# Advancing EMS & Paramedicine



## thegreypilgrim (Nov 25, 2009)

I think we're all aware of the "hammering" of paramedics that goes on around this site - about how we're all uneducated, incompetent, and not to be trusted with "real" medicine, etc. Now, I admit to being among those who've done this. I acknowledge full well that the educational standards for EMS are seriously lacking and must be improved to college degree-appropriate level if we're going to be recognized as medical professionals from our colleagues. However, I think it must be said that these other medical people (physicians & RN's) do bear at least *some* level of responsibility for the overall sorry state of EMS education. After all, they're the ones in charge of developing and carrying out the educational process of prehospital personnel. Somewhere along the line they agreed that it's adequate.

Further along these lines, it seems (at least in my experience) that a large center of resistance to expanding the role of paramedics through education and, thus, scope of practice have been nursing associations. Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.

So, it seems like those of us who would like to see EMS professionalized, and paramedics advanced as medical professionals are fighting a multi-front war. We have fire services and private sector agencies that want to maintain the status quo of having paramedics mass produced every 6 months or so to keep the supply/demand curve in their favor by keeping costs down. While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on. It's hard to see where this will leave us, and incredibly frustrating.


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## VentMedic (Nov 25, 2009)

After being in EMS for over 30 years, I can tell you it is not nursing, RT, PT, OT, SLP, RRT or any of the others that are to blame for this mess. Many of these professions are a lot younger than EMS which is now middle-aged but the others have achieved so much more in professional and legislative recognition by not whining about "nurses picking on them". They also took over many of the duties that had been done by nurses for decades and once they showed their education and professional status, they became health care team members *FOR THE PATIENT* and not hated enemies. EMS providers need to get over this "what everyone else should be doing for them" and take some responsibility for their own future. 



thegreypilgrim said:


> I think we're all aware of the "hammering" of paramedics that goes on around this site - about how we're all uneducated, incompetent, and not to be trusted with "real" medicine, etc. Now, I admit to being among those who've done this. I acknowledge full well that the educational standards for EMS are seriously lacking and must be improved to college degree-appropriate level if we're going to be recognized as medical professionals from our colleagues. *However, I think it must be said that these other medical people (physicians & RN's) do bear at least some level of responsibility for the overall sorry state of EMS education. After all, they're the ones in charge of developing and carrying out the educational process of prehospital personnel. Somewhere along the line they agreed that it's adequate*.


 
One of the reasons nurses still have some control in the educational programs and in the state legislative offices is that there are not many EMS providers who have advanced their education enough to assume the roles. The same for the role of educators. Few have advanced to where college programs are common and thus you have certified teaching certified classes in the tech schools where the instructors are not required to have higher education of even a 2 year degree. 

RNs and doctors did not force anyone to go to a medic mill instead of to a college. Every other health care profession saw what needed to be done and started advancing their education long before anyone *MADE* them get a degree. Unfortunately in EMS "if it ain't required I ain't gonna do it". It is amazing that in 2009 when some find out I have a 2 year degree in EMS from 1979 they are shocked and ask "did someone make you get that degree?" "Why on earth would you get a degree if no one made you get it?" or "That was stupid to waste your time getting a degree when you could have gotten a cert and still joined the FD for good pay and a pension." These are comments made to me by EMS providers and are repeated over and over today on many of the EMS forums. 



thegreypilgrim said:


> Further along these lines, it seems (at least in my experience) that a large center of resistance to expanding the role of paramedics through education and, thus, scope of practice have been nursing associations. Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.


 
Did you happen to check your public health rules and regulations for your state? This is not a "not gonna let them do it" decision by nurses. The rules have been made by higher authorities than them. Also EMS agencies did help determine what they did and did not want to do when some of these rules were being designed. Florida has very liberal statutes for Paramedics and public health but many agencies have chosen not to expand into that area because "it's boring" as it involves more than just sticking a needle into someone's arm. This one "skill" mentality has been what has keep EMS out of expanding into other avenues. 




thegreypilgrim said:


> So, it seems like those of us who would like to see EMS professionalized, and paramedics advanced as medical professionals are fighting a multi-front war. We have fire services and private sector agencies that want to maintain the status quo of having paramedics mass produced every 6 months or so to keep the supply/demand curve in their favor by keeping costs down. While on the other hand we have *nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on.* It's hard to see where this will leave us, and incredibly frustrating.


 
Can you show me anything in the Paramedic curriculum that prepares you to work in a critical care unit? 

It is amazing at how other professions have over come being stepped on by becoming the peers of other professionals rather than alienating themselves as enemies with the "us against them" crap attitude. Get over it. Every allied health professsion has had to meet the challenges expected by nursing and set by their own state and national accrediting/certifying agencies. The other agencies also knew there was not substitute or shortcuts to education. They pushed for their degrees and encouraged as many in the profession to become educated so that when licensing standards were raised, very few were left out with only a diploma or tech cert. 

Maybe you should review the history of nursing to see exactly how far they have come and the changes they have gone through since the 1970s. EMS had every opportunity to become stronger than nursing in the 70s but too many in the profession, providers and agencies, fell for the quick cert mentality. If you notice, many of us that did start in the 1970s in EMS have a 2 year degree from a college in Paramedicine. That was the way it was intended to be. Nursing still hadn't acheived its goal at that time. Nurses and the other allied health professions have streamlined their professions to just a couple of levels. They don't keep adding a cert level for each "skill" until there are over 50 different certs. Nursing also doesn't force everyone to be a nurse as FDs want every FF to be a Paramedic. They do encourage their lower levels such as the CNA and the LPN to become RNs and do not allow the lowest level (CNA) to dictate what direction RNs should take their professional status. 

