# Paramedicine as an AAS?



## AMF (Apr 10, 2011)

So we recently had our last day of basic class, and I've begun to understand the difference between technicians and medics.  Basically, while EMTs consult with a physician pretty much every time they give medication, paramedics never do (except for... I want to say... Heparin?).  So basically, they have to understand everything about the drugs they're using, the drugs the pt could be on, their interaction with the body, their interaction with each other, variations between individuals with differing hx, etc.  But our instructor told us that p school is basically an associates degree... how is even that possible??  I know medics aren't quite physicians, but still, 2 - ( 4 undergrad + 4 very intense grad + 1 very very intense internship + 4 very intense residency + 4 fellowship ) is kind of a ridiculous difference.  I know PAs and RNs are much further behind, but they're not independent practitioners (usually).  A Paramedic is the only autonomous health care provider in the field and the foremost authority thereof; shouldn't they receive over twice the training that an RN receives? 

Also, I wikipedia'ed RSI... probably the principal reason why I won't get my p.  I want a BS, an MPH, an MD, and an IM internship behind me before I try that ludicrous procedure.


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## medicRob (Apr 10, 2011)

AMF said:


> A Paramedic is the only autonomous health care provider in the field and the foremost authority thereof



lol.


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## Shishkabob (Apr 10, 2011)

Be careful with the generalities, as in my agency I have heparin, RSI, and many other things many agencies don't have, and I don't have to call in for a single one of them.


Also, PAs, NPs, and many RNs are autonomous as well (Just look at offices run by PAs/NPs, and look at flight or ICU RNs)   Yes, a Paramedic in many places is pretty autonomous, making our own decisions most of the time... but then you look at archaic EMS states like California, and their medics have to ask nurses for orders... (That's f'd up)



Also keep in mind that RNs are more generalist, taught to operate in all parts of healthcare in school, and out of school they specialize.  From the get go, Paramedics specialize in emergency medicine, and specifically cardiology, airway and trauma management.   That doesn't mean one is more capable than the other... just the basic knowledge starts off differently.



Now, yes, RSI is a scary procedure, and yes, it's no fun to make the decision of "I'm going to paralyze you now and hope I get the tube", however, studies have shown fantastic success rates in agencies with RSI, with minimal adverse outcomes most of the time... roughly equal, if not parallel, to RSI being performed in the ED.

When taught correctly, and taken seriously by an EMS agency, RSI is very safe all things considered.


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## AMF (Apr 10, 2011)

I understand what you're saying, but I don't see how that justifies a 2-year paramedic degree, especially if RNs have to specialize beyond their 2-year degree to work in the ER


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## Shishkabob (Apr 10, 2011)

Meh, you're taking "specialize" too literally.  They generally don't go to more school to work in different areas, they learn on the job.  An OB nurse that wants to move to the ED doesn't have to go back to school.



Or do you simply think that someone with a 2 year degree (or less) is not capable of being a good provider?


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## AMF (Apr 10, 2011)

It's possible, yes, but as far as standards go, I think requiring a BS would be a step in the right direction.  

A lot of this stems from the fact that while I'm training to be a QRS Basic, which is sort of by definition an over-qualification, I'm also training to be a Basic/I99 in 911 (Even those of us with Organic/BioPhysical Chem don't really understand what paramedics have us do).  

Also, I was in Boston where I saw some pretty sketchy paramedics working IFT.  I know Boston EMS makes Paramedics work as QRS Basics first... it just seems like all signs point to longer education.  Plus American Premed consists of a year of cell hell, genchem, orgo, english, physics, calculus, and a semester of biochem... that's over a year and a half already without actually studying medicine.

That being said, take everything I say with a grain of salt; I plan on pursuing a physics PhD, which frequently takes over ten years.


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## medicRob (Apr 10, 2011)

AMF said:


> It's possible, yes, but as far as standards go, I think requiring a BS would be a step in the right direction.
> 
> A lot of this stems from the fact that while I'm training to be a QRS Basic, which is sort of by definition an over-qualification, I'm also training to be a Basic/I99 in 911 (Even those of us with Organic/BioPhysical Chem don't really understand what paramedics have us do).
> 
> ...



I have an AAS in Paramedicine, Masters of Nursing, Completed a BS Biochemistry as Pre-Med, and just took the MCAT. I like to think that I am quite qualified as a paramedic. 

Also, there are several issues that must be addressed with EMS education (see my other posts on the topic, I rant about it regularly).


