# National Standards should all be the same across the Nation?



## 1badassEMT-I (Jun 21, 2010)

My question is this should we have the same standards/protocols across the Nation......
SCOPES of Practice EMT-B in NC be the same as EMT-Bs in Ca or EMT-Is in WV the same as the EMT-Is in  Texas. Should the EMT-Ps in Florida have the same protocol as NM.

I think in the interest of pt. care we should NOT vary protocol from state to state. As we all have the training standards the same why not have thwe same protocols......Have a set uniform standard across the nation for the same protocols....What do you think?


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## JPINFV (Jun 21, 2010)

1. No, not all of the training standards are the same. In large part, the national standards are a guideline than a hard requirment.

2. Are you saying that middle of no-where BFE has the same challenges and patient population as downtown Los Angeles?


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## 1badassEMT-I (Jun 21, 2010)

JPINFV said:


> 1. No, not all of the training standards are the same. In large part, the national standards are a guideline than a hard requirment.
> 
> 2. Are you saying that middle of no-where BFE has the same challenges and patient population as downtown Los Angeles?



The national standards are the guideline.....however I am not able to push meds I trained to push.....I am just asking do you think we should all have the same protocols uniform protocols....in our bag......sure where I am at I have alot of rural area where as you in Pomona is largely urban I wont run up against things that you will as well as you wont run into the same as me.....however I would to know that I can give the same care as you can if I did run into it.....make any sense?


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## ExpatMedic0 (Jun 21, 2010)

Yes we should, just like nurses and doctors do and most other providers.


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## ExpatMedic0 (Jun 21, 2010)

JPINFV said:


> 1. No, not all of the training standards are the same. In large part, the national standards are a guideline than a hard requirment.
> 
> 2. Are you saying that middle of no-where BFE has the same challenges and patient population as downtown Los Angeles?



Thats why there are Intermediates....
To me your statement is like arguing doctors RTT, and nurses in downtown LA should should be completely different than those in BFE nowhere.


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## MrBrown (Jun 21, 2010)

Yes, all Ambulance Officers should have the same education, scope of practice and continuing education requirements


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## 1badassEMT-I (Jun 21, 2010)

MrBrown said:


> Yes, all Ambulance Officers should have the same education, scope of practice and continuing education requirements



Mr Brown how is the standards in New Zealand......hopefully not as mess up as us in the good ole USA......I just have a problem with from one state to the next. MY training is not worth a damn......and I think that needs to change.....  I am trained NATIONALLY to push meds that could save a life however I am not allowed to push them in my state I practice in......To me 22 years of service thats is wrong!


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## 1badassEMT-I (Jun 21, 2010)

schulz said:


> Yes we should, just like nurses and doctors do and most other providers.



Could not agree more with that statement


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## MrBrown (Jun 21, 2010)

1badassEMT-I said:


> how is the standards in New Zealand......



*Ambulance Technician*
_Diploma in Ambulance Practice (24 weeks)_


Oxygen
Oro and nasophayrngeal airway
Laryngeal mask airway
Automated defibrillation
3 lead ECG monitoring
Aspirin PO
GTN SL (nitro)
Salbutamol nebules
Glucagon IM
Paracetamol PO
Methoxyflurane 
Ondansetron PO
Combat application tq.

*Paramedic*
_Bachelors Degree in Health Science (Paramedic)_


Intravenous cannulation
IV fluid
10% glucose IV
Manual defibrillation
12 lead ECG interpretation
Synchronised cardioversion
Adrenaline IM, IV, nebules
Morphine IV, IM
Ondansetron IV
Naloxone IM, IN, IV

Looking to add
Midazolam IM, IN for seizures

*Intensive Care Paramedic*
_Post Graduate Certificate in Intensive Care Paramedicine_


Endotracheal intubation
Cricothyrotomy
Intraosseous access
Chest decompression
Cardiac pacing
Atropine IV
Amiodarone IV
Midazolam IM, IN, IV
Ketamine IM, IV, PO
Frusemide IV

Selected Intensive Care Officers only 
Fentanyl IV
Suxamethonium IV
Vecuronium IV
Heparin IV
Streptase IV


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## 1badassEMT-I (Jun 21, 2010)

MrBrown said:


> *Ambulance Technician*
> _Diploma in Ambulance Practice (24 weeks)_
> 
> 
> ...



WOW I need to quit *****ing.....I can do more than Paramedics can down under..... here is just a few of what I can do here in the US....

Endotracheal intubation
Intraosseous access 
Chest decompression 
Cardiac pacing 
Atropine IV 
Manual defibrillation 
12 lead ECG interpretation 
Synchronised cardioversion 
Naloxone
Intravenous cannulation 
IV fluid 
Fentanyl
Morphine
D-50
Valium
and others


And that is as a EMT-I


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## MrBrown (Jun 21, 2010)

1badassEMT-I said:


> WOW I need to quit *****ing.....I can do more than Paramedics can down under..... here is just a few of what I can do here in the US....
> 
> Endotracheal intubation
> Chest decompression
> ...



But when you can't spell the name of the drug you're gonna administer Brown gets worried .... :unsure:

... although should you trust me in that orange jumpsuit with "DOCTOR" written on it?  

Seriously tho ... in particular endotracheal intubation is recognised here as a high level procedure requiring an advanced level of knowledge, skill and experience so it is restricted to a select group of Officers in order to retain competency

Some other skills like cardiac pacing and intraosseous access could probably drop down to Paramedic level as could midazolam. but would I feel confident using them with my current knowledge base ... bit of midaz for a seizure maybe but some of the cardiac stuff no.

Now certian skills (specifically thrombolysis and rapid sequence intubation) are viewed here as so complex and specalised requiring a level of knowledge. experience and skill that is even moreso highly specalised that they are restricted above Intensive Care Paramedic level in general to a selected group of Intensive Care Paramedics.

You can teach Whacker R. Rescue to stick in a drip, pop a few amps of some drugs and ram a tube down somebodys throat in a couple weeks (hell the Houston Fire Department do it in 12) but I would need quadruple that amount of time to teach the anatomy, physiology and pharmacology behind probably one of the skills mentioned above let alone let people go out and do it in that timeframe.


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## 1badassEMT-I (Jun 21, 2010)

Ok Brown I got the E out of morphine......to early here I tell you!


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## JPINFV (Jun 21, 2010)

schulz said:


> Thats why there are Intermediates....
> To me your statement is like arguing doctors RTT, and nurses in downtown LA should should be completely different than those in BFE nowhere.



...except not all areas recognize intermediates and there are a dozen and a half levels of intermediates. Even still, the skills needed at the paramedic level are going to differ from area to area. It's a lot easier to justify, say, RSI, when your transport time is 30 minutes than 5 minutes.


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## 1badassEMT-I (Jun 21, 2010)

JPINFV said:


> ...except not all areas recognize intermediates and there are a dozen and a half levels of intermediates. Even still, the skills needed at the paramedic level are going to differ from area to area. It's a lot easier to justify, say, RSI, when your transport time is 30 minutes than 5 minutes.



I have to argue that there only two I levels I-85 and I-99 the I 99 will be the paramedics in 2014.......According to NR......I am a I-99 however I get your point!


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## JPINFV (Jun 21, 2010)

schulz said:


> Yes we should, just like nurses and doctors do and most other providers.



You mean scope of practice and standing orders for non-physicians should be determined by the facility that they work at instead of the state level? Sorry, I don't trust most ambulance companies to allow them to set their provider's scope of practice. It's definitely not fair to compare any level to physicians since physicians don't have a legal scope of practice similar to other providers (the scope of practice of an unrestricted license to practice medicine is medicine in it's entirety. If a psychologist wanted to do open heart surgery, legally he can. Ethically and liability, on the other hand).


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## JPINFV (Jun 21, 2010)

1badassEMT-I said:


> I have to argue that there only two I levels I-85 and I-99 the I 99 will be the paramedics in 2014.......According to NR......I am a I-99 however I get your point!



The NREMT is only a testing agency who's standards follows the NHTSA standards and no one elses. Just because the NREMT only tests for specific levels and the NHTSA recommends specific standards and standards does not mean that the individual states are compelled to follow said standards. 

Additionally, the EMT-I/99 will not necessarily be a paramedic. If the provider opts to take the EMT-I/85 transition course instead of the longer bridge course, then he will be an EMT-I/85.


Edit: In the above post about scope of practice, I meant a *psychiatrist* not a psychologist...


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## 1badassEMT-I (Jun 21, 2010)

JPINFV said:


> The NREMT is only a testing agency who's standards follows the NHTSA standards and no one elses. Just because the NREMT only tests for specific levels and the NHTSA recommends specific standards and standards does not mean that the individual states are compelled to follow said standards.
> 
> Additionally, the EMT-I/99 will not necessarily be a paramedic. If the provider opts to take the EMT-I/85 transition course instead of the longer bridge course, then he will be an EMT-I/85.



You are wrong sir!  In 2014 I-99 with the proper recerts over time will be the NREMT PARAMEDIC ........ The I-85 will become AEMT......NHTSA has already got the standards in line for the change NR just didnt do this on there own.....however you are right the state level has to adopt it......but dont you think if your state is a NR state they will go with it......HMMM now there is a tought. 

here is the link to support what I am saying!!!! GO READ!!!

http://nremt.org/nremt/downloads/Newsletter_2009.pdf

 I see your point dont get me wrong but why would want to go down a level instead of up!


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## EMSLaw (Jun 21, 2010)

1badassEMT-I said:


> WOW I need to quit *****ing.....I can do more than Paramedics can down under..... here is just a few of what I can do here in the US....