Do the RNs tell agencies not to monitor the QA/QI of Paramedic performance for certain skills? Do they tell EMS medical directors not to be involved with their Paramedics? Do RNs tell your agencies not to provide you with continuing education? Are RNs responsible for all the publicity Paramedics are getting for not recognizing misplaced tubes? Do you actually blame nurses each time you miss a tube? The one advanced skill that was given to Paramedics in the 1960s by physicians (not nurses) and somehow some have managed to muck it up? 

It is also amazing that at one time the Paramedic could do central lines (including subclavian), intracardiac epi, chest tubes and pericardiocentesis and not once did any RN give me grief about what I did as a Paramedic. Evidence based medicine took those things out of EMS and NOT nurses. 

However, don't expect anyone to allow you or support you to do something you have NEVER been trained and educated for. 

Here's some good reading for you and it wasn't written by a nurse.
*2,000 Hours to train a Paramedic?*

http://www.fd-doc.com/2000Hours.htm

You might also review some of the EMS history in the states that increased their "hours of training" by a whopping 100 hours. It was the EMS providers that thought it was scandalous to require that many more hours. Maybe you should go to a few of your state meetings and see who is against the changes. Usually educated people like RNs and MDs support education and rarely if ever tell people to do less or stay at a low level. Unfortunately, the numbers in EMS with only a cert out number those with education and that includes the RNs and MDs who have tried to help. The whole issue that RNs and MDs have with EMS providers is that they DO NOT have the education to expand their roles. If RNs do not want LPNs with 2x the education and training of Paramedics in the ICUs and EDs, what makes you think they should make the exception for someone with 624 hours of PREHOSPITAL taining? The hospitals didn't want RTs in the ICUs to manage the ventilators until we had some proof of education. How about Radiology Technologists? Why do some in EMS believe they are the exception and that they are being picked on "just because"? 


There are many, many articles for you to look up as this is a topic that has been in EMS journals for decades and there is nothing mentioned about the mean nurses picking on the poor Paramedics. Problems were identified in the early 80s and the EMS agencies that responded to the problem areas went on to be successful. Those who whined about education and blamed everyone else are those that still feel that way today and still have gone nowhere. 

Just do a search on EMS training on any medical search engine and start reading. Enlighten yourself about what EMS has been and where it tried to go. 

So no, EMS did this mess all by itself. Until EMS providers stop blaming everything on others and take some responsibility for their own education, there is nothing nursing, RT or MDs can do to help you. Hell some in EMS see absolutely no need for any college level A&P and are perfectly happy have a 10th grade reader for a Paramedic text and an 8th grade book for EMT-B.


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## VentMedic (Nov 25, 2009)

Here were some of the better discussions on the topic way back when Rid was here.

*Progression of EMS*

http://www.emtlife.com/showthread.php?t=5495&highlight=progression+EMS

*Basics before Advanced*
http://www.emtlife.com/showthread.php?t=4830

*Decent JEMS article:*
*EMS Needs a National Brand Identity*

http://www.jems.com/news_and_articles/articles/EMS_Needs_a_National_Brand_Identity.html



> As a profession, EMS has a lot of work to do to create a respected image or "brand identity" on a state and national level. Perhaps the most poignant comment to illustrate this point came from an elected official in the Florida Senate when several of us were lobbying for an innovative change to the statutes that would dramatically improve patient care. One senator said, "We cannot vote to pave a road for you EMS people when you all want to take different roads." Painful. But you know, she was right. The measure failed.
> 
> We've been so busy pursuing the public vs. private agenda that we've lost credibility on a national front. We've invested so many resources battling each other that we've almost lost the war.


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## jgmedic (Nov 25, 2009)

Vent, you make some great points here. Until we as a profession can show that we are willing to take on that extra education and show that we are medical professionals we can't expect people to just give us that respect we crave. It's not all about big, bad fire and nursing and all that. It's about us being ok with the status quo. People continue to flock to medic mills, because(esp. in SoCal), it's seen as a fast ticket to FD, and why not, when that's where the benefits and pay are. If students all of a sudden stopped being willing to pay the money for a quick P-card and demanded a better educational standard, these places would not exist.


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## Summit (Nov 25, 2009)

VentMedic said:


> Here's some good reading for you and it wasn't written by a nurse.
> *2,000 Hours to train a Paramedic?*
> 
> http://www.fd-doc.com/2000Hours.htm



That's a bunch of crap.


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## VentMedic (Nov 25, 2009)

Summit said:


> That's a bunch of crap.


 
I agree but if you read some of the posts written by EMTs and Paramedics on the forums who are trying to differentiate or justify street smarts over college level courses, it all comes out the same "don't need no book learnin' stuff" to get the job done.


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## thegreypilgrim (Nov 25, 2009)

VentMedic, I strongly suggest you take a long deep breath, go back and _*re-read*_ my OP. You're on auto-pilot mode here. 

I really don't know where to begin here, except to say that I'm not whining about "nurses picking on EMS". I don't know where you got that from. I realize that _*we*_ (that is, prehospital providers) are largely the problem. We are very naive to think that 6 months in a medic mill qualifies us to practice advanced medicine independently whereas others in allied health hold 2-4 year degrees to do what they do. Since you apparently missed my being clear about this in the OP, let me be even clearer now: If there is going to be change it has to come from us first.

