getting some EMT-B experience before going to paramedic could really solidify some of the core practices of medicine: High-flow NRBs for everybody, large blouses of diesel, delay transport so paramedics can meet you on scene, and of course, my personal favorite, Tredelenburg...


To be fair, when the education advocates (written by people with MD, DO, and PhD after their name) high flow NRB for everyone, and trendelenburg position, we well as backboarding any neck or back pain, can the provider really be faulted?  and how can you practice large diesel boluses and delay transport so paramedics can meet you on scene?  don't those practices oppose each other?

in 10 years, when ACLS is shown to not improve walking out of the hospital neurologically intact, and gets taken out of the protocol (since my former medical director is convince most of ACLS doesn't help save lives), will you be calling all the paramedics who followed ACLS protocols stupid?


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## STXmedic (Jan 27, 2012)

DrParasite said:


> To be fair, when the education advocates (written by people with MD, DO, and PhD after their name) high flow NRB for everyone, and trendelenburg position, we well as backboarding any neck or back pain, can the provider really be faulted?  and how can you practice large diesel boluses and delay transport so paramedics can meet you on scene?  don't those practices oppose each other?


Somebody looked a little too far into my post...


> in 10 years, when ACLS is shown to not improve walking out of the hospital neurologically intact, and gets taken out of the protocol (since my former medical director is convince most of ACLS doesn't help save lives), will you be calling all the paramedics who followed ACLS protocols stupid?


If +10 years after that evidence is released, people are still performing practices proved detrimental, then yes. However, I am fairly certain that will not be the case. And if by some chance it is, I plan on being much further in my education and well out of EMS by then anyway


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## DrParasite (Jan 27, 2012)

PoeticInjustice said:


> If +10 years after that evidence is released, people are still performing practices proved detrimental, then yes. However, I am fairly certain that will not be the case. And if by some chance it is, I plan on being much further in my education and well out of EMS by then anyway


you missed my point.  the fact that the evidence proves the practices are detrimental is kinda inconsequential.  stupid, yes, but not the point I was trying to make.

It's unfair to judge any group of people as stupid or wrong when they are only doing what they are taught by a higher medical authority, or by the course curriculum that is designed by more educated people.  When they don't know better, and are taught the incorrect practices by more educated people, they can't be faulted for following their training.


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## STXmedic (Jan 27, 2012)

DrParasite said:


> It's unfair to judge any group of people as stupid or wrong when they are only doing what they are taught by a higher medical authority, or by the course curriculum that is designed by more educated people.  When they don't know better, and are taught the incorrect practices by more educated people, they can't be faulted for following their training.





PoeticInjustice said:


> Should there be limitations put to entering into EMS training? Sure, by the means of increasing standards. Require more prerequisites prior to admission. Raise the standard of teaching and make the class work more in depth, instead of teaching the material as superficially as possible. Make it more difficult to get in and get through and you'll significantly decrease the number of people wanting to be EMTs, and increase the competency of providers.


Last two sentences.


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## SliceOfLife (Jan 27, 2012)

Do you really want the government deciding what careers you can train for with your own money?   

Any schooling you consider should be weighed against the availability of the job market your training for.  I have no sympathy for someone who buries themselves in debt in college or a trade and can't find work after.  Make better life choices.


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## mycrofft (Jan 27, 2012)

Harsh words. Most people do not work in the field they get their (first) degree in. And without any degree your earnings are likely to be greatly reduced. 
That said, people need to stop chasing their dream into a brick wall.


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## Veneficus (Jan 27, 2012)

SliceOfLife said:


> Any schooling you consider should be weighed against the availability of the job market your training for.  I have no sympathy for someone who buries themselves in debt in college or a trade and can't find work after.  Make better life choices.



I would find this a viable argument if there were not doctors going bankrupt because their earnings from medicare won't cover their student debt payments.

Just like easy credit, housing bubbles, realestate bubbles, etc.

Education finance and US healthcare I suspect are the next bubbles.

The government is going to take a really large hit on these and it is nobody's fault but their own.