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## medicstudent101 (Apr 10, 2011)

medicRob said:


> I have an AAS in Paramedicine, Masters of Nursing, Completed a BS Biochemistry as Pre-Med, and just took the MCAT. I like to think that I am quite qualified as a paramedic.
> 
> Also, there are several issues that must be addressed with EMS education (see my other posts on the topic, I rant about it regularly).



How'd you do on your MCAT btw?


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## medicRob (Apr 10, 2011)

medicstudent101 said:


> How'd you do on your MCAT btw?



Takes 30 days before results will show up on THx, couldn't hurt to check though.


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## medicstudent101 (Apr 10, 2011)

Oh. Well belated good luck!! B)


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## medicRob (Apr 10, 2011)

medicstudent101 said:


> Oh. Well belated good luck!! B)



Thank you very much.


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## AMF (Apr 10, 2011)

Yes, Rob, you are well qualified, but that level of education is not required of and in my limited experience is not common amongst paramedics, nor is it sufficiently rewarded.

I've read a few of your posts, but unfortunately I lack the vocational background to understand them.


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## MrBrown (Apr 10, 2011)

Here in New Zealand a Paramedic (ILS) requires a Bachelors Degree while Intensive Care Paramedic (ALS) requires a Post Graduate Degree.

We have a 97% success rate with RSI and so far have managed all failed intubations without cricothyrotomy.  

Brown does not really understand what this dude is on about


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## AMF (Apr 10, 2011)

MrBrown said:


> Here in New Zealand a Paramedic (ILS) requires a Bachelors Degree while Intensive Care Paramedic (ALS) requires a Post Graduate Degree.
> 
> We have a 97% success rate with RSI and so far have managed all failed intubations without cricothyrotomy.
> 
> Brown does not really understand what this dude is on about



I am asking why our government (the sentiments of whom I assume some on this forum understand) doesn't feel it is necessary to maintain and mandate a BS curriculum for paramedics.  Even if someone wanted to, he or she couldn't necessarily pursue a more advanced degree in paramedicine... to my knowledge.  

While someone who worked for SW AMR dispatch on this forum said they had a shortage of medics, I was under the impression that this was generally not the case.



For the record, in the US, Post Baccalaureate refers to classes taken after graduation from Bac, independent of a degree program.  Post Grad refers to the same thing, except after graduation from High School.  If you attend school for a Masters, a Doctor (Medicinae Doctor, Juris Doctor, etc) or a Doctorate (PhD, LLD, etc), you are referred to as attending graduate school.  Which I'm sure you knew.


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## MrBrown (Apr 10, 2011)

Why not? Here is why not

- Lack of a professional identity as a health profession vs public safety role

- Lack of unified national professional representation i.e. analogous to the AMA, ANA, FACEP etc

- Lack of national industrial representation i.e. analogous to the IAFF/PBA/Teamsters etc

- Industrial influence by the Fire Service unions to keep standards low

Until the US recognises that Paramedics are a health professional and not a public safety provider there will be little advancement.  Until the Fire Service stops using EMS as a justification to keep the Fire Service funded (and therefore standards as low as possible to make it easy) there will be little advancement.  

The new "EMS Education Agenda" is a joke, the Fire Service managed to get the College affiliation requirement for a Paramedic program to be accredited by CoAESMP dropped and even if it did not there is only minor improvements.

Basically its the age old notion that until the providers themselves want it there will be little to no advancement.


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## VFlutter (Apr 10, 2011)

medicRob said:


> I have an AAS in Paramedicine, Masters of Nursing, Completed a BS Biochemistry as Pre-Med, and just took the MCAT. I like to think that I am quite qualified as a paramedic.
> 
> Also, there are several issues that must be addressed with EMS education (see my other posts on the topic, I rant about it regularly).




You are officially my hero lol hopefully I will be able to follow a similar path as you in the long future ahead of me


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## usafmedic45 (Apr 10, 2011)

> A Paramedic is the only autonomous health care provider in the field and the foremost authority thereof



*falls out of chair laughing*  Wow....someone's a bit full of themselves regarding their chosen career aren't you? LOL


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## usalsfyre (Apr 10, 2011)

The longer your in EMS the more you'll realize few paramedics are able to put an autonomous medical thought together, much less carry out a treatment plan...

Given the choice between the few paramedics I trust to control an airway and Joe Schmoe interenist, I'll choose the medics every time (Jane Schmoe anesthesiologist may be a different story).