Now, my point was that I think there is a growing population of EMS providers who actually are tired of being looked down on and want to change their circumstances. I did not go to a medic mill - I went to a college paramedic program that could confer an AS degree. I'm currently working on a BS degree in EMS at a university as well. I would like to see other people start doing this as well. I believe I also made it clear in my OP that FD's and private companies represent the largest barrier to EMS advancement - a point you entirely passed over in that rant of a response.

For the record, I don't believe paramedics should be allowed to do XYZ procedure despite not having degrees "just because". I don't know how you could have formed that impression, but as it is I most certainly don't. I don't think that _as things currently stand_ paramedics have the right to enter into critical care medicine. I never said that - I merely stated that we should expand our education first. Nor did I ever state that RN's & MD's should "force us" into getting degrees...another suggestion from way out of left field. No, we should push for this ourselves.

As for this: 





> Did you happen to check your public health rules and regulations for your state? This is not a "not gonna let them do it" decision by nurses. The rules have been made by higher authorities than them. Also EMS agencies did help determine what they did and did not want to do when some of these rules were being designed.


 As a matter of fact I have. By all means, however, feel free to lecture me about what's happening in my own state while you're not even from here. Of course, the decision to not have paramedics help out with this was not "made" by nurses. I doubt any individual RN in the area actually gives a :censored::censored::censored::censored: about who's giving H1N1 vaccines. I'm simply saying, that this suggestion came from public health & EMS and probably met a whole lot of resistance from FD's & ambulance services in the area because "it's boring" like you said. But the nursing association about had a seizure and raised a hellstorm about the idea as well - the combined efforts are what resulted in it not happening. The point was, it was an _*example*_ of what is the general atmosphere in my state. People - both in EMS and in healthcare - just seem apathetic about the system, and would rather things just stay as they are. This was the inspiration for this thread - I'm simply reporting what I'm experiencing in my region. Sure, there's probably less resistance from RN's, MD's, etc. than FD's & private ambulance but nevertheless _*there is some resistance*_ from those areas as well. Remember I said this is a _*multi-front*_ battle? You're responding as though I'm bashing nurses and trying to say it's all their fault, which is a horrendous misrepresentation of what I said.

Having read a fair amount of your posts here, I have a good deal of respect for you as a medical professional and as a person; but, your reply to me here was entirely inappropriate, and turned my OP into a straw man. Please, for future reference, don't twist my words or take something you read in a post and in a reactionary fashion just run away with it. It's just unwarranted.


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## VentMedic (Nov 25, 2009)

thegreypilgrim said:


> Now, my point was that I think there is a growing population of EMS providers who actually are tired of being looked down on and want to change their circumstances. I did not go to a medic mill - I went to a college paramedic program that could confer an AS degree. I'm currently working on a BS degree in EMS at a university as well. I would like to see other people start doing this as well.


 
Unfortunately you are looked upon by the minimum education standard for your profession. That standard is still the "hours of training" cert present in all states but a couple. 



thegreypilgrim said:


> I believe I also made it clear in my OP that FD's and private companies represent the largest barrier to EMS advancement - a point you entirely passed over in that rant of a response.


 
Did you bother to read my posts? The link I posted, "2000 Hours to Train a Paramedic?", was by a FD medical director. 



> I don't think that _as things currently stand_ paramedics have the right to enter into critical care medicine. I never said that - I merely stated that we should expand our education first.


 
Then what did you mean by this comment?



> While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on.


 
Or this?



> Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.


 
I also don't know what state you are from to even pull up your public health statutes to see where EMS stands in them. 

Nurses will defend the statutes and as I stated before, they do not allow other lesser trained individuals to do patient care without proper supervision so why should EMS be the exception? RT and other professions (Radiology, Ultrasound, Nuclear Med, Radiation Therapy, PT, SLP) were able to put restrictions on RNs from doing certain assessments and skills without the term "education" being properly defined. Thus, it is about who is the most qualified to do what is best for the patient.


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## thegreypilgrim (Nov 26, 2009)

VentMedic said:


> Unfortunately you are looked upon by the minimum education standard for your profession. That standard is still the "hours of training" cert present in all states but a couple.


 Don't I know it. 



> Did you bother to read my posts? The link I posted, "2000 Hours to Train a Paramedic?", was by a FD medical director.


 Yeah, I read that swill. I don't understand your point, though, as I said FD's often stand in the way of increasing paramedic education standards...





> Then what did you mean by this comment?
> Quote:
> While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on.


 Obviously, if paramedics education was augmented to the university level, then they could feasibly engage in critical care medicine. The vibe I get from nurses associations in my area leads me to believe that they would fight against increasing EMS education if they thought paramedics would be involved in CCT's. Hence the "stepping on their toes" metaphor.




> Or this?
> 
> Quote:
> Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.


 I think this is pretty self-explanatory.




> I also don't know what state you are from to even pull up your public health statutes to see where EMS stands in them.


 California.



> Nurses will defend the statutes and as I stated before, they do not allow other lesser trained individuals to do patient care without proper supervision so why should EMS be the exception? RT and other professions (Radiology, Ultrasound, Nuclear Med, Radiation Therapy, PT, SLP) were able to put restrictions on RNs from doing certain assessments and skills without the term "education" being properly defined. Thus, it is about who is the most qualified to do what is best for the patient.


 Well, I don't know about where you're from, but around here paramedics can give medications via the IM and/or IN route...the fact that it's a vaccine we're talking about here doesn't make the process any more mysterious. I gave tons of vaccines in my clinical rotations - as far as I know nobody died from this. Then again, I am a paramedic so therefore _*must*_ have screwed it up somehow right?