In education, the gov backs most loans, so unlike other forms of finance the gov assumes all risk. 

Some claim the student does, but let's face it, when one party has money and the other doesn't it doesn't take much education to figure who is going to be the loser. 

The only way to solve this problem is for government to only pay and back interest or offer all aid directly. The later has been done, but ultimately, the interest is still too high and the economy not stable enough. Which simply means they will absorb the loss.

While this may seem like a bad thing. It is generally people that can't otherwise afford education who will benefit. 

An educated society is the first step to a wealthy society. 

Healthcare is a bit more complex. But it will be a devastating event. As costs rise, people get shut out of the market, which creates a viscious circle of increased prices for those still in the market. Eventually nobody can pay and the system collapses. 

At which point anyone who cannot afford to pay loses. Which will increase the demands on social programs like disability and welfare. 

As every society has discovered, when your consumers out consume producers, your society collapses.

Your next depression is forthcoming. Likely due to a collapse of the healthcare industry.

As an EMS provider, the collapse of healthcare creates a big problem for you. If nobody is paying for EMS, nobody will be providing it. So unless you plan to volunteer your entire EMS career, you might want to reconsider your position on private healthcare.

One of the things most people don't seem to understand is a nations economy is not a one industry or independant issue. Like medicine it is a series of interconnected issues each depending on another.

No matter which individual card you pull, if you remove any part of a house of cards, the whole thing falls.

No need to believe me or be convinced by my statements. Wait and see.

This has been a week of quotes for me, so in keeping with it. Something from Return of the Jedi:

"Young fool, only now at the end do you realize... You will pay the price for your lack of vision."


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## SliceOfLife (Jan 27, 2012)

Veneficus said:


> I would find this a viable argument if there were not doctors going bankrupt because their earnings from medicare won't cover their student debt payments.
> 
> Just like easy credit, housing bubbles, realestate bubbles, etc.
> 
> ...



Please don't call me a fool.  You have never met me nor do you know anything about me.

I disagree wholeheartedly with your opinion.  I can understand your confusion on why things are the way they are.  The education bubble was created by .gov securing student loans.  With everyone being able to afford college at any cost, the colleges can charge whatever they want, there is no free market competition. Anyone can attend college and rack up 100 grand in debt for a major with no job market.  The colleges are more then willing to take their money.

It's only recently that some people are waking up and saying maybe I should be learning a marketable skill instead of a degree in art history, criminal justice, history, etc.  

So your solution, instead of removing government and having an actual market correction is to further regulate and subsidize a failing system?  

You only deserve what you earn, good or bad.  I pay 700 a month for healthcare insurance and I don't expect or want anyone to pay for my bills.  My education has been paid for in cash which I saved over the years.  Consequently, I don't want my tax dollars paying off someones student loans or medical bills.  If you feel the need or guilt to do so then that is on you.


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## SliceOfLife (Jan 27, 2012)

mycrofft said:


> Harsh words. Most people do not work in the field they get their (first) degree in. And without any degree your earnings are likely to be greatly reduced.
> That said, people need to stop chasing their dream into a brick wall.



Harsh but true.  Kids need to be taught this in high school and not learn it after they are upside down in debt.

I have a degree outside of EMS that is useless.  So this is coming from someone who found out the hard way.  But, I dug myself out of my own hole.


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## mycrofft (Jan 27, 2012)

Roger Veneficus:
"So there I was locked in an epic batlle with death". (When I use war stories, I use the ones that embarrassed me. Far more effective:blush.

Not that we need to cut the number of instructors but raise the quality. My nursing college only began requiring baccalaureate degrees of their instructors in 1982, and immediately started requiring Master's degrees. Shook some good people out, but most got with it and were still aboard. Shook out some bad ones as well.

While I like most of another reply, this phrase hits a flat note:
"Obviously there is a problem with the flooded market, but the solution isn't to get the state/government involved(as it pretty much never is), but to increase the standards, which the NR is starting to get around to doing."

Who gives any body the teeth to make change and enforce standards? Other than consensus in the field (and currently unification is anathema), it IS "the government", through qualification and denial/granting of licenses. They are involved in every operation, but at too low a level without oversight. Like voter registration in Mississippi in the Fifties.