And as long as we keep focusing on who gets to do the neat skills, rather than the level of knowledge involved, EMS in the USA will remain the sort of technician-level drudge work it is now. 

I have to agree with Brown.  While I think a Bachelor's Degree may be too much to ask right now, it would be nice to see people actually get some sort of didactic background to support their use of all the "neat skills".  I admit to a certain degree of equivocation, because there are skills that are low-risk, high-benefit that I think should be more widely available among various EMS certification levels, but that being said, you need to know why you're doing something, and not just how to do it.    

Otherwise, we're back in the days of Johnny and Roy, where paramedics were just a pair of hands to do what the doctor tells them over the radio.


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## JPINFV (Jun 21, 2010)

> All NREMT-Intermediate/99’s must take the Paramedic cognitive examination by their expiration date*, or “fall back”to EMT Advanced without testing.*


Emphisis added.

http://nasemso.org/Meetings/Annual/documents/ImplementationoftheEMSEducationAgendafortheFuture.3.pdf Page 31

Edit: There are additional descriptions of the transition courses somewhere on the EMS.gov website, but I'm having trouble finding it right now.


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## 1badassEMT-I (Jun 21, 2010)

EMSLaw said:


> And as long as we keep focusing on who gets to do the neat skills, rather than the level of knowledge involved, EMS in the USA will remain the sort of technician-level drudge work it is now.
> 
> I have to agree with Brown.  While I think a Bachelor's Degree may be too much to ask right now, it would be nice to see people actually get some sort of didactic background to support their use of all the "neat skills".  I admit to a certain degree of equivocation, because there are skills that are low-risk, high-benefit that I think should be more widely available among various EMS certification levels, but that being said, you need to know why you're doing something, and not just how to do it.
> 
> Otherwise, we're back in the days of Johnny and Roy, where paramedics were just a pair of hands to do what the doctor tells them over the radio.



Oh I agree with this 100% I get mad sometimes that we as a whole from Bs to Ps are not able to use what we are taught due to STATE protocols dont think we know what we are doing.......Like I said in a earlier post I can give Morphine but cant give Zofran because my state protocol does not allow it..... I make you sick with the Morphine but not help you from getting sick...makes me mad......but I am no DOCTOR .......nor do I have a understanding why they wont let me push it........


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## JPINFV (Jun 21, 2010)

1badassEMT-I said:


> nor do I have a understanding why they wont let me push it........



Have you tried asking the state medical director?


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## 1badassEMT-I (Jun 21, 2010)

JPINFV said:


> Emphisis added.
> 
> http://nasemso.org/Meetings/Annual/documents/ImplementationoftheEMSEducationAgendafortheFuture.3.pdf Page 31
> 
> Edit: There are additional descriptions of the transition courses somewhere on the EMS.gov website, but I'm having trouble finding it right now.



Your right you get 6 times to pass the test instead of 3 times...... All I am saying why would you want to go down a level instead of go up...

Here again I think all states should be on the same level as your trained be it a B or P....... Not have one set of standards  or protocol  per state, make it even across the Nation!


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## 1badassEMT-I (Jun 21, 2010)

JPINFV said:


> Have you tried asking the state medical director?



Are you kidding? You cant get  a sr8t answer from nobody in this state.....our  OEMS office is a joke here.


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## emt_irl (Jun 21, 2010)

thats the way it is over here in ireland, but i supposed we are a smaller country so its easier regulated. we all train to the same standard and all work off the same clinical practice guideline that your licenced to use(emt, paramedic, advanced paramedic)


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## medic417 (Jun 21, 2010)

1badassEMT-I said:


> Your right you get 6 times to pass the test instead of 3 times...... All I am saying why would you want to go down a level instead of go up...
> 
> Here again I think all states should be on the same level as your trained be it a B or P....... Not have one set of standards  or protocol  per state, make it even across the Nation!



To go up requires more classes, not just a test.


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## 1badassEMT-I (Jun 21, 2010)

medic417 said:


> To go up requires more classes, not just a test.



oh yes I know that! I am bridging now so I wont have to worry about it!


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## 1badassEMT-I (Jun 21, 2010)

emt_irl said:


> thats the way it is over here in ireland, but i supposed we are a smaller country so its easier regulated. we all train to the same standard and all work off the same clinical practice guideline that your licenced to use(emt, paramedic, advanced paramedic)



It can be done here if the states would get thier head out thier ***! or I should say the MEdical Directors should....


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## mycrofft (Jun 21, 2010)

*In answer to thee title: yes.*

As was pointed out talking about radios, regional autonomy is king.

My feelings on this are everywhwere here. Go back to NHTSA/DOT original EMT-A and EMT-P. Adjust the permissables, write protocols, but quit slicing the proverbial baloney thinner and thinner and allowing areas to invent their own versions.

And, yes, you are a doctor's hands still, just following protocols instead of relying on a wonky radio. If you stray, you are on your own without the  MD license.


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## JPINFV (Jun 21, 2010)

Here's my problem with a single nationwide scope and protocol. Does that mean if a medical director wants to introduce new treatments like CPAP or theraputic hypothermia, that they have to wait for the rest of the country to get their proverbial poop in order before he can do so? How do we reconcile the mother-may-I technician systems with the health care professional systems?


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## ExpatMedic0 (Jun 21, 2010)

emt_irl said:


> thats the way it is over here in ireland, but i supposed we are a smaller country so its easier regulated. we all train to the same standard and all work off the same clinical practice guideline that your licenced to use(emt, paramedic, advanced paramedic)



Exactly, just like it is in many countries. Paramedics in Dublin vs Paramedics in rural areas, do they have any training or scope of practice differences?

A huge problem in the U.S. is you have firemen getting trained on a fire department in 12 weeks to be state certified Paramedics in Texas, and then you have Paramedics in Oregon taking almost 3 years of school with a minimum mandatory AAS or the option of bachelors in various subjects.

You do not have Registered Nurses and Respiratory Therapist getting trained in 12 weeks in Texas and having other states require a degree, while some offer a year of vocational training. There is a standard for them across the board.....
The NREMT is still a huge work in progress to help with these issues and the problem go's beyond them.


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## 1badassEMT-I (Jun 22, 2010)

JPINFV said:


> Here's my problem with a single nationwide scope and protocol. Does that mean if a medical director wants to introduce new treatments like CPAP or theraputic hypothermia, that they have to wait for the rest of the country to get their proverbial poop in order before he can do so? How do we reconcile the mother-may-I technician systems with the health care professional systems?



Do it across the spectrum......submit it as one make it a standard for the whole country.....  if you in Ca. are doing something that is saving a life let me do it in my scope in WV


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## JPINFV (Jun 22, 2010)

...but what if you in WV can't afford the equipment or the additional training to implement it? What if you want to implement something, but the fire departments out here don't want to spend money to equip their bijillion and a half fire apparatuses with it? How do we deal with places like Wake County who have paramedics doing preventative care to keep people from calling 911 by fixing problems before they escalate. Their Advanced Practice Paramedics can't operate under the same protocols as the rest of the medics.


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## 1badassEMT-I (Jun 22, 2010)

JPINFV said:


> ...but what if you in WV can't afford the equipment or the additional training to implement it? What if you want to implement something, but the fire departments out here don't want to spend money to equip their bijillion and a half fire apparatuses with it? How do we deal with places like Wake County who have paramedics doing preventative care to keep people from calling 911 by fixing problems before they escalate. Their Advanced Practice Paramedics can't operate under the same protocols as the rest of the medics.



So JP are you saying that we cant go to the government and say hey we need this for this give us the money so we can do it.....look the government spends way to much money on BS.......agree...why not give us a chance to save a life with some of that money.......there is way to much RED TAPE in EMS anyways Also are you saying my pt in WV is not as important to save as the one in Ca. because you are using a different treatment than me that is saving lives?


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## JPINFV (Jun 22, 2010)

No. I'm saying that the environment, both the physcial environment and the social environment (ability and willingness to do training, especially fire-based where fire fighters are forced to do EMS. i.e. most of So. Cal.) are different. On the contrary, are you saying that your patient population and system resources (including transport time, available units, availablity of paramedics) are the same in WV as in So. Cal. or middle of nowhere Alaska? 

Also, with which money is the government going to spend? While, yes, there are plenty of programs that can and should be cut, there is still a ton of cutting that needs to happen just to truely balance the budget, little less start paying off the national debt.


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## 1badassEMT-I (Jun 22, 2010)

JPINFV said:


> No. I'm saying that the environment, both the physcial environment and the social environment (ability and willingness to do training, especially fire-based where fire fighters are forced to do EMS. i.e. most of So. Cal.) are different. On the contrary, are you saying that your patient population and system resources (including transport time, available units, availablity of paramedics) are the same in WV as in So. Cal. or middle of nowhere Alaska?
> 
> Also, with which money is the government going to spend? While, yes, there are plenty of programs that can and should be cut, there is still a ton of cutting that needs to happen just to truely balance the budget, little less start paying off the national debt.



I can tell you this pt population is going to be way different than So.Cal. my transport time will sometimes be longer than So. Cal. and the fewer units we have as well as Medics are few..... while you have a dense population I am more spread out and have less resources than you we are still a concern with the end result (both of us) SAVING LIVES! my whole point Let me have the same treatments as you..... Oh the fire dept here SOME not all are our first responders.....


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## 1badassEMT-I (Jun 22, 2010)

Also JP I can get so remote....that transport times to closest hospital can be 3 hours.... even in some places Air transport cant be done! Hell sometimes may take me a hour just to get to pt. or better!