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## Aidey (Nov 26, 2009)

thegreypilgrim - We had the same issue with vaccines in the state where I first started. While I was in paramedic school the county received a grant to put together a mass vaccination plan in the event of a pandemic or attack of some sort that required vaccinations to be administered. 

While putting the plan together the suggestion was made to utilize Paramedics and the EMTs whose normal scope covered IM medications. The State RN association had what I can only describe as a hissy fit. They did not care that we were already trained in how to administer IM medications. They didn't care that the plan stated we would have to attend a class/briefing in the vaccine being given prior to being able to give it (I think that provision covered everyone in cases of vaccinations not normally given). I honestly never heard a reason besides "They aren't nurses".  

The whole thing finally got resolved when the local medical directors got involved, and the state eventually decided to let Paramedics participate and that the RN association had no say in what happened because of how everything was organized in the state. The state ended up adding the EMTs who normally have IM medications this year with all the H1N1 issues.


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## Akulahawk (Nov 26, 2009)

*Advancing Paramedicine: My Rant*

Education is a WONDERFUL thing. Somehow, I get the very distinct impression that all the non-nursing alphabet letter folks (RT, PT, OT, and so on) weren't able to just suddenly be able to provide patient care within their scopes in hospital at an almost overnight pace. I suspect that it took a while to get things going, even after the educational level for an entry into those fields was raised significantly. I also get the impression that nursing (as a profession and lobby) tends to resist sharing portions of _their _scope to non-nurses because they're not nurses and weren't trained as a nurse, even though the educational level is comparable, if not superior in that specific area. I just don't get the feeling that all those "younger" professions were welcomed with open arms at first, even with the increased education requirements. Now they're well-regarded and well-respected fields. 

Nursing is an old profession. It has been around for a long time. EMS has also been around for a long time, longer than some/most of the other allied health care professions. What was it that got nursing and those other professions going like gang-busters to increase _their_ educational standards and professional recognition? Those groups banded together, acknowledged that they needed to increase their standards to improve their level of care, and here's the kicker: they _also _formed/became powerful lobbying groups to get the State Legislatures to write laws and regulations to more specifically define their scopes. Now, those lobby groups are protective over what they fought to secure. It's little wonder why they'd have a hissy fit from time to time over what they'd view as an encroachment into _their _accomplishments. 

To be completely fair, I have yet to meet an individual health care provider who wasn't supportive of someone increasing their education. Most have even been willing to educate me about their profession. I've enjoyed every minute of it.

What did EMS do? Well, EMS had the potential to become a pre-hospital parallel to nursing or go even beyond that... but stalled in it's infancy. EMS attracts a certain personality... and getting EMS people to agree on _anything _can be a lot like herding cats. That doesn't help. For a variety of reasons and causes, EMS stuck to maintaining the status quo, which kept the profession from improving itself.

Would I like to see a degree be required for someone to become a Paramedic? Absolutely. Would I like to see the time required for a Paramedic be increased to _at least _4 semesters of at least 11 units average each? Yes. I'd also like to see clinical and field time better interspersed throughout that time period to more properly and thoroughly ingrain the knowledge and skills into the student? Yep. Would I like to see prerequisites for entry into a degree program mirror those of most other allied health care fields? Yep. 

You know what? ADN/BSN (and others) programs have a good model... I was educated in just a similarly modeled program, where I earned a bachelor's degree. That kind of program does work. Given a proper base education, a Paramedic could truly function as a physician extender, in a manner more like a PA, and would have the knowledge and skills necessary to do ICU-ICU transports as a team leader. That provider would still be able to work on the street just as effectively and efficiently. The only higher level of care possible (as I envision it) would be a Physician accompanying and caring for the patient during transport. 

I don't see this happening overnight... but should this level of care and ability be what we aim for? Personally? I think so.


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## VentMedic (Nov 26, 2009)

Aidey said:


> The whole thing finally got resolved when the local medical directors got involved, and the state eventually decided to let Paramedics participate and that the RN association had no say in what happened because of how everything was organized in the state. The state ended up adding the EMTs who normally have *IM medications* this year with all the H1N1 issues.


 
Where were your EMS officials when these Public Health statutes were being formed? Did anyone represent EMS or care enough about these issues? Why is it you think the RNs are wrong for following the laws of your state especially if your EMS representatives didn't feel some things were important enough to address? These are not new issues. Florida redefined many of their statutes for EMS after Hurricane Andrew in Public Health. Other states got busy after Katrina and 9/11. Massachusetts was one of those states with an extensive statute recently put through its governing bodies for approval. Why is it the nurses' fault if EMS in your state chose to sit on its butt when Public Health issues were being addressed but then for some to whine when something does happen and they feel ENTITLED to that "skill" also?

It is no different either when EMS statutes are written by EMS officials to include the word PREHOSPITAL and then for some to whine that their titles don't extend into the hospital. Again they will blame the hospital and NURSES for what their own EMS statutes state.


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## Aidey (Nov 26, 2009)

Vent do you even have the ability to reply to a post without blaming EMS/EMTs/Paramedics every single? You don't even sound rational anymore, every thing you say is a rant based on how someone in EMS was at fault. 

It wasn't an EMT or Paramedic that suggested Paramedics and EMTs could be used, but one of the local MD sponsors who was on the committee. None of us demanded anything. A suggestion was made in an attempt to use all resources available. 

I don't see how RNs getting upset at what the state is allowing paramedics to do is "following the law". The RNs got upset because they saw it as an encroachment on their "territory" not because it was against the law. In fact, it turned out that it was perfectly legal for Paramedics to participate.

The laws governing RNs and the laws governing Paramedics and the laws governing EMTs are all separate, and each group is goverened by separate boards. RNs have no right to get pissy over what the medical board lets paramedics do and the EMS board lets EMTs do. 