The problem is that licenses to individuals and companies are governed apparently by local politics and corruption.


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## SliceOfLife (Jan 27, 2012)

281mustang said:


> My neighbor is an 18 year old Freshman in college that's EMT certified. His EMT-B course was offered in high school for free to anyone eligable that thought it might be interesting to take. What does that say about our profession when an EMT course is a high schooler's 4th period class?



In my state we have an ambulance run entirely by volunteer high school students.  The janitor drives.  No I'm not kidding.


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## Veneficus (Jan 27, 2012)

SliceOfLife said:


> Please don't call me a fool.  You have never met me nor do you know anything about me.
> 
> I disagree wholeheartedly with your opinion.  I can understand your confusion on why things are the way they are.  The education bubble was created by .gov securing student loans.  With everyone being able to afford college at any cost, the colleges can charge whatever they want, there is no free market competition. Anyone can attend college and rack up 100 grand in debt for a major with no job market.  The colleges are more then willing to take their money.
> 
> ...



Firstly, I was not refering to you specifically as a fool. 

Even so, being a fool is not always a bad thing. I am particularly fond of the character of the fool in King Lear. Particularly of the line:

"I am better than thou art now, I am a fool, thou art nothing."

But you offer an oversimplified explanation of a rather complex problem which you seem to think is limited in its extent. A rather common miscalculation of simple and unsecure minds.

When the top earners in society (such as doctors) are unable to effectively meet their financial obligations,( student loan payments) it goes well beyond a few college kids mistakenly thinking a degree in underwater basket weaving will allow them to earn enough money to meet any financial obligation. (like rent)

Now then, knowing you or your background is of no consequence. 
You offer a simple perspective on a complex set of problems and absolute ideology. I have no use for such people other than for them to pay the bill for my service.

It is generally an accepted statement in physics that when an unstoppable force meets an immovable object, both will be destroyed.

It would be a mistake to confuse my observation for opinion. 

Depending on the source and how it is counted (direct service or ancillary service), between 24% and 18% of the total US economy is healthcare related.

If I might solicit your opinion? 

What do you think would happen to any nation if 1/5 to 1/4 of its total economy collapsed?    

Look at some recent examples around the world, what would make the consequences any different for the US?

Student loans are an equally complex issue. 

The value of educated society is a statement of fact. Comparing the wealth of highly educated societies to that of uneducated societies, say for example: Sweden vs. Afghanistan, res ipsa loquitur.

If you economically remove access to education, you will be left with some level of skilled or unskilled labor. Which did work well in the industrial age. 

Time and discovery has advanced the minimum knowledge required to be of minimal value in modern society. The solution of a labor force that has to support itself while attempting to pay cash for education is not sustainable.

The value of education is simply too great and the wage of uneducated labor too small. I should also mention nations that must import educated people generally pay more for the same goods and services they provide which further reduces the opportunity and quality of life for its citizens.

To my knowledge, the only nations that can actually sustain such an economy are dictatorships which subsidize the cost of services with revenue from natural resource exports. In those same societies wealth is concentrated to a handful of individuals. That sort of kills the idea of the American dream that anyone can achieve anything if they work hard.

Perhaps consider the indivual quality of life and benefit to average citizens of nations who rely on an uneducated laborforce?

In the maintenence of modern society, ideology is counter-productive.  It is only by objective observation and definitive action which ultimately will decide a nation's fate.

However, as is evident in multiple societies all over today's world, when ideological factors cause inaction or eliminate potential solutions, the only possible outcome is collapse.

So, to make my opinion clear from my observation:

Anyone whos ideology prevents viable solutions or ignores complex modern realities is going to find themself in a very undesirable position in a very near future.

Finally to clarify my quote in simple words. In the part of the movie I was eluding to, a naive idealist finds himself in a position in which two of his absolute ideals conflict. He undergoes the realization that the position of absolute uncompromising beliefs cannot coexist and requires a position of accepting exceptions and compromises. Aka: The lesser of 2 evils.