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## JPINFV (Jun 22, 2010)

1badassEMT-I said:


> I can tell you this pt population is going to be way different than So.Cal. my transport time will sometimes be longer than So. Cal. and the fewer units we have as well as Medics are few..... while you have a dense population I am more spread out and have less resources than you we are still a concern with the end result (both of us) SAVING LIVES! my whole point Let me have the same treatments as you..... Oh the fire dept here SOME not all are our first responders.....



If the patient population and system resources aren't the same, why are you instantiating that we treat them the same? Why, also, are you assuming that Los Angeles has better protocols than you do?


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## MrBrown (Jun 22, 2010)

You mean someplace is worse than Los Angeles? Is that possible?


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## JPINFV (Jun 22, 2010)

MrBrown said:


> You mean someplace is worse than Los Angeles? Is that possible?



Orange County, but it's damn close.


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## 1badassEMT-I (Jun 22, 2010)

JPINFV said:


> If the patient population and system resources aren't the same, why are you instantiating that we treat them the same? Why, also, are you assuming that Los Angeles has better protocols than you do?



I am not saying that So. Cal. has better I am just saying that if from one state to the next is the same it would make better for pt care.....and pt population will vary from state to state......has nothing to do with how I treat my pt ......help or give me the same resources as all the others to help me provide the level of care for my pt deserves...( if you are doing a treatment out there that we should using here and it is working why not allow me the same benefit).....


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## 1badassEMT-I (Jun 22, 2010)

We need Brown with his jumpsuit in WV....here if it is raining in Florida they wont fly in WV.....hehehe... seriously if it is partly cloudy we cant get a helicopter..... our birds dont fly in weather!


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## JPINFV (Jun 22, 2010)

The problem is that  a lot of interventions include a risk benefit analysis that is drastically different between something as simple as long and short transport times. It's a lot easier to justify having RSI as an option with a 3 hour transport time than a 5 minute transport time. How about transport decisions? If you have 1 hospital within 2 hours, it might make more sense using HEMS IFT and stabilizing patients at the local hospital than sending them for a 3 hour transport than going a 5 minutes longer to a specialty hospital.


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## 1badassEMT-I (Jun 22, 2010)

JPINFV said:


> The problem is that  a lot of interventions include a risk benefit analysis that is drastically different between something as simple as long and short transport times. It's a lot easier to justify having RSI as an option with a 3 hour transport time than a 5 minute transport time.



This is true.....heres the point.....the next state over VA and my county borders VA..... there they can RSI .......here we CANT.....see my point! There have been times I would have loved to put someone down that needed it...but just cant do it! Medics cannot even in WV RSI......


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## looker (Jun 22, 2010)

MrBrown said:


> Yes, all Ambulance Officers should have the same education, scope of practice and continuing education requirements



So as an owner of an Ambulance company and not being EMT or anything related to health, i should not be able to run my company?


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## 1badassEMT-I (Jun 22, 2010)

looker said:


> So as an owner of an Ambulance company and not being EMT or anything related to health, i should not be able to run my company?



You dont get what he is saying! He is saying the crews not the owners.......beside if I own a Ambulance Service I would want to be train in some form....thats just insane if you are not!


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## JPINFV (Jun 22, 2010)

If you are not (or ever been) an EMT or higher, you shouldn't be making any clinical decisions, including setting education requirments. If you aren't educated in health care, how can you evaluate any treatment provided?


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## 1badassEMT-I (Jun 22, 2010)

JPINFV said:


> If you are not (or ever been) an EMT or higher, you shouldn't be making any clinical decisions, including setting education requirments. If you aren't educated in health care, how can you evaluate any treatment provided?



Totally AGREED to that! And the liabilty that comes with that.....WOW factor on that!


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## looker (Jun 22, 2010)

JPINFV said:


> If you are not (or ever been) an EMT or higher, you shouldn't be making any clinical decisions, including setting education requirments. If you aren't educated in health care, how can you evaluate any treatment provided?



That is why i hire professionals whos job it's to know what type of treatment they should provide. As for education requirement, it's pretty simple. At this time as long as you're certified EMT that is all i care. In the future once i start running ALS, I am sure my standard of education will change as i will get medical director etc. For now i am just doing IFT


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## 1badassEMT-I (Jun 22, 2010)

looker said:


> That is why i hire professionals whos job it's to know what type of treatment they should provide. As for education requirement, it's pretty simple. At this time as long as you're certified EMT that is all i care. In the future once i start running ALS, I am sure my standard of education will change as i will get medical director etc. For now i am just doing IFT



Well thats good that you got people.....in WV if you just do IFTs you still got to have a Medical Director.....and he or she must be a MD......


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## JPINFV (Jun 22, 2010)

Now, I'll add a clarification to my point. Want to make the minimum requirment for paramedic at least an associates degree, preferably a bachelors degree and base them out of universities? Sure, I can go with a national standards because the background given will be significant enough to gap the differences in environments. As long as any Joe Schmoe can open a school and get by on focusing on their local protocols, a national standard doesn't make sense. However, we need to sit down and make these decisions as a "profession."

To add to this point, the Federal Government does not accredit medical schools. The Liaison Committee on Medical Education (LCME), made up of the AMA and the American Association of Medical Colleges (AAMC) accredits MD schools and the Commission on Osteopathic College Accreditation (COCA), a part of the American Osteopathic Association (AOA) accredits DO schools. The medical profession determines the education standards for physicians, not the government (even if the states have their own licensing requirements which are below the profession standards).


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## 1badassEMT-I (Jun 22, 2010)

JPINFV said:


> Now, I'll add a clarification to my point. Want to make the minimum requirment for paramedic at least an associates degree, preferably a bachelors degree and base them out of universities? Sure, I can go with a national standards because the background given will be significant enough to gap the differences in environments. As long as any Joe Schmoe can open a school and get by on focusing on their local protocols, a national standard doesn't make sense. However, we need to sit down and make these decisions as a "profession."
> 
> To add to this point, the Federal Government does not accredit medical schools. The Liaison Committee on Medical Education (LCME), made up of the AMA and the American Association of Medical Colleges (AAMC) accredits MD schools and the Commission on Osteopathic College Accreditation (COCA), a part of the American Osteopathic Association (AOA) accredits DO schools. The medical profession determines the education standards for physicians, not the government (even if the states have their own licensing requirements which are below the profession standards).



I disagree making it a degree......thats the problem now why we are so short on medics.....we have taking it out of the community or votech college and put in a higher college....people cant AFFORD the training there for we have a medic shortage......I remember back when 410 hours you were cert as a medic.... cost $500.... done .....now thats not even a drop in the bucket!!!!


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> I disagree making it a degree......thats the problem now why we are so short on medics.....we have taking it out of the community or votech college and put in a higher college....people cant AFFORD the training there for we have a medic shortage......I remember back when 410 hours you were cert as a medic.... cost $500.... done .....now thats not even a drop in the bucket!!!!



I hope you are kidding here! Yeah, lets take EMS back to stupid medics that only know how to read a protocol book. I mean come on, we don't need to know how to think. We just put round peg in round hole.

Those that cannot take the time and effort to get a real education. Have no reason being a medic in the first place. Some of us strive to pull EMS out of the dark ages, not set it back 20 years.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> I hope you are kidding here! Yeah, lets take EMS back to stupid medics that only know how to read a protocol book. I mean come on, we don't need to know how to think. We just put round peg in round hole.
> 
> 
> 
> ...


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> I am not saying go back I am saying go forward......however I don't think it should be a degree.....



Why? 

Why should we not be held to the same standard as every other medical professional?

We are medical professionals. Not FF's or LEO. We are not Ricky rescues. We are here to treat medical problems

The standard right now should be an Associates degree and eventually made to a required Bachelors. That is the only way we will ever advance.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> I hope you are kidding here! Yeah, lets take EMS back to stupid medics that only know how to read a protocol book. I mean come on, we don't need to know how to think. We just put round peg in round hole.
> 
> Those that cannot take the time and effort to get a real education. Have no reason being a medic in the first place. Some of us strive to pull EMS out of the dark ages, not set it back 20 years.



Oh yeah lets not forget.......the protocol book ....what are you a PARAGOD that dont follow the protocol book GET REAL MAN! that whole statement is BS.... in itself......I mean come on are you serious!


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> Why?
> 
> Why should we not be held to the same standard as every other medical professional?
> 
> ...



Sir have you ever live in WV?.......... Paramedics here make at best 13.00 a hour...this state is a poor state......how many people do you think can afford a degree education here?


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> Oh yeah lets not forget.......the protocol book ....what are you a PARAGOD that dont follow the protocol book GET REAL MAN! that whole statement is BS.... in itself......I mean come on are you serious!



Yes, I do not follow a protocol book! See we are educated and we are aloud to think for ourselves. We do not practice cookbook medicine. You see, that comes from having an education and not just taught how to do some skills and no knowledge of why you are doing them.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> Yes, I do not follow a protocol book! See we are educated and we are aloud to think for ourselves. We do not practice cookbook medicine. You see, that comes from having an education and not just taught how to do some skills and no knowledge of why you are doing them.



To me that is STUPID on your part ........not follow the protocols.....that means you dont have standards.....educated or not......you got to have guidelines to follow regardless..... to me sir and this is just my opinion you are a IDIOT! with a educations that may get somebody hurt! So cowboy up and rock on cause you are the MAN! ....yeah right!


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> Sir have you ever live in WV?.......... Paramedics here make at best 13.00 a hour...this state is a poor state......how many people do you think can afford a degree education here?



Does not matter if they make $9.00 an hour. If they want to be a medic, they will get the education. I don't want it avalible to "anyone who wants it". I want them to be here for the medicine, not the cool job, with cool hours.