Yes EMS education is vastly under where it needs to be.


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## Shishkabob (Apr 10, 2011)

AMF said:


> Even if someone wanted to, he or she couldn't necessarily pursue a more advanced degree in paramedicine... to my knowledge.



There are a few BS/BA in EMS programs out there... just no real need to get them with the current pay most Paramedics get / would get with it.


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## AMF (Apr 10, 2011)

usafmedic45 said:


> *falls out of chair laughing*  Wow....someone's a bit full of themselves regarding their chosen career aren't you? LOL



Unfortunately, I will never be a paramedic.  With the new UTSW plan, I may never leave the MICU after I get my coat.



usalsfyre said:


> The longer your in EMS the more you'll realize few paramedics are able to put an autonomous medical thought together, much less carry out a treatment plan...
> 
> Given the choice between the few paramedics I trust to control an airway and Joe Schmoe interenist, I'll choose the medics every time (Jane Schmoe anesthesiologist may be a different story).
> 
> Yes EMS education is vastly under where it needs to be.



Agreed.  Being good at your job>Experience/Education/"Skills"/Letters



Linuss said:


> There are a few BS/BA in EMS programs out there... just no real need to get them with the current pay most Paramedics get / would get with it.



Ah.  That's what I was asking, I guess.


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## Veneficus (Apr 10, 2011)

Linuss said:


> Paramedics specialize in emergency medicine, and specifically cardiology, airway and *trauma management*.



I feel compelled to register my disagreement that paramedics whose education barely scratches the surface of the disease of trauma, can claim to "specialize" in it.


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## jwk (Apr 17, 2011)

Veneficus said:


> I feel compelled to register my disagreement that paramedics whose education barely scratches the surface of the disease of trauma, can claim to "specialize" in it.



Ditto - I know it's semantics, but...

An EM MD specializes in emergency _medicine_.  A cardiologist specializes in cardiology.  The anesthesia folks are the specialists for airway management.  

Paramedics have technical and didactic training in a wide variety of areas, including physiology, pharmacology, etc., but as Veneficus noted, it's scratching the surface in many cases.  

Specialization implies a certain subset of skills.  So if a paramedic "specializes", what do they specialize in compared to a paramedic who doesn't "specialize" ?


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## medicRob (Apr 17, 2011)

jwk said:


> Paramedics have technical and didactic training in a wide variety of areas, including physiology, pharmacology, etc.,



Again, lol.


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## mikeward (Apr 17, 2011)

AMF said:


> A Paramedic is the only autonomous health care provider in the field and the foremost authority



Not an accurate statement. Depending on the state, you are working as a delegated agent of a physician medical director.

The physician medical director (or the Office of the Medical Director) determines the range of activity and the levels of reporting when a paramedic is delivering out of hospital care.

You cannot "practice" as a paramedic without the permission of the agency's physician.

Good question about the AAS versus a four year degree.  There are about eight programs that provide paramedical certification training as a bachelor degree.  The additional academic work is not consistent - some provide clinical others focus on education or management.

About 350 community and technical colleges provide paramedic training as a two year degree.  The Scope of Practice (2013) model for paramedics will be very difficult to deliver as an applied science associate. 

Bryan Bledsoe, DO, former Texas paramedic, covered this concept in a June 13. 2007 online item in JEMS titled "I Can Do That"



> I went from being a paramedic to being a physician, and I see the importance of education. For example, once in the ED, we were discussing the role of paramedics in the ED (of which I am in favor with added education). The conversation basically was that the paramedics could do anything that the nurses could do. About this time, a new graduate nurse brought some lab reports to me and said, His BUN/creatinine ratio is 62. Should I increase his IV rate? I asked the paramedics what they thought. They admitted they didn t know what the GN was talking about. Granted, an experienced motivated paramedic may learn lab data and such, but in the nursing program, this was a part of the initial education. I ve met many self-taught paramedics who were sharper than many nurses (or doctors). But I have met some who self-taught themselves the wrong information and were, in fact, dangerous.



Within 30 years, becoming a registered nurse moved from training at mom-and-pop hospitals or vocational schools to preferring RNs have a bachelor degree.

There are masters and doctoral programs for nurse practicioners. 

This change was generated by the profession.