Surely your background and education permits you the insight of such abstract concepts expressed in artistic work?

If my observations are erroneous, it would not be a bad thing, but I am generally told my insights are quite keen.


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## SliceOfLife (Jan 27, 2012)

I find your repeated insults offending and juvenile.  Are you really that insecure, is your position so weak?  You quote others often.  Is that because you don't have an opinion of your own?

What is your solution?  Cut the BS and man up, don't hide behind snide remarks and quotes.  If there was ever a thing as educated idiocy I think you might be offering up the greatest proof.


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## Veneficus (Jan 27, 2012)

SliceOfLife said:


> I find your repeated insults offending and juvenile.



I admit to being an elitist, but I think you are being overly sensitive if you find it insulting. 



SliceOfLife said:


> Are you really that insecure, is your position so weak?  You quote others often.  Is that because you don't have an opinion of your own?



No, I think that my opinions based on my observations are rather obvious. 

Not sure if it was this post or another, but out of some strange coincidence I noticed my week has been filled with quotes that I think say what takes me many words to convey in relatively few.



SliceOfLife said:


> What is your solution?.



To simply copy solutions that have some degree of success in other nations rather than constantly try to implement the opposite of them in spite. I don't have a particularly favorite one. All have benefits and drawbacks.



SliceOfLife said:


> Cut the BS and man up, don't hide behind snide remarks and quotes.  If there was ever a thing as educated idiocy I think you might be offering up the greatest proof.



If you say so.


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## SliceOfLife (Jan 27, 2012)

Finally it's coming to a head.  Refreshing from your last schizophrenic post.  I do get offended easy because I expect people to behave in a civilized manner even if opinions diverge.  We are part of some "type" of community and we owe each other better.

You offer no solutions except copy what other people have done with marginal success, which you freely admit.  To that end you haven't even put forth specific instances of any particular health care system that is better then ours.

You consider yourself an elitist and I would agree.  You are part of a small group that I have encountered often who tow-the-line but are incapable of independent thought.  There is a difference between reading, regurgitating and understanding.


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## Handsome Robb (Jan 27, 2012)

SliceOfLife said:


> Finally it's coming to a head.  Refreshing from your last schizophrenic post.  I do get offended easy because I expect people to behave in a civilized manner even if opinions diverge.  We are part of some "type" of community and we owe each other better.
> 
> You offer no solutions except copy what other people have done with marginal success, which you freely admit.  To that end you haven't even put forth specific instances of any particular health care system that is better then ours.
> 
> You consider yourself an elitist and I would agree.  You are part of a small group that I have encountered often who tow-the-line but are incapable of independent thought.  There is a difference between reading, regurgitating and understanding.



You do know who your arguing with? Right?


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## SliceOfLife (Jan 27, 2012)

Nope.  Please enlighten me.


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## ffemt8978 (Jan 27, 2012)




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## Veneficus (Jan 27, 2012)

*it is not important who*

Only what.

While villifying me, you will please observe that I meet none of the DSM criteria for schitzophrenia, schitzo-affective disorder, borderline personality disorder, nor depression with psychotic features and please try to do better and be more creative in your attempts.

But I accept that when a person does not wish to acknowledge arguments or positions that cause them to question their own beliefs, they often attempt to rationalize the offending position as "crazy."

It is not that I cannot come up with a specific healthcare system that is superior the the current failing US one, it is that I really don't care to hear you spew mindless propaganda at me to show me how wrong I am when I already know you are grossly uninformed.

Every healthcare insider in the US knows the current system is unsustainable and has been failing for years. 

At the same time every expert who offered a workable or even definitive solution has been the target of political attacks, many by protesters who actually stand to gain the most but have been worked into a fearful frenzy mob by those who actually would have to pay for it.

Has it ever crossed your mind why wealthy Americans who complain about everything from slackers to taxes don't simply pack their bags and go to another first world country?

Because they would have more than double the tax liability and social responsibility. The US has the lowest taxes in the entire modern world by a longshot. Since wealthy people benefit most from infrastructure, cutting out every program that doesn't benefit them saves or makes them money while eliminating things that benefit you.