You may want to search these forums for the educational threads. Your arguments have been shot down a thousand times before.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> Does not matter if they make $9.00 an hour. If they want to be a medic, they will get the education. I don't want it avalible to "anyone who wants it". I want them to be here for the medicine, not the cool job, with cool hours.
> 
> You may want to search these forums for the educational threads. Your arguments have been shot down a thousand times before.



Dont have too....you got it dont to a sceince! Your educated! People want they just cant afford it!


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> To me that is STUPID on your part ........not follow the protocols.....that means you dont have standards.....educated or not......you got to have guidelines to follow regardless..... to me sir and this is just my opinion you are a IDIOT! with a educations that may get somebody hurt!



When you achieve an education, you will know how it's done. This is coming from someone that choose not to further their education in 22 years. Glad you have your Pt's best interests in mind. Let's just do it the way it's always been done. Be damned if it sucks.

We don't use protocols in our system. Our MD allows us to use our minds and not a one size fits all mentality!


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> Dont have too....you got it dont to a sceince! Your educated! People want they just cant afford it!



Damn right I am.

I didn't choose to stay stuck at a minimum level all my life. I cared about my Pt's welfare, not just getting to do cool skills.

You wonder why there is no national standard. I would not want you to have the treatments available to educated medics. You would be dangerous.


Funny, I paid my way through Medic school, making $7.50 an hour. Money is nothing but an excuse for the lazy. If it is wanted, it can be had.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> When you achieve an education, you will know how it's done. This is coming from someone that choose not to further their education in 22 years. Glad you have your Pt's best interests in mind. Let's just do it the way it's always been done. Be damned if it sucks.
> 
> We don't use protocols in our system. Our MD allows us to use our minds and not a one size fits all mentality!



Goes to show how much you know about me...... and glad your medical director allows you to do that .....see some of us dont have a medical director like yours ......we have to follow the guidelines and as for your statement about my educations I am college educated BA in Fire Science and ALSO I am bridging my medic.....and BTW working working on my MASTERS.... See I am not from WV just live and work here trying to get WV out of the dark.....


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> Damn right I am.
> 
> I didn't choose to stay stuck at a minimum level all my life. I cared about my Pt's welfare, not just getting to do cool skills.
> 
> ...



And if you would read all the threads posted here in this thread you would not jump to so quick there cowboy.....


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> Goes to show how much you know about me...... and glad your medical director allows you to do that .....see some of us dont have a medical director like yours ......we have to follow the guidelines and as for your statement about my educations I am college educated BA in Fire Science and ALSO I am bridging my medic.....and BTW working working on my MASTERS.... See I am not from WV just live and work here trying to get WV out of the dark.....



Then you should be at the top of the list to push for a degree. To bring WV out of the dark.

Why is it that a FF needs a degree, but a medic does not?

Does WV not have Dr's there? They all gained their education and I'm sure some were poor when doing it.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> Then you should be at the top of the list to push for a degree. To bring WV out of the dark.
> 
> Why is it that a FF needs a degree, but a medic does not?
> 
> Does WV not have Dr's there? They all gained their education and I'm sure some were poor when doing it.



FF dont need a degree.....some choose to get them.....I feel the same about medics.....as for the doctors here for the most part are not from WV research WV friend!


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> And if you would read all the threads posted here in this thread you would not jump to so quick there cowboy.....



I have read all the posts. Not one has mad a good argument to allow a national standard. Especially when you are arguing against a better education.

 A national standard will do nothing but bring the educated down to the lowest common denominator. That will never happen. When the standard is a degree medic, then the rest of the country will benefit from the it.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> Then you should be at the top of the list to push for a degree. To bring WV out of the dark.
> 
> Why is it that a FF needs a degree, but a medic does not?
> 
> Does WV not have Dr's there? They all gained their education and I'm sure some were poor when doing it.



Better yet look at what we have to DANCE to:::::: to see what we are up against in WV

http://wvoems.org/medical-direction/protocols


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> FF dont need a degree.....some choose to get them.....I feel the same about medics.....as for the doctors here for the most part are not from WV research WV friend!



I have plenty of family in WV. I know plenty of Dr's that were born and raised in small coal towns, that put themselves through medical school. They knew what they wanted and made it happen. They didn't use excuses to lower the standards.

You want to raise WV out of the dark, then push for education.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> I have read all the posts. Not one has mad a good argument to allow a national standard. Especially when you are arguing against a better education.
> 
> A national standard will do nothing but bring the educated down to the lowest common denominator. That will never happen. When the standard is a degree medic, then the rest of the country will benefit from the it.



I am not saying that it should not be better educated just in a form of a DEGREE! REALLY does it take 2 years to know your job..... I will put old medics up against you that would run circles around you! Now tell me that could not happen......it doesnt take 2 years to be a outstanding medic sorry!


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> I have plenty of family in WV. I know plenty of Dr's that were born and raised in small coal towns, that put themselves through medical school. They knew what they wanted and made it happen. They didn't use excuses to lower the standards.
> 
> You want to raise WV out of the dark, then push for education.



I do push education!!! I also  teach it here...... I can also tell you this the medical directors from state level to the local level here will not allow us to practice outside the protocols.....meaning if that was the case we would all be doctors.......I dont believe your MD lets you FREELANCE either..... I am sure you got protocols.....I am not stupid friend!


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> Better yet look at what we have to DANCE to:::::: to see what we are up against in WV
> 
> http://wvoems.org/medical-direction/protocols



That is why you fight at the state level to change things. Sitting in your town and complaining how bad it is, will not get anything changed. Become active in EMS education and reform at the state level.

Do you think that your state MD will allow greater depth of treatments, when the people in EMS in the state are arguing to keep education at a minimum standard? Hell no, he won't. If the education standards were changed to require a degree and better depth of knowledge. Your treatments would follow suit.


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> I do push education!!! I also  teach it here......



How are you pushing it? You stated that it should go back to 410 hours and be cheap enough for anyone to get.

Real education is not measured in hours. If you truly pushed education, you would be the first to scream for degree medics. Same way as Rn's are now degreed. We are about the only medical field that does not require a degree. Why is that? Because every time the push comes up, FD's and Volley services fight it. Why would anyone fight against better educated health care providers, unless the don't really care about the health care part of it.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> That is why you fight at the state level to change things. Sitting in your town and complaining how bad it is, will not get anything changed. Become active in EMS education and reform at the state level.
> 
> Do you think that your state MD will allow greater depth of treatments, when the people in EMS in the state are arguing to keep education at a minimum standard? Hell no, he won't. If the education standards were changed to require a degree and better depth of knowledge. Your treatments would follow suit.



Oh I am sure that to be the case.....And I do ...... I do sit on a committee for education here but alot of things fall on deaf ears at the state level.... however we got a new MD thinks do look promising for change but how long will take we dont know...... still alot of old money on the state level...


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> I do push education!!! I also  teach it here...... I can also tell you this the medical directors from state level to the local level here will not allow us to practice outside the protocols.....meaning if that was the case we would all be doctors.......I dont believe your MD lets you FREELANCE either..... I am sure you got protocols.....I am not stupid friend!



Then you have not worked in a progressive system. Our actual protocol book is 3 pages. It states that we can treat to what we believe is needed and to call med control if we have any questions. We do not have protocols that spell everything out on what you can and can't do. That is a one size fits all system and it does not work in real medicine.

The difference is our MD knows that we are educated and has trust in our decisions.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> How are you pushing it? You stated that it should go back to 410 hours and be cheap enough for anyone to get.
> 
> Real education is not measured in hours. If you truly pushed education, you would be the first to scream for degree medics. Same way as Rn's are now degreed. We are about the only medical field that does not require a degree. Why is that? Because every time the push comes up, FD's and Volley services fight it. Why would anyone fight against better educated health care providers, unless the don't really care about the health care part of it.



NO I DID not read it again dude I said I remember back when it was only 410 hours and it was only 500.00 is what I said.....that was the old is that a enough hours hell no..... see you read into the statement not what it was meaning.....And my wife is RN BSN with her MSN next year..... I am fire chief here in WV I dont fight anything EMS especially educations standards.....my FF/medics down to FF/EMT-Bs are trained well and the ones who want to further that I help do it...... And to be honest I wish EMS wasnt not in the fire services then that would fix the problem you are talking about....but wont happen!


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> Then you have not worked in a progressive system. Our actual protocol book is 3 pages. It states that we can treat to what we believe is needed and to call med control if we have any questions. We do not have protocols that spell everything out on what you can and can't do. That is a one size fits all system and it does not work in real medicine.
> 
> The difference is our MD knows that we are educated and has trust in our decisions.



Did you look at our protocols? We have to call ONLINE medical directions on every CALL and they notify the hospital! We dont call direct to hospital like the old days.....I would love your system!!!!! But because we dont have a system in place make not as worhty as you? Are we not trained enough as you even we wear a PARAMEDIC patch on out sleeve like you?


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> NO I DID not read it again dude I said I remember back when it was only 410 hours and it was only 500.00 is what I said.....that was the old is that a enough hours hell no..... see you read into the statement not what it was meaning.....And my wife is RN BSN with her MSN next year..... I am fire chief here in WV I dont fight anything EMS especially educations standards.....my FF/medics down to FF/EMT-Bs are trained well and the ones who want to further that I help do it...... And to be honest I wish EMS wasnt not in the fire services then that would fix the problem you are talking about....but wont happen!