Did you ever consider the fact that the public health codes/laws/regulations may have been written prior to a structured EMS system being in place? Why does it have to be that the EMS representatives were at fault?


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## MrBrown (Nov 26, 2009)

I think a radical shift in the very core of what must be ambo's business is required before the service gets anywhere.  For so long it has been "prehospital" care, i.e. before the hospital; I'd much perfer the term "out of hospital" to recognise that ambulance treatment and decision making takes place outside the hospital *and* possibly before it *but* treatment and transport are not mutually exclusive!

The argument to keep education down is "oh well we only have the patient for a half hour while we take them to the hospital" and "I'll never use that stuff, I don't need to know it, I don't want to be a doctor".

I personally think there must a serious foci change within EMS in the next decade or two.  90% of the patients I have seen do not require emergency treatment, they don't need an ambulance and most are not managed best by presentation at a hospital emergency department.  There *will* come a time for the requirement of a RN/ambo hybrid "super-medic" who does low priority primary care just as much as (if not more than) high priority life threatning calls.

Recently I had the pleasure to listen to Prof. Malcom Wollard from the UK who said while trauma and cardiac arrests are fun they are *not* the real ambulance service.  If we are honest, I mean really honest, that's probably 5-10% of the ambulance services' work.  Most of the "skills" that Paramedics and Ambo's are taught are to deal with high priority, life threatning cases. 

Let me list the drugs in the Advanced Paramedic drug roll and thier uses ...

- Adrenaline, for *compromising* bradydysrhythmias and *life threatning* croup, asthma, anaphylaxis and cardiac arrest
- Atropine, for *compromising* bradydysrhythmias 
- Amiodarone, for *compromising* tachyarrythmias and *life threatning* cardiac arrest
- Asprin, for *potentially life threatning* myocardial infarctions
- Fentanyl, for sedation pre-induction (RSI), for *life threatning* ventilatory emergency
- Frusemide, for *compromising* cardiogenic pulomonary edema
- Glucagon and glucose; for *severe* hypoglycemia 
- GTN (nitro), for angina and *compromising* cardiogenic pulomonary edema
- Ketamine, for induction (RSI) during *life threatning* ventilatory emergencies
- Midazolam, for *life threatning* status epilepticus and sedation post-intubation (for *life threatning* ventilatory emergency and pre-cardioversion for *life threatning* tachydysrhythmias[/b])
- Naloxone, for *life threatning* narcotic overdose
- Salbutamol nebules, for *compromising and potentially life threatning* asthma

Do you see a trend here; most of what ambo does has been built up around 10% of it's patients; nearly every drug and piece of equipement carried (airway kit, defibrillator, suction etc) is primarily designed for life threatning, high priority emergencies.

While they are important I can't argue that, they neglect the other 90% of patients who do not have high priority, life threatning emergencies.  Most paramedics and ambo's have neither the knowledge nor options to deal with these patients other than to take them to an already overcroweded hospital.

I see a radial change being required to equip the ambulance service to deal with not only high priority life threatning emergencies but also low risk, unschedule care patients.

This change will require a massive shift in the education of ambo's away from "skills" and a "gloss" over of patho and pharm to a proper Degree based education of college level science and the pathways to allow ambo's to refer patients to other options than going to the hospital.

Only when this occurs can Paramedicine truly advance as a speciality and a profession.

I got ahold of the A&P section of my Essentials of Paramedic Care and Paramedic A&P by the AAOS (ironically - makers of the original orange book) and became so frustrated with thier content (and lack of it) I almost had a stroke.  

I've gotten so annoyed and so angry with the tiny amount of science being taught to ambo's that I am seriously considering getting a Masters Degree in physiology, finding a Pharmacologist and rounding up a few RN friends of mine and writing a textbook.

Talking with my American friends who are EMT-Intermediate and EMT-Paramedic and the lack of knowledge they have at how the body and drugs works makes me so mad ... it's dispicable.  I voluntarily spend my time reading medical journals, going through my textbooks, podcasting and the internet to learn more, they say knowledge is power!


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## NJnewbie (Nov 26, 2009)

MrBrown said:


> I've gotten so annoyed and so angry with the tiny amount of science being taught to ambo's that I am seriously considering getting a Masters Degree in physiology, finding a Pharmacologist and rounding up a few RN friends of mine and writing a textbook.



I hope you do write that book.  I know I'd buy it, and so would a lot of other people.  It's sorely needed.  I'm not even in school yet for EMS, but I've been looking for books to read that match the description of what you're describing and haven't been able to find anything.


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## HuiNeng (Nov 26, 2009)

*Systems*

I'm all for education. 

How many people with nursing degrees choose to add paramedicine to their careers?  Also, how many go the other way, adding MD or nursing after paramedicine? (Not counting tv characters!  )

What data are available to answer the question, "Do morbidity and mortality differ among patients treated by those paramedics who hold nursing or medical degrees versus those paramedics without such degrees?"


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## VentMedic (Nov 26, 2009)

HuiNeng said:


> What data are available to answer the question, "*Do morbidity and mortality differ among patients treated by those paramedics who hold nursing or medical degrees *versus those paramedics without such degrees?"


 
In a word, yes. Paramedics are not doctors.