So you take up the standard against that which you might lose but don't have. Blissfully unaware you are 1 illness or injury from financial ruin or that you could find yourself without the ability to better your current circumstance.

Mob mentality is known for its emotionalism, not its rationality.

You have a job, with insurance, but what happens if you are seriously injured in a car accident and disabled? As soon as your sick/PTO time is up, and you go on FMLA, your employer will cease to pay its share of your healthcare insurance? Where would the difference come from? Once you lose your insurance, who will pay for your ongoing medical bills? How will you provide for your family in both the short and long term? If you have children, how will they attend college without your financial support if there are no jobs that pay a livable wage nor the ability to finance their education? Did you know the number 1 cause of divorse is financial reasons? Bet you didn't know that healthcare expenses are among the top 3 reasons for bankruptcy. 

Think your relationship will survive it? What are you willing to bet? 

The biological purpose of a female finding a life long mate is to reduce the energy requirements of reproduction and raising children to adulthood. The social purpose marriage is to conserve wealth within the family unit in order to elevate the social status of the offspring.

Consider all the things that could cause you or your spouse or children life long financial ruin in a moment. (like unplanned teen pregnancy or found against in a lawsuit)

These things don't affect you yet? Think you are immune to them? Perhaps these examples, but the list is infinite.   

As for my lack of ability, please consider that my whole vague argument was in response to your rather dim self righteousness of not wanting to pay for slackers. All of my innuendo is specifically crafted to work on the sensitivities of mindless idealists, to which you respond to as if directed at you personally, make counter accusations and justifications in order to assuage the mental conflict created by seeing somebody use the same selfrighteous tone in order to challenge your positions.

http://en.wikipedia.org/wiki/Dunning–Kruger_effect

I understand perfectly, I must be the crazy stupid one.

You have not only judged me in error, you likely don't even think you have made an error.  

As for toeing the line, regurgitating, and not understanding complex interactions, your assessment in not only inaccurate, demonstrated by only by my past posts, but also your simplification of response and selective ignorance of many of the points here it is obvious you really don't know what you are talking about. 

The truth and accuracy of my character is rather diametrically opposed to your assessment.

Never the less, I eagerly await to hear whatever response you must craft in order to feel better.

But I suggest it is not lack of civility and comraderie that has upset you. It is that I have called your beliefs into question instead of offering consensus on them or acceptence they are sound logically. 

But I didn't call you an ignorant, spoiled slacker I don't want to pay for like you expressed in your opinion of others.


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## Handsome Robb (Jan 27, 2012)

SliceOfLife said:


> Nope.  Please enlighten me.



A medical student who either has graduated or is close to graduating I can't remember which.


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## firecoins (Jan 27, 2012)

ethomas4 said:


> Wondering what you all think.
> 
> Should states limit EMT and Paramedic course entry?
> 
> ...



NO!  No govt resretiction on who can learn this. Those who can't get jobs in EMS just wont get jobs in EMS. That seems to limit those in EMS.  ANyone should be able to get the training who wants it.


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## SliceOfLife (Jan 27, 2012)

Veneficus said:


> It is not that I cannot come up with a specific healthcare system that is superior the the current failing US one, it is that I really don't care to hear you spew mindless propaganda at me to show me how wrong I am when I already know you are grossly uninformed.



Then why do you continue?



Veneficus said:


> Has it ever crossed your mind why wealthy Americans who complain about everything from slackers to taxes don't simply pack their bags and go to another first world country?
> 
> Because they would have more than double the tax liability and social responsibility. The US has the lowest taxes in the entire modern world by a longshot. Since wealthy people benefit most from infrastructure, cutting out every program that doesn't benefit them saves or makes them money while eliminating things that benefit you.



Exactly.  My ideology is that low taxes are part of the American identity.  You work for it; you should be able to keep it.  I don't want a socialist society that cost me half of my income.  Since we are obviously polar on this issue, it's fair to say "my side" doesn't want the US to become like our neighbors.  That would contradict the founding fathers and the thousands that have died fighting for those ideals.