If you feel that way and are the Fire chief, then push for EMS to be separate. There are thousands on EMS systems all over the country that are not in with Fire. They are stand alone systems that their only priority is Pt care. It does work quite well. Again it all comes down to pushing for change. Does it happen over night? No, it will not. But, the change will never happen till people start pushing it. I have seen the changes work in over 22 years. It does happen and will, if it is pushed.


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> Did you look at our protocols? We have to call ONLINE medical directions on every CALL and they notify the hospital! We dont call direct to hospital like the old days.....I would love your system!!!!! But because we dont have a system in place make not as worhty as you? Are we not trained enough as you even we wear a PARAMEDIC patch on out sleeve like you?



Then push for the change in it! 

No, just because someone wears a Paramedic patch on their arm, does not mean they are trained or educated enough. Thinking like that is why the state MD's maintain a "mother may I" system in place.


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## John E (Jun 22, 2010)

*Why not...*

set national standards to become an EMT and a Paramedic and then let the communities that are going to pay them decide what level of care they're willing to pay for?

Do people in West Virginia bleed differently than we do here in California?

Do people in Alaska respond differently to cardiac drugs than the folks who live in Arizona?

Get the education, then go to where the people are willing to pay you a livable wage for providing them with exceptional emergency medical care.

The entire mess that is the EMS system in the U.S. boils down to one simple thing, control. 

JohnE


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## usafmedic45 (Jun 22, 2010)

> Are you kidding? You cant get a sr8t answer from nobody in this state.....our OEMS office is a joke here.



Actually, I know a few people affiliated with the WV EMS system at the state level and I beg to differ.  Simply because they might smack you on the hand and tell you "no" when you ask to do something you have no business- or at least no concrete argument for doing- does not mean they are a joke.  I say this because normally this is the sort of things that lead to EMS personnel getting their panties in a twist and maligning their state EMS authorities.  



> ......help or give me the same resources as all the others to help me provide the level of care for my pt deserves..



I think you missed the point he was trying to make.  Not only are you going to see a different spread of patients (less penetrating trauma vs more "got drunk and fell out of a tree while deer hunting"*), a rural EMS provider is going to be with the patient a lot longer which in some ways, contrary to the idea that a high-volume system is the only one that should have advanced protocols, leads to the need to have a bigger scope of practice.  If you're ten minutes out from a hospital, you are simply going to have less time to do things for the patient than if you have that same patient and are 30 minutes out, assuming you're not screwing around on scene either playing Ricky Rescue or waiting on a dash for cash flight.

I believe there should be a basic standard of care across the board, but it should not be 



> there is way to much RED TAPE in EMS anyways



Judging by some of the people in our ranks, I could make a very good argument for exactly the opposite.



> You do not have Registered Nurses and Respiratory Therapist getting trained in 12 weeks in Texas and having other states require a degree, while some offer a year of vocational training. There is a standard for them across the board.....



Actually there are a few states with screwball requirements.  One of them is New York where you have to have an associates or bachelors in respiratory to practice.   A colleague of mine who holds a PhD in biochemistry can not get his license to practice there because he was trained as an RT before the requirement for associates degrees came into practice.   But by and large, you are correct.  



> It can be done here if the states would get thier head out thier ***! or I should say the MEdical Directors should....



"The primary role of a medical director is to protect the patients seen by those under his guidance from those under his guidance"



> I get mad sometimes that we as a whole from Bs to Ps are not able to use what we are taught due to STATE protocols dont think we know what we are doing



No offense, but just because you know how to do something does not mean you should be allowed to do it.  I know how to do a thoracotomy, I've been shown how to do them on cadavers and assisted with them on live patients, just like how doctors learn to do them.  It does not mean I have a divine mandate to do so.  

Also, once again said with no offense, but you don't come across as all that well educated so that may be something else that is shooting you in the foot in terms of getting yourself moved forward.   It's a huge problem in EMS and you're exhibiting textbook symptoms of it.



> the next state over VA and my county borders VA..... there they can RSI .......here we CANT.....see my point!



No, I don't.

Think about the biggest moron paramedic you know.  OK, now imagine him trying to RSI your youngest child.  See my point? 



> ....here if it is raining in Florida they wont fly in WV.....hehehe... seriously if it is partly cloudy we cant get a helicopter..... our birds dont fly in weather!




That is a good thing. 



> thats the problem now why we are so short on medics


Is that why the value of a medic in terms of salary is so low?  Because of the shortage?  



> I am not saying go back I am saying go forward......however I dont think it should be a degree.....and should be made affordable for all that want it be able to get it!



So all the fun stuff and none of the things needed to assure high quality care, eh?




> how many people do you think can afford a degree education here?



You really don't understand why nurses, RTs and docs are paid so well do you?  



> To me that is STUPID on your part ........not follow the protocols.....that means you dont have standards.....educated or not



Congrats, you just dismissed the highest level of care we could possibly see in EMS: autonomy.  



> I am college educated BA in Fire Science and ALSO I am bridging my medic



How did you do during the English composition course? Your posts here are atrociously hard to follow.



> And if you would read all the threads posted here in this thread you would not jump to so quick there cowboy.....



No comment. 



> to see what we are up against in WV



I never thought I would say this but "Thank God for a strong authoritarian state EMS agency".  



			
				Reaper said:
			
		

> I didn't choose to stay stuck at a minimum level all my life. I cared about my Pt's welfare, not just getting to do cool skills.



OK, we've rebutted his points well enough.  Let him troll himself out until he gets upset and the mods start swinging the ban stick.   His mind is made up and nothing we say will change it.  





*-Actual case I worked, by the way.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> If you feel that way and are the Fire chief, then push for EMS to be separate. There are thousands on EMS systems all over the country that are not in with Fire. They are stand alone systems that their only priority is Pt care. It does work quite well. Again it all comes down to pushing for change. Does it happen over night? No, it will not. But, the change will never happen till people start pushing it. I have seen the changes work in over 22 years. It does happen and will, if it is pushed.



Well that is one thing we can agree about then......trust me man I have pushed for change and meet alot of resistance in doing so.......and get this WV is not a NFPA state.....you know why MONEY.....they cant afford the the funding to train.....the VOLLYS ..... the vollys have to depend on donations..... I have pushed for getting a fire tax.....to raise money.....not going to happen.... they rather spend the tax dollar on the county farm (fairgrounds) than education and it pisses me off.....I would not respond to another first responder call if didnt have too but my Dept is a transport Dept meaning we run five trucks for EMS services here....and it is a income for us.


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## reaper (Jun 22, 2010)

John E said:


> set national standards to become an EMT and a Paramedic and then let the communities that are going to pay them decide what level of care they're willing to pay for?
> 
> Do people in West Virginia bleed differently than we do here in California?
> 
> ...



John,

 We do have a National Standard to become an EMT or Paramedic. Unfortunately it is a MINIMUM standard. A lot of states choose to stay at that minimum and that is the problem.

They will never be able to raise that Standard, because of the people that jump up whining about the higher education that would be needed.


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> Well that is one thing we can agree about then......trust me man I have pushed for change and meet alot of resistance in doing so.......and get this WV is not a NFPA state.....you know why MONEY.....they cant afford the the funding to train.....the VOLLYS ..... the vollys have to depend on donations..... I have pushed for getting a fire tax.....to raise money.....not going to happen.... they rather spend the tax dollar on the county farm (fairgrounds) than education and it pisses me off.....I would not respond to another first responder call if didn't have too but my Dept is a transport Dept meaning we run five trucks for EMS services here....and it is a income for us.



Then work at the local level. If the politicians in there now won't help. Start pushing for people in office that will. Replace the leaders and the change will start!


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## 1badassEMT-I (Jun 22, 2010)

usafmedic45 said:


> Actually, I know a few people affiliated with the WV EMS system at the state level and I beg to differ.  Simply because they might smack you on the hand and tell you "no" when you ask to do something you have no business- or at least no concrete argument for doing- does not mean they are a joke.  I say this because normally this is the sort of things that lead to EMS personnel getting their panties in a twist and maligning their state EMS authorities.
> 
> 
> 
> ...



Whatever dude !!!!!!!! these are just my opinions I am like anybody else it is just a opinion...... nothing but my opinion..... that what this forum is about ..... Call it want you want.....BAN me as you call it I am not mad just enjoying the conversation with the ones I got going with......


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> John,
> 
> We do have a National Standard to become an EMT or Paramedic. Unfortunately it is a MINIMUM standard. A lot of states choose to stay at that minimum and that is the problem.
> 
> They will never be able to raise that Standard, because of the people that jump up whining about the higher education that would be needed.



ok can we agree to this I agree with what you are saying.... Dont you think we need to make it affordable to get the education....meet me half way here...


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## 1badassEMT-I (Jun 22, 2010)

John E said:


> set national standards to become an EMT and a Paramedic and then let the communities that are going to pay them decide what level of care they're willing to pay for?
> 
> Do people in West Virginia bleed differently than we do here in California?
> 
> ...



John it is not about what we get paid for.....it is about pt care.....


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## reaper (Jun 22, 2010)

1badassEMT-I said:


> ok can we agree to this I agree with what you are saying.... Dont you think we need to make it affordable to get the education....meet me half way here...



What does the cost have to do with the degree? Community colleges are normally the cheapest place to get an education. They provide 2 year degrees there. Yes, I agree that tuition has skyrocketed, we are in desperate financial times and states have cut funding to colleges. They have no choice but to raise the costs, to survive.

Again, if someone wants it, they find a way to get it done.


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## 1badassEMT-I (Jun 22, 2010)

reaper said:


> What does the cost have to do with the degree? Community colleges are normally the cheapest place to get an education. They provide 2 year degrees there. Yes, I agree that tuition has skyrocketed, we are in desperate financial times and states have cut funding to colleges. They have no choice but to raise the costs, to survive.
> 
> Again, if someone wants it, they find a way to get it done.