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## MJSBM (Apr 19, 2011)

*Bachelors Degree?  Really?!*

Okay... Number 1, In the United States paramedics don't make enough to justify requiring a bachelors degree.  That said, in Texas Licensed Paramedics are required to have either a bachelors degree in anything or an Associates degree in something emergency services related.  Either way, it's the quality of the education that I think is important not how long you go for.  If you are taking an intensive program for just a few months (think military combat medic school) that is very good vs a random bachelors degree program that is not so good I think you are better off with a shorter program.


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## medicsb (Apr 19, 2011)

MJSBM said:


> Okay... Number 1, In the United States paramedics don't make enough to justify requiring a bachelors degree.  That said, in Texas Licensed Paramedics are required to have either a bachelors degree in anything or an Associates degree in something emergency services related.  Either way, it's the quality of the education that I think is important not how long you go for.  If you are taking an intensive program for just a few months (think military combat medic school) that is very good vs a random bachelors degree program that is not so good I think you are better off with a shorter program.




Or does the standard paramedic training curriculum not justify higher pay?  If one wants to move the profession forward, they'll advocate for a college level education, no less.  US EMS needs to go the way of Canada and Australia when it comes to education.  In my opinion, EMT should have its training be 1000 hours (~ equiv to an associated degree with emphasis on managing low acuity complaints and providing relatively basic treatments for acute/emergenct illness) and the present paramedic should be at least double that.  Oh, and in my opinion, the title "EMT" should be abolished.  But, I'm not holding my breath.  The general EMS populace is far too complacent for change to come anytime soon.


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## jwk (Apr 19, 2011)

medicRob said:


> Again, lol.



Like I said - semantics.  I'm hunting for the word I want, but "specialization" isn't it.


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## medicsb (Apr 19, 2011)

Linuss said:


> Now, yes, RSI is a scary procedure, and yes, it's no fun to make the decision of "I'm going to paralyze you now and hope I get the tube", however, studies have shown fantastic success rates in agencies with RSI, with minimal adverse outcomes most of the time... roughly equal, if not parallel, to RSI being performed in the ED.
> 
> When taught correctly, and taken seriously by an EMS agency, RSI is very safe all things considered.



You might want to check the research on that.  The EMS systems that have come near ED in terms of success are ones where the intubators, so-to-speak, are limited (King County, Wa; Whatcom County, Wa; Boston, Ma; Melbourne, AU; French SAMUs; and some flight services).  Though RSI has been shown to improve the overall success rate marginally, it doesn't translate in to success nearing ED success.  Dr. Wang's latest publication demonstrates this pretty well (http://www.ncbi.nlm.nih.gov/pubmed/21288624).


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## MrBrown (Apr 19, 2011)

medicsb said:


> You might want to check the research on that.  The EMS systems that have come near ED in terms of success are ones where the intubators, so-to-speak, are limited (King County, Wa; Whatcom County, Wa; Boston, Ma; Melbourne, AU; French SAMUs; and some flight services).  Though RSI has been shown to improve the overall success rate marginally, it doesn't translate in to success nearing ED success.  Dr. Wang's latest publication demonstrates this pretty well (http://www.ncbi.nlm.nih.gov/pubmed/21288624).



We have had a near 100% success rate with RSI (~97%) since 2006


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## medicsb (Apr 20, 2011)

MrBrown said:


> We have had a near 100% success rate with RSI (~97%) since 2006



Is the skill of intubation or RSI limited to a relatively small group of paramedics?  I believe this is the practice in Victoria, Australia, so I would assume it is not much different in NZ.  Correct me if I am wrong.


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## MrBrown (Apr 20, 2011)

medicsb said:


> Is the skill of intubation or RSI limited to a relatively small group of paramedics?  I believe this is the practice in Victoria, Australia, so I would assume it is not much different in NZ.  Correct me if I am wrong.



You are correct sir, RSI is limited to a selected group of Intensive Care Paramedics, whereas in Melbourne (MAS) all MICA Paramedics have RSI as part of their scope.

Now, early on it was restricted to only a few people as this was a very controversial procedure to introduce and we wanted to ensure high quality.  RSI is just now (five years later) being taken outside of Metropolitan Auckland and to the rest of the country, it is still however, select Officers only.

In time Brown expects it to become a procedure for all Intensive Care Paramedics however it will take a few years yet.


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## Gecko24 (Apr 22, 2011)

God I stumbled on this forum, and the first thread I read makes me laugh.


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## Gecko24 (Apr 22, 2011)

Glide scopes make RSI so easy a monkey can do it.  And for that 1% that can not be intubated, I am sure they live in China.


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