Veneficus said:


> So you take up the standard against that which you might lose but don't have. Blissfully unaware you are 1 illness or injury from financial ruin or that you could find yourself without the ability to better your current circumstance.



True, but not unaware. We hedge against this by having short/long term disability insurance, home equity and savings. Those will run out eventually and if someone still can't work there is SSDI, free health care, section 8 housing, food stamps, and bankruptcy to wipe out your debt.  How would you improve on this? Do you want some type of system that maintains a persons expenses if they are no longer able to work, forever?





Veneficus said:


> The biological purpose of a female finding a life long mate is to reduce the energy requirements of reproduction and raising children to adulthood. The social purpose marriage is to conserve wealth within the family unit in order to elevate the social status of the offspring.
> 
> Consider all the things that could cause you or your spouse or children life long financial ruin in a moment. (like unplanned teen pregnancy or found against in a lawsuit)
> 
> These things don't affect you yet? Think you are immune to them? Perhaps these examples, but the list is infinite.



No argument, this is called life.  What should the US be doing different?  I hear people talk about a safety net, beyond one's personal assets, what exactly does that entail?  How much I'm I responsible for someone else or them for me?



Veneficus said:


> But I suggest it is not lack of civility and comraderie that has upset you. It is that I have called your beliefs into question instead of offering consensus on them or acceptence they are sound logically.



I extend this to you as well.  You have no problem slinging mud but somehow you get upset when it comes back at you.  The schizophrenic comment was at one of your posts not at you personally.

Solutions not criticisms and try to have an open mind.


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## SliceOfLife (Jan 27, 2012)

NVRob said:


> A medical student who either has graduated or is close to graduating I can't remember which.



I see.  Well congrats to you Veneficus and good luck in your endeavors.


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## ffemt8978 (Jan 27, 2012)

Knock it off or become the focus of my complete and undivided attention.

Last chance to get back on topic and stay there.


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## Cup of Joe (Feb 9, 2012)

Absolutely, they should limit it, or at least make it a little tougher to get into the class.  Ideally, we should all have much higher education, expanded scopes, and higher wages.  But how many times have we repeated that one before.

My EMT instructor said he would not pass us at the end of the course if he didn't feel comfortable with one of us showing up if one of his family members called 911.


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## Tigger (Feb 9, 2012)

Cup of Joe said:


> Absolutely, they should limit it, or at least make it a little tougher to get into the class.



How do you go about making to tougher to get into an entry level class? The MCAT is one thing, MDs are looking at years of schooling. But how do you "weed out" someone from a 120 hour class? The obvious answer is make the class longer than that (or however long it is your state, it is still not long enough).


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## Handsome Robb (Feb 9, 2012)

Cup of Joe said:


> Absolutely, they should limit it, or at least make it a little tougher to get into the class.  Ideally, we should all have much higher education, expanded scopes, and higher wages.  But how many times have we repeated that one before.
> 
> My EMT instructor said he would not pass us at the end of the course if he didn't feel comfortable with one of us showing up if one of his family members called 911.



I've had instructors tell me that before as well yet people who had no business working on another human being still passed.

As for expanding the scope, I think education needs to be increased with the same scope before they further increase it and increase the scope but that's just my opinion. Baby steps.


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## JDub (Feb 9, 2012)

NVRob said:


> I've had instructors tell me that before as well yet people who had no business working on another human being still passed.



Unfortunately I think that instructors for most college based programs have almost no say in who passes and who doesn't. If someone can make good enough grades and check off during skills testing, then they are good to go even if they have no business working on another human being.

To be honest, I think Paramedic should be the first real level of EMS and should require a 2 year degree. Then I think there should be a level above Paramedic that requires and 4 year degree and has an expanded scope of practice. I feel that a combination of those should make up the bulk of units, with an additional unit or two staffed with at least one MD/PA/NP on-board. 

With all that being said however, with salaries as low as they are already, no company or municipality/county would be able to afford to staff all of those people so I really feel that it is a moot point.


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