Due to the cost and you are right community colleges are the cheapest however they want to take it out of the community colleges and put it into a University..... BIG cost....

And you are right people do find ways to overcome the cost.....

OK I will retract the statement I made about the degree.....how ever I still believe we can do some thing better... how I dont know? ..... but hey if it will get more medics in the street I am for it!

I lobby to my town officers all time about my spending.....you got understand fighting the town is a :censored::censored::censored::censored::censored:! To get them to understand why we need equipment on the trucks so we can better provide for our citizen....it is a task


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## 1badassEMT-I (Jun 22, 2010)

Quote:
I get mad sometimes that we as a whole from Bs to Ps are not able to use what we are taught due to STATE protocols dont think we know what we are doing  

No offense, but just because you know how to do something does not mean you should be allowed to do it. I know how to do a thoracotomy, I've been shown how to do them on cadavers and assisted with them on live patients, just like how doctors learn to do them. It does not mean I have a divine mandate to do so. 

Also, once again said with no offense, but you don't come across as all that well educated so that may be something else that is shooting you in the foot in terms of getting yourself moved forward. It's a huge problem in EMS and you're exhibiting textbook symptoms of it.
 I AM VERY WELL EDUCATED!!!!!! But thanks for your opinion!


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## 1badassEMT-I (Jun 22, 2010)

usafmedic45 said:


> Actually, I know a few people affiliated with the WV EMS system at the state level and I beg to differ.  Simply because they might smack you on the hand and tell you "no" when you ask to do something you have no business- or at least no concrete argument for doing- does not mean they are a joke.  I say this because normally this is the sort of things that lead to EMS personnel getting their panties in a twist and maligning their state EMS authorities.
> 
> 
> 
> ...



I am very WELL EDUCATED but thanks for your opinion! Have a nice day!


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## 1badassEMT-I (Jun 22, 2010)

Reaper I had no right to call you a IDIOT and for that I am SORRY.... JUST wanted that out there so nobody thinks I am a ***.....he was expressing his opinion as I was mine ......however I expressed mine in the wrong way and for that I am sorry!


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## usafmedic45 (Jun 22, 2010)

> JUST wanted that out there so nobody thinks I am a ***.....he was expressing his opinion as I was mine ......however I expressed mine in the wrong way and for that I am sorry!



It's not often we see mea culpas from newbies on this site.  *thumbs up*


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## EMSLaw (Jun 22, 2010)

1badassEMT-I said:


> I disagree making it a degree......thats the problem now why we are so short on medics.....we have taking it out of the community or votech college and put in a higher college....people cant AFFORD the training there for we have a medic shortage......I remember back when 410 hours you were cert as a medic.... cost $500.... done .....now thats not even a drop in the bucket!!!!



West Virginia has a state university system.  It's amazingly reasonable in terms of tuition - around $5000 a year for in-state undergrads.  And they have generous scholarship packages for WV residents.  I'm sure the reason for this is to put college within the grasp of the economically disadvantaged of your state.  

I'm the first to agree that maybe a college degree isn't for everyone.  The associates degree level is still quite the technical degree.  Baby steps, baby steps.  

But I'd rather see the education level go up, rather than down.  Who should have more training?  The guy who injects you with drugs and may be making life-or-death decisions.... or the guy who cuts your hair?


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## 1badassEMT-I (Jun 22, 2010)

EMSLaw said:


> West Virginia has a state university system.  It's amazingly reasonable in terms of tuition - around $5000 a year for in-state undergrads.  And they have generous scholarship packages for WV residents.  I'm sure the reason for this is to put college within the grasp of the economically disadvantaged of your state.
> 
> I'm the first to agree that maybe a college degree isn't for everyone.  The associates degree level is still quite the technical degree.  Baby steps, baby steps.
> 
> But I'd rather see the education level go up, rather than down.  Who should have more training?  The guy who injects you with drugs and may be making life-or-death decisions.... or the guy who cuts your hair?



I do agree with the baby steps yes! And I do agree education needs to go up not down. Like I stated before just make it affordable for the one who want to attain it.... 5000.00 does not seem like alot of money but here in WV it is like giving up your first born.


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## EMSLaw (Jun 22, 2010)

1badassEMT-I said:


> I do agree with the baby steps yes! And I do agree education needs to go up not down. Like I stated before just make it affordable for the one who want to attain it.... 5000.00 does not seem like alot of money but here in WV it is like giving up your first born.



It's an investment, of course.  I have a Bachelors and a JD.  Other people on this site have a Bachelors and are partway through an MD or DO.  There are people with multiple masters degrees who post here regularly.  We all understand the sacrifices of going to college.  But there really shouldn't be an option, especially at the paramedic level.

Professions, like it or not, are characterized by a significant amount of formal learning.  Whether you're talking about the three traditional professions (medicine, law, and the clergy), or about the more expanded colloquial definition, there is a significant period of learning involved.  For some reason EMS thinks its excused, both from the formal education requirements of a profession and from the combined education and apprenticeship period of the skilled trades. 

If a degree were required to enter EMS, those who really wanted to do it would find a way to pay for it - savings, a part-time job, scholarships, student loans - just like the rest of us did.


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## 1badassEMT-I (Jun 22, 2010)

EMSLaw said:


> It's an investment, of course.  I have a Bachelors and a JD.  Other people on this site have a Bachelors and are partway through an MD or DO.  There are people with multiple masters degrees who post here regularly.  We all understand the sacrifices of going to college.  But there really shouldn't be an option, especially at the paramedic level.
> 
> Professions, like it or not, are characterized by a significant amount of formal learning.  Whether you're talking about the three traditional professions (medicine, law, and the clergy), or about the more expanded colloquial definition, there is a significant period of learning involved.  For some reason EMS thinks its excused, both from the formal education requirements of a profession and from the combined education and apprenticeship period of the skilled trades.
> 
> If a degree were required to enter EMS, those who really wanted to do it would find a way to pay for it - savings, a part-time job, scholarships, student loans - just like the rest of us did.



Yes I see your point as I have a BA and working on my Masters I understand however  I am in better shape than some in WV....But I do see the point..


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## Sasha (Jun 22, 2010)

> I disagree making it a degree......thats the problem now why we are so short on medics.....we have taking it out of the community or votech college and put in a higher college....people cant AFFORD the training there for we have a medic shortage......I remember back when 410 hours you were cert as a medic.... cost $500.... done .....now thats not even a drop in the bucket!!!!



I don't know if it's the same everywhere, but here, if it's a degree program you can get financial aid to go to paramedic school. I think that makes it far more affordable as a degree, you pay it off a little at a time. $500 would barely cover the cost of books, and it is not as simple as "Make it cheaper! *poof!* it's cheaper!" 

I would rather have a medic shortage and the medics you have be quality medics than to have an overabundance of medic mill wonders. Quite frankly, I'd rather have no medic at all than a bad medic, at least an EMT can't really hurt you with what they don't know (or think they know) while a medic's lack of knowledge and abundance of cool skills and meds could definitely hurt you. 

You want more pay, more respect? That doesn't happen without higher standards and more education. 



> Yes I see your point as I have a BA and working on my Masters I understand however I am in better shape than some in WV....But I do see the point..



Please forgive me for being rude, but if you are so educated why don't your posts reflect that? I have been reading over your them and sometimes it is really hard to decipher exactly what you meant due to poor spelling, sentence structure and grammar. Maybe you type too fast and need to slow down.


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## 1badassEMT-I (Jun 22, 2010)

Sasha said:


> I don't know if it's the same eveywhere, but here, if it's a degree program you can get financial aid to go to paramedic school. I think that makes it far more affordable as a degree, you pay it off a little at a time. $500 would barely cover the cost of books, and it is not as simple as "Make it cheaper! *poof!* it's cheaper!"
> 
> I would rather have a medic shortage and the medics you have be quality medics than to have an overabundance of medic mill wonders. Quite frankly, I'd rather have no medic at all than a bad medic, at least an EMT can't really hurt you with what they don't know (or think they know) while a medic's lack of knowledge and abundance of cool skills and meds could definitely hurt you.
> 
> You want more pay, more respect? That doesn't happen without higher standards and more education.



I dont want people here to get me wrong I believe in higher education lets make that really clear..... just because a medic doesnt have a "degree" as a paramedic or didnt get his from a "college" does not mean he/she does not have the skills set as the rest of you medics..... I am saying and please understand this while some of you have a degree for your paramedic or not, does that make you better than the ones that dont....but they are medics and fine ones at that,that dont have a degree. And when I made the statement that BACK IN THE DAY (PLEASE READ IT) I remember when you could get a medic certfication @ 410 hours and costed about $500.00 to get it. I was using as a reference as to back then compared to now is all that statement was. And I say again is 410 hours enough training NOW I say hell NO! Further more this thread turn into a nite mare how it got on this beyond me but it is here. I am sure everyone does a fine job at his or her skill set here on this forum you got what you got because you EARNED it and that is GREAT. What I am saying we have made it to where we cant recruit new MEDICS because of 1: cost 2: I have been told by some " if I spend that kind of money I should go be a RN" and that cool too... I am just also saying in my state West Virginia PEOPLE HERE DONT THINK LIKE the rest of us do.

Thanks to all thats commented on this.