Since the OP is in California, that is a good (bad?) example to use. The Paramedics' protocols in that state are very, very limited even for what they considered "advanced" or "expanded". In some areas the Paramedics must still take a suspected STEMI (very few 12-lead ECGs in much of CA) to the nearest facility. If any medicated drips are started, an RN from the ED must then accompany the patient to the more appropriate facility which might be just another mile down the road. Most of their Flight teams and their CCTs do use RNs with 2 EMTs to drive and help move the patient. Again, it is because of the limitations the states has placed on the Paramedics and they are essentially catering to the lowest denominator among the Bubba EMS managed counties. 

As well, Paramedics who do get their RN degrees can be Flight RNs provided they get at least 3-5 years of ICU experience regardless of how many years they have an a Paramedic even if it is as a Flight Paramedic. Canada's system is set up much differently in that the Paramedics do get extensive education and then the critical care experience they need to function at that level. However, in the U.S., the Paramedic who does hold a degree as a Paramedic might have a better shot at becoming part of a very progressive EMS system be it ground or flight. It is much easier for a medical director to have confidence in his/her Paramedics if he knows they have already extended themselves to get at least the "basics" of a medical education. There was actually a couple of counties in TN that was hiring only those with a degree. Their feeling was that those who went the distance for an education probably won't be as likely to job hop looking for the perfect company if the job isn't like what the medic mills promised. They may know there's more to patient care with the many disease processes and it isn't all about the trauma stuff. You also don't see many Paramedics from OR complaining about education and how unfair nurses are to them. 

Essentially, a better educated Paramedic has the opportunity to do advanced skills and accept the responsibilty of critically ill patients for transfer to where that patient has a better of survival. If the medical director feels the Paramedics are capable of doing expanded protocols, patient out come can be affected. You don't see 600 hour medic mill grads working with Seattle's finest. So yes, education can improve patient outcomes. 

However, until ground EMS improves its education, few studies can be done on how patient outcomes can be improved since the protocols still cater to the lowest denominator which is the most minimal trained/educated Paramedic that the state allows.

We also haven't even begun to explore the role of the Paramedic in the role of public health to any great extent. FL did have a couple of involved counties but that side has been quiet over the past few years even with the statutes in existence that allow them to take a more active role.  Since the Paramedic curriculum does not address many of the issues needed in preventitive medicine or public health, it might be a long time before we see a change there.


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## VentMedic (Nov 26, 2009)

Aidey said:


> Vent do you even have the ability to reply to a post without blaming EMS/EMTs/Paramedics every single? You don't even sound rational anymore, every thing you say is a rant based on how someone in EMS was at fault.
> 
> It wasn't an EMT or Paramedic that suggested Paramedics and EMTs could be used, *but one of the local MD sponsors who was on the committee. None of us demanded anything. *A suggestion was made in an attempt to use all resources available.
> 
> ...


 
Again you blame the RNs for following the law. Guess who would have to supervise the Paramedics at the Public Health clinics? The RNs. Even at the places here where the Paramedics did give the flu shots, the Public Health RNs oversee the whole process and were responsible for the education. It falls on their RN licenses when they are in that role of supervising others during this process regardles of what title you hold. Thus, RNs have every right to get pissy if they are given people who do not have the proper training or by law, do not have the right. 

Believe it or not a lot of other health care providers can give IM injections such as the LPN and MA, but even with more "hours of training" than the Paramedic and while working in some of these clinics they can not participate in every Public Health act either. However, they do what their role calls for in the time of a disaster or pandemic and don't waste time blaming RNs for their own lack of education in other areas.  Also, who some forget, it is a little  more than just the "skill" of sticking a needle in someone's arm.  You also have to be able to ask and answer the questions correctly and not jsut from hearsay on an anonymous EMS forum which means a little addition training.  If some in EMS complain about all that training stuff they are required to do now, what makes you thing some are up for more? 

The fact that as you state, EMS didn't even want to get involved by a physician thought of you does show a lack of initiative on EMS to participate. Again with the "make us" thing. 

Actually from your post I have no clue what you and your EMS system wants. Do you want to be involved or do you just want something to complain about nurses? 

Most states in the U.S. have updated their Public Health Statutes since 9/11 especially where it concerns EMS. Pull up your statutes and read them because there will probably be more disasters to come either by nature or man made. 

Also, if you have ever attended a state or national EMS conference, you will find at almost everyone there will be political representatives from some part of government and those in high ranking position in state EMS offices. However, out of 10,000 conference attendees only about 20 will show enough interest in any of that boring stuff to attend one of these scheduled meetings. The other 9,980 will be at the pool griping about the very same issues being discussed in that meeting but don't care enough to vocalize their opinion where it might count.


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## thegreypilgrim (Nov 26, 2009)

VentMedic said:


> Again you blame the RNs for following the law.


 Good grief, this is getting ridiculous. You're just stimulus-response now. What "law" are you talking about? Paramedic scope of practice in every state includes IM/IN medication administration, every paramedic textbook ever published includes sections on proper techniques for doing this, and every paramedic program in existence (one hopes) teaches its students how to properly do this. Is it against the law for me to give my anaphylaxis patient IM epi? What about my narcotic OD pt with no vascular access to speak of? Is it illegal for me to give him IN narcan? Gee I hope not, maybe I should check with an RN though since they're apparently the only one's who have a clue about anything. Here's the thing, public health regulations can be amended by committee approval. If a local public health/EMS agency wants paramedics to give vaccines then all they need to do is vote on it, write up a proposal to the state authority, and get it approved. No one needs to break the damn law for something like this to happen. No one suggested circumventing this process and just throwing medics in clinics willy-nilly.


> Guess who would have to supervise the Paramedics at the Public Health clinics? The RNs. Even at the places here where the Paramedics did give the flu shots, the Public Health RNs oversee the whole process and were responsible for the education. It falls on their RN licenses when they are in that role of supervising others during this process regardles of what title you hold. Thus, RNs have every right to get pissy if they are given people who do not have the proper training or by law, do not have the right.