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## 1badassEMT-I (Jun 22, 2010)

Sasha said:


> I don't know if it's the same everywhere, but here, if it's a degree program you can get financial aid to go to paramedic school. I think that makes it far more affordable as a degree, you pay it off a little at a time. $500 would barely cover the cost of books, and it is not as simple as "Make it cheaper! *poof!* it's cheaper!"
> 
> I would rather have a medic shortage and the medics you have be quality medics than to have an overabundance of medic mill wonders. Quite frankly, I'd rather have no medic at all than a bad medic, at least an EMT can't really hurt you with what they don't know (or think they know) while a medic's lack of knowledge and abundance of cool skills and meds could definitely hurt you.
> 
> ...



Thats what it is!


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## medic417 (Jun 22, 2010)

1badassEMT-I said:


> I dont want people here to get me wrong I believe in higher education lets make that really clear..... just because a medic doesnt have a "degree" as a paramedic or didnt get his from a "college" does not mean he/she does not have the skills set as the rest of you medics..... I am saying and please understand this while some of you have a degree for your paramedic or not, does that make you better than the ones that dont....but they are medics and fine ones at that,that dont have a degree. And when I made the statement that BACK IN THE DAY (PLEASE READ IT) I remember when you could get a medic certfication @ 410 hours and costed about $500.00 to get it. I was using as a reference as to back then compared to now is all that statement was. And I say again is 410 hours enough train NOW I say hell NO! Further more this thread turn into a nite mare how it got on this beyond me but it is here. I am sure everyone does a fine job at his or her skill set here on this forum you got what you got because you EARNED it and that is GREAT. What I am saying we have made it to where we cant recruit new MEDICS because of 1: cost 2: I have been told by some " if I spend that kind of money I should go be a RN" and that cool too... I am just also saying in my state West Virginia PEOPLE HERE DONT THINK LIKE the rest of us do.
> 
> Thanks to all thats commented on this.



Now I see the problem you are focusing on the skills not the education.  Any monkey can be trained to do Paramedic skills but they can not be educated as to when and why they should be done.  That is why so many services are mother may I or strictly algorithm services, never allowing the Paramedics to think for themselves.


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## Sasha (Jun 22, 2010)

1badassEMT-I said:


> Thats what it is!



Then slow down! You turn a lot of people off your posts when they read like they were written by a 12 year old. 

I do think degree medics are better because the required classes like College English and A&P, give the students a better foundation to be a better, well rounded medic.


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## 1badassEMT-I (Jun 22, 2010)

medic417 said:


> Now I see the problem you are focusing on the skills not the education.  Any monkey can be trained to do Paramedic skills but they can not be educated as to when and why they should be done.  That is why so many services are mother may I or strictly algorithm services, never allowing the Paramedics to think for themselves.



I refuse to go any further with this it is not worth it.... and for the record YOU GOT BE EDUCATED ON THE SKILLS SO YOU KNOW WHEN AND WHY AND WHERE  TO DO THEM!!!!! DONE FINISHED!


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## 1badassEMT-I (Jun 22, 2010)

Sasha said:


> Then slow down! You turn a lot of people off your posts when they read like they were written by a 12 year old.
> 
> I do think degree medics are better because the required classes like College English and A&P, give the students a better foundation to be a better, well rounded medic.



And that maybe so!


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## usalsfyre (Jun 22, 2010)

1badassEMT-I said:


> I refuse to go any further with this it is not worth it.... and for the record YOU GOT BE EDUCATED ON THE SKILLS SO YOU KNOW WHEN AND WHY AND WHERE  TO DO THEM!!!!! DONE FINISHED!



Much better to be educated on physiology, pathophysiology, disease process, anatomy, chemistry, pharmacology ect, ect to know if a procedure or medication will be beneficial, useless or downright harmful in a paticular case. If you just learn to use a hammer, sooner or later everything looks like a nail.

You won't find the obsession with "skills" anywhere else in our healthcare system, and I think there's a reason for that.


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## thegreypilgrim (Jun 22, 2010)

Well, looks like I joined this party a little late, but I'll chime in nevertheless.

I think the only way to truly unify EMS clinical and scope of practice standards to a national level is really to completely overhaul the system as it is. Just completely erase it and start over. All this DOT-Curriculum and NHTSA "Scope of Practice Model" and "Core Principles" stuff is really just kind of :censored::censored::censored::censored::censored:-footing around in my opinion.

What needs to happen is move the EMS regulation responsibilities at the federal level to the Department of Health and Human Services (HHS) rather than the DOT/NHTSA, and then stop trying to have the government control education standards and accreditation. That should be left to professional associations as it is with medical and nursing schools. 

Paramedic education, then, should be shifted to the university system and the coursework should lead to a Bachelor of Science degree with a much longer internship phase. This would weed out all the Ricky Rescue types who want to spend the least amount of time in a classroom possible, and go right into "running code" (i.e. driving the ambulance real fast) and using all their Hollywood medic skills. Also, it would attract a different sort of person - someone who might have otherwise gone into research or nursing or perhaps even PA or medical school - with a more academic mindset and a mature enough mentality to grasp the gravity of what they'll be doing in their clinical practice as a medic. It will also make paramedics more valuable commodities and able to earn a decent salary because they would actually now have an educational foundation.

Finally, EMS needs to be removed from the auspices of fire departments and volunteer services and allowed to stand on its own. Just to show I'm not an "anti-fire" guy I also think private ambulance companies have no business doing it as long as they are a for-profit organization. EMS, therefore, should consist entirely of public 3rd Service agencies or NPOs. Once all that's done (not bloody likely to be any time soon) I think having nationwide clinical practice guidelines would be appropriate.


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## 1badassEMT-I (Jun 22, 2010)

thegreypilgrim said:


> Well, looks like I joined this party a little late, but I'll chime in nevertheless.
> 
> I think the only way to truly unify EMS clinical and scope of practice standards to a national level is really to completely overhaul the system as it is. Just completely erase it and start over. All this DOT-Curriculum and NHTSA "Scope of Practice Model" and "Core Principles" stuff is really just kind of :censored::censored::censored::censored::censored:-footing around in my opinion.
> 
> ...



It is a start and you have made the most sense out of all the the threads....Look I know I have no chance of the degree deal working out... I SURRENDER THAT BATTLE A FEW POST AGO! Whatever way it goes as far as education goes I am for it.  But the system does need overhauled!!!! But how to get that started would take a act god for sure!


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## John E (Jun 23, 2010)

reaper said:


> John,
> 
> We do have a National Standard to become an EMT or Paramedic. Unfortunately it is a MINIMUM standard. A lot of states choose to stay at that minimum and that is the problem.
> 
> They will never be able to raise that Standard, because of the people that jump up whining about the higher education that would be needed.



I take your point but we don't really have national standards, we have a national registry which isn't recognized by all states. There will always be minimum levels of training and education, not everyone needs to be walking around with a PhD or a Masters degree. We just need to set the minimum level high enough that fewer idiots can work in the field. With that increased education should come better pay, more responsibility and more respect within the health care field.

I should have been clearer, what I'm suggesting is a nationally recognized level of training/education for EMT and for Paramedic which are agreed upon nationally. Not just a qualifying testing agency. For example, an EMT can perform procedures A,B, and C while the Paramedic can perform procedures A, B, C, as well as X, Y, and Z. The Paramedic level would be at the Associates Degree level at a minimum in my world by the way. EMTs would probably be at the 1 semester or 1 year of community college level of education. The specific details aren't that important as none of us are in a position to effect this sort of change anyway.

 Once you've gotten your education you can be hired only at the level that you're trained at, no extra IV certs or whatever, if you wish to be allowed to perform more advanced procedures you have to continue your education to the Paramedic level. Then communities can decide what the health of their citizens is worth. If the public wants their EMS providers to be able to push drugs, read 12 lead EKGs, etc, then they'll have to pony up, if they're satisfied with advanced first aid providers with fewer treatments available to them, so be it. Since we're dreaming, I'd like to see even the basic EMT be trained/educated to a higher minimum level than is now the norm. Not just allowed to perform more skills. If it means that it's a 2 semester class or several classes all taken in one semester, so be it.

What we have now are states,  counties and sometimes cities determining what level of training and what sort of procedures the various EMS providers will be performing, it's counter intuitive, it's wasteful and it's silly. A person living in a rural county should be treated by someone with the same level of training/education as the person living in the large urban city. The procedures allowed should be broad enough to deal with the wide range of available hospital care. It needn't be artificially dumbed down to suit the needs of a particular area or region or city.

I'd also get EMS out of the fire dept. I mean, since we're talking a fantasy world and all...

JohnE


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## John E (Jun 23, 2010)

1badassEMT-I said:


> John it is not about what we get paid for.....it is about pt care.....




I have no idea what you mean by that. What is "about pt. care"? 

EMS is job, a career for most of us who work in it. I don't work for free and I don't advocate anyone do either. Patient care is part of the entire EMS system, as are things like salaries, working conditions, equipment, vehicles, training, etc., etc. Obviously patient care rates very highly on the scale of importance, that's so obvious it needn't be stated. 

John E


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## reaper (Jun 23, 2010)

John,

 What you think is fantasy is what should happen. It can happen when it is pushed in that direction. Nurses used to think it would never change and they made it happen. It takes time and small steps.

We do have a National training standard all ready. It is controlled by the DOT and it is a joke. What you are proposing is a national protocol. That will never happen until the education level is raised and mandated.

I am the first to hate Federal government running things. But, this is something that they need to control. We need a national standard and take control away from the states. Then we will not have this fractured system. Every state will work under the same standards and policies. We need two levels and no more. EMT would be entry level  and Paramedic would be advanced level. No intermediate, no add on certs.

This would force the hold outs to come up to the standards. They would have no more excuses. Like you stated, the counties can decide if they want minimum care or advanced care. That would be the only choice they get to make.

All it takes is the professionals to fight for it.


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## ExpatMedic0 (Jun 23, 2010)

John E said:


> What we have now are states,  counties and sometimes cities determining what level of training and what sort of procedures the various EMS providers will be performing, it's counter intuitive, it's wasteful and it's silly. A person living in a rural county should be treated by someone with the same level of training/education as the person living in the large urban city. The procedures allowed should be broad enough to deal with the wide range of available hospital care. It needn't be artificially dumbed down to suit the needs of a particular area or region or city.
> 
> I'd also get EMS out of the fire dept. I mean, since we're talking a fantasy world and all...
> 
> JohnE



Thats exactly what I was saying earlier in the post.  I do not think anyone addressed my point(forgive me if I missed a post) 

Do Nurses and RTT's face problems this big? They may have small scope of practice laws that vary from state to state, but nothing like we face that I am aware of.
For example are there any states that do not accept the NCLEX test from the NCSBN? Are there also any states, counties, city's or rural areas that have registered nurses that did not take the NCLEX or nursing program that did not need to meet the NCSBN OR NCLEX requirements? Does any licenced Registered Nurse from any state's training vary from 12 weeks in one state and 3 years in another state like our Paramedics?


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## jjesusfreak01 (Jun 23, 2010)

The idea that the DHHS would do a better job than any organization at anything amuses me...


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## emt_irl (Jun 23, 2010)

schulz said:


> Exactly, just like it is in many countries. Paramedics in Dublin vs Paramedics in rural areas, do they have any training or scope of practice differences?
> 
> A huge problem in the U.S. is you have firemen getting trained on a fire department in 12 weeks to be state certified Paramedics in Texas, and then you have Paramedics in Oregon taking almost 3 years of school with a minimum mandatory AAS or the option of bachelors in various subjects.
> 
> ...





from coast to coast both north-south and east-west you will have the same level of training and professionalism. We all work under the 3rd edition clinical practice guidelines where are our protocols/guidelines to practice with our licence. the only different may be a younger paramedic may be able to lift the stretcher easier or do cpr longer then an old guy lol, also all our ambulances are the exact same also they are all cen compliant so everything is in the same place in the back(admitidly there are some older models still about and used as back up trucks when the main rig is gettin repaired)


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## thegreypilgrim (Jun 23, 2010)

jjesusfreak01 said:


> The idea that the DHHS would do a better job than any organization at anything amuses me...


That's nice. At least in that case, however, we'd have a healthcare service (which is what EMS is right? Or do you agree that we're just DOT materials handlers?) overseen and represented by a healthcare agency. Which would make sense right? What if instead of law enforcement being regulated at the federal level by the DOJ or Homeland Security (whatever it is) it wad regulated by the Department of Interior? That wouldn't make a whole lot of sense would it? I'm sure if that happened a bunch of odd and borderline nonsensical changes to how law enforcement is conducted across the country.


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## jjesusfreak01 (Jun 23, 2010)

The idea of DHS having control of state law enforcement is equally terrifying. It's the job of the states to mandate the level of care within that state. I'm all for national suggested guidelines, but in the end, every state also has the right to reject the out of state training for anyone if they don't think it's up to par.

Sure national would = a higher standard of care, but EMS is just not something that the Feds have jurisdiction over.

The DOT looked at a bad situation in our country gave a massive suggestion on how to fix it, which the states followed. I trust the DOT over other government agencies.


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## reaper (Jun 23, 2010)

A majority of states have proved that they cannot handle the job. So yes, Federal over site and mandated training standards would be one thing that is needed.

No more state certs. Have a national cert that is good in all 50 states. Only two levels and required education!


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## 1badassEMT-I (Jun 23, 2010)

John E said:


> I have no idea what you mean by that. What is "about pt. care"?
> 
> EMS is job, a career for most of us who work in it. I don't work for free and I don't advocate anyone do either. Patient care is part of the entire EMS system, as are things like salaries, working conditions, equipment, vehicles, training, etc., etc. Obviously patient care rates very highly on the scale of importance, that's so obvious it needn't be stated.
> 
> John E



Patient Care


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## Ridryder911 (Jun 24, 2010)

Wow! What ignorance! One comes on here questioning why there is not this or that, then when appropriately stated the only way to correct is by doing the proven old fashion way : by proper education defends the old bull sh*t line of .."can't afford it"... or let's also place the old .. ".. don't have time".. crap. Really how bad do you want it and how dedicated are you? Can't afford it, do like every other professional has done.. get a student loan or part time job... Why do we think those in EMS should be exempt, really why are we so damn special? 

Can't do it right then get the h*ll out! Really, not the top of your profession after 10 years then really how interested are you really in the profession? There are always excuses for not going forward, the main one is lack of persistence. Like your position, fine then don't gripe about it and on how to lower it to meet your standards instead of going forward as one should. 

There are already National Standards set in place. Have been since the development of EMS. Again, research some history of EMS. However; protocols are a different thing. Protocols should be *only* used as guidelines. Cookbook medicine is dangerous, unethical and just provide poor care! Usually utilized due lack of education, liability for the service and economic reasons.The only reason most services utilizes them is due to the education level of their medics. Again, one of the reason medics are not respected as health care professionals is because they want to play the game without the responsibility of obtaining a proper education and formal clinical training. EMS is one of the only so called health profession that does not require academic higher level to enter the profession, and it shows. 

Don't believe me? Look at the so called text book (yes book not books) that are written at a high school reading level... really? Our profession is taught with a textbook (single) ? Health care professional? Geez.... 

We require a kindergarten teacher to have a four year degree to teach Tommy to color within the lines and to learn ABC's ... but for someone to perform differential diagnosis, interpret ECG's, perform intubation and administer medications.. only require a GED and a one year vo-tech course? Do we not see some problems here?  Really, one goes to school longer to become a beautician than a Paramedic in most states. 

One of the acknowledged problems in EMS is that we already have too many titles and levels. That is why many states have abandon the Intermediate level and will continue do so. As the title inflicts: half-way... implying the ability to provide the "almost a Paramedic" but not quite the real thing when needed. Administrators love the economics of using such as cheap way to have ALS charges without the pay structure
Unfortunately, those that do not have a formal education do not understand skills are only that. They should only reflect the action(s) of the knowledge in intervention. A monkey could perform most the EMT's skills... understanding and interpreting the risks, involvement and potentials is another story. Treating patients is *never* black and white. If one thinks so, then they lack the knowledge of quality medical care. Each case is unique, each case should be treated accordingly and have latitude of what is *best * for that patient in the given circumstance. Is there generalized care? You bet! .... But alike treating headaches not all are treated with Tylenol nor should be. Treat patients not protocols. 

Really want to do proper care, then do it properly. Suck it up, go to an accredited program that has high academia ratings and provide good clinical settings. Let's beef up our educational programs that require one to be able to read, write and have critical thinking skills before allowing entrance to them. Have a National Standard Test that actually can evaluate one's knowledge level based upon academia and as well practical testing based on critical thinking skills that demonstrate one's ability to think "outside" the box or standard protocols, as patients present in the real world. 

When and IF we ever do this, then we will be able to have nationalized EMS standards.. 

R/r 911


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## ExpatMedic0 (Jun 24, 2010)

I get the overall point your trying to make but I am going to have to say that 2 of your statements are at least somewhat wrong


Ridryder911 said:


> medics are not respected as health care professionals


I have to disagree with the above line. Majority of the public, registered nurses and docs that I encounter appear to respect myself and other Paramedics. I guess you cant win them all over though. 


Ridryder911 said:


> Don't believe me? Look at the so called text book (yes book not books) that are written at a high school reading level... really? Our profession is taught with a textbook (single) ? Health care professional? Geez....



Many schools are using the brady set for text now, which are several text books. Most schools also require additional text books like the duben, 12 lead the art of interpretation, and others. I had a huge stack of books.....

I can not speak for schools all over the U.S. just the ones in my area.


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## thegreypilgrim (Jun 24, 2010)

schulz said:


> I have to disagree with the above line. Majority of the public, registered nurses and docs that I encounter appear to respect myself and other Paramedics. I guess you cant win them all over though.


It's good to hear that at least in your area, paramedics enjoy some measure of respect among healthcare professionals. I wish I could say my experience was the same, but unfortunately it lines up more with what Rid was saying. Especially since I don't work for a fire department, but a private ambulance company there's even less respect in that I'm not perceived as a "real" paramedic. Nurses are the healthcare professionals we most commonly interact with, and they tend to save what little respect they have for EMS to the firefighter/paramedics they interact with (it must be those yellow pants). We hardly ever speak to physicians or have any sort of extended interaction with them.



> Many schools are using the brady set for text now, which are several text books. Most schools also require additional text books like the duben, 12 lead the art of interpretation, and others. I had a huge stack of books.....
> 
> I can not speak for schools all over the U.S. just the ones in my area.


Mine was the same way. I had to use one of those wheeled luggage carriers to carry all the books we had to have. I'm sure some of the better schools in my area were similar, but we do have some notorious medic mill programs here (this is SoCal after all) which I would be very surprised if used any sort of standard, recognized textbook from a reputable publisher at all.

One of the local medic factories is known for having almost entire classes of firefighters intentionally fail out, so as to not have to become a medic. The students there are also rumored to circulate a something known as the "book of love" amongst themselves which is supposed to be a bound book full of captured exams with the correct answers filled in that the students all study from. What's incredibly frustrating is this is one of the primary training centers utilized by fire departments to cross-train their firefighters to paramedics. It's really no wonder then why the LA EMS system is broken beyond repair.


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