 Give me a break. So first you suggest RNs were doing nothing but being upscale citizens by defending the rule of law, now they're eternal professionals worried about someone revoking their license because some medic screwed up a vaccine admin on their watch? This strains credulity. Do you ever stop and consider for one second that even RNs in all their glory can act out of self-interest? It's patently clear that they raised hell over this because they don't want anyone encroaching on their territory - as qualified as they may be to have a right to it. In my area, this whole thing was over before it even started. I didn't even know about the proposal to have medics help out with vaccinating people against H1N1 until it had already been killed. It's hard to blame EMS for not being on the ball when the proposal is eliminated before most people even know about it. Finally, where on earth do you get the idea that paramedics are not qualified to do something like this? Or do you think that there's something about IM/IN admin that we don't know about.



> Believe it or not a lot of other health care providers can give IM injections such as the LPN and MA, but even with more "hours of training" than the Paramedic and while working in some of these clinics they can not participate in every Public Health act either. However, they do what their role calls for in the time of a disaster or pandemic and don't waste time blaming RNs for their own lack of education in other areas.


 Further forays into irrelevance. Intramuscular or intranasal medication admin are not areas paramedics are lacking in education. Neither is vaccination, necessarily. Like I said earlier, I was authorized as a paramedic _*student*_ to give all sorts of vaccines during my clinical rotations. People didn't freak out about this - in fact, the RNs usually came and found me to do it for them when they had better things to do.



> Do you want to be involved or do you just want something to complain about nurses?


Believe it or not, I don't have some sort of personal vendetta against nurses. I like nurses. I would like to be their peers. The impetus for this thread was not to bash nurses as I've repeatedly stated. I'm simply saying they're not always on the side of advancing EMS either, for which the H1N1 thing in my area was simply an example.



> Also, who some forget, it is a little  more than just the "skill" of sticking a needle in someone's arm.  You also have to be able to ask and answer the questions correctly and not jsut from hearsay on an anonymous EMS forum which means a little addition training.  If some in EMS complain about all that training stuff they are required to do now, what makes you thing some are up for more?


 Ooh yeah, that sounds pretty involved. Asking people if they're allergic to eggs seems like something best left to the professionals.


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## thegreypilgrim (Nov 26, 2009)

> I got ahold of the A&P section of my Essentials of Paramedic Care and Paramedic A&P by the AAOS (ironically - makers of the original orange book) and became so frustrated with thier content (and lack of it) I almost had a stroke.
> 
> I've gotten so annoyed and so angry with the tiny amount of science being taught to ambo's that I am seriously considering getting a Masters Degree in physiology, finding a Pharmacologist and rounding up a few RN friends of mine and writing a textbook.
> 
> Talking with my American friends who are EMT-Intermediate and EMT-Paramedic and the lack of knowledge they have at how the body and drugs works makes me so mad ... it's dispicable.  I voluntarily spend my time reading medical journals, going through my textbooks, podcasting and the internet to learn more, they say knowledge is power!


Not that I disagree, but you do realize that the A&P section of the Essentials of Paramedic Care is meant as a review right? It's meant for people who've already taken college A&P.

But I agree with you the AAOS A&P book is a travesty. I actually really enjoy physiology and was happy at how rigorous and in-depth it was covered in my paramedic program (I took college anatomy and physiology courses after medic school and aced them, hardly had to study). Still though I've felt the need to continue to study my college A&P textbooks and read through medical journals to keep up to date.

I would totally buy your book too!


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## daedalus (Nov 26, 2009)

MrBrown, you have my full support in any endeavor to create a paramedic text book that is actually worth reading. I would buy it and promote it. 

pilgrem, I also find it fairly stupid that the emergency medical paramedic workforce cannot help with he H1N1 problem. I have started to get involved in the local medical reserve for Ventura County and will be working o change this if I have time.


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## VentMedic (Nov 26, 2009)

thegreypilgrim said:


> Good grief, this is getting ridiculous. You're just stimulus-response now. What "law" are you talking about? *Paramedic scope of practice in every state includes IM/IN medication administration, every paramedic textbook ever published includes sections on proper techniques for doing this, and every paramedic program in existence* (one hopes) teaches its students how to properly do this. Is it against the law for me to give my anaphylaxis patient* IM epi?*


 


> Intramuscular or intranasal medication admin are not areas paramedics are lacking in education.


 


> Or do you think that there's something about IM/IN admin that we don't know about.


Wow, it is all about the "skill" with you. Again, do you know how many people can do IM injections including the LPN and MA who both have more "hours of training" then the Paramedic. The difference is both know their roles as it concerns Public Health and don't whine if they aren't allowed to do something since they know where they stand with education. 

Now because someone allowed you to do something as a "student" does not necessarily make it right. If an EMT student wants to intubate or needle a chest, I guess you would allow them to do that since it seems okay with you. 



> Ooh yeah, that sounds pretty involved. Asking people if they're allergic to eggs seems like something best left to the professionals


I guess you have pretty much proven my points and have shown your knowledge about vaccines. It is more than just poking a needle into someone's arm. 



> I'm simply saying *they're not always on the side of advancing* EMS either, for which the H1N1 thing in my area was simply an example.


If California EMS does not want to advance why should nurses do it for them? They can not make you get an education if so many of the EMS providers in CA do not want to. If they stated they wanted EMS providers to get an education and advance, can you imagine how that would go over? Sorry but get an education for EMS and then ask for the nurses to help out. You might also try to get all the Bubba county EMS systems to agree that education is good. 


This is a website for California EMS.  
http://www.emsa.ca.gov/

And this page addresses H1N1
http://www.emsa.ca.gov/about/H1N1/default.asp 

This is the Department of Public Health for California. Again, you need to be familar with some of these statutes especially as their pertain to EMS, disasters and pandemics. 

http://www.cdph.ca.gov/Pages/Default.aspx



> If a local public health/EMS agency wants paramedics to give vaccines then all they need to do is vote on it, write up a proposal to the state authority, and get it approved.


 
If you really understand this why are you complaining about the "RNs won't let us"?  



> Not that I disagree, but you do realize that the A&P section of the Essentials of Paramedic Care is meant as a review right? It's meant for people who've already taken college A&P.


A review for what? Not that many Paramedic programs in California require college level A&P. You stated yourself you took A&P after the Paramedic program The little book used as a supplement to even the college Paramedic programs is a job. The Paramedic mills such as AMR's is also a joke with their "Everything to know about A&P for the Paramedic in one easy week". Remember the minimum for California is only a little over 1000 hours of training.

Just face it. You are in California with one of the most fragmented and limited State EMS systems for Paramedics and EMTs. It hasn't changed in 40 years and probably won't except for doing background checks now. Even then a county medical director can override the system to allow a baby killer get a cert as an EMT.  

This thread isn't about advancing EMS at all but about you getting your feeling hurt by a nurse.    

Many EMS providers in other states do know their role for disaster management and pandemic including vaccinations.  If they are not used for the vaccinations, they find out what other situations they will be utilized in instead of whining about ONE "skill" although important, it isn't the end of the world if Paramedics in California aren't giving vaccinations.   With the shortage of the H1N1 vaccine in that state, there are more than enough RNs to give out what little there is.


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## daedalus (Nov 26, 2009)

Vent, I know thegreypilgrim enough to know that he does not think that being a paramedic is all about skills. He is saying that, in a time of crisis or potential crisis, paramedics should be able to help out in emergency public health matters. In theory, paramedics are the perfect type of professional to deploy to combat a public health crisis. I think that you, I, and grey pilgrim all agree that paramedic education is currently lacking for us to take on that kind of responsibility. However, idealism should not be squashed. 

However, I am sure that greypilgrim understands that inncoluating people against the flu or other viruses that pose a threat is more than sticking a needle in the arm. While LPNs and MAs can give these vaccines, paramedics should also be able to because we at least have the same education as them in the administration of IM medications, and hopefully paramedics also have enough physiology and pharm to understand the immunology of what they are doing, and understand the epidemiology the current crisis. I know that I have covered these topics in microbio, a&p, and paramedic school enough to know much more about H1N1 than a MA. It seems logical than, that I should be able to vaccinate people as well. (at this time, that may have to be under the direction of an RN until we give ourselves a seat at the table of Public Health).



> Just face it. You are in California with one of the most fragmented and limited State EMS systems for Paramedics and EMTs. It hasn't changed in 40 years and probably won't except for doing background checks now. Even then a county medical director can override the system to allow a baby killer get a cert as an EMT.
> 
> This thread isn't about advancing EMS at all but about you getting your feeling hurt by a nurse.


Why the hostility? I think greypilgrim is a breath of fresh air in the southern california culture of idiots leading the blind that is EMS.


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## thegreypilgrim (Nov 26, 2009)

VentMedic said:


> Wow, it is all about the "skill" with you. Again, do you know how many people can do IM injections including the LPN and MA who both have more "hours of training" then the Paramedic. The difference is both know their roles as it concerns Public Health and don't whine if they aren't allowed to do something since they know where they stand with education.


 *Sigh* 
No, VentMedic it is decidedly _*not*_ "all about the skills" with me. My whole point is, if paramedics are already qualified to give medications via this route then it isn't a very far cry to provide them with appropriate education on the risks, adverse effects, etc. of vaccinations to have them do it...or do you just not think paramedics are qualified to do anything? 



> Now because someone allowed you to do something as a "student" does not necessarily make it right. If an EMT student wants to intubate or needle a chest, I guess you would allow them to do that since it seems okay with you.


 No, and let me tell you why. I was not "allowed" to give vaccines, I was _*authorized*_ to do so - big difference. It was an express authorization - meaning the category of "vaccinations" was included in the list of medications paramedic students could administer in clinical internship. It was in writing, and it came from the state of California. Somewhat different than an EMT who gets "allowed" to intubate.




> I guess you have pretty much proven my points and have shown your knowledge about vaccines. It is more than just poking a needle into someone's arm.


I honestly have nothing to prove to you. You don't know me, you have no idea about my knowledge-level of anything whatsoever (irrespective of medicine). I'm not going to sit here and, like a little child, show you how much I know. Get over yourself.



> If California EMS does not want to advance why should nurses do it for them? They can not make you get an education if so many of the EMS providers in CA do not want to. If they stated they wanted EMS providers to get an education and advance, can you imagine how that would go over? Sorry but get an education for EMS and then ask for the nurses to help out. You might also try to get all the Bubba county EMS systems to agree that education is good.


 I don't know if your misunderstanding is deliberate or accidental, but I never said I would like nurses to advance our education for us. What an absurd concept.




> This is a website for California EMS.
> http://www.emsa.ca.gov/
> 
> And this page addresses H1N1
> ...


You really need to read your own links:

_*EMSA Role in the H1N1 Response:*_

_    *  Provide guidance to local EMS agencies on airborne infectious diseases, personal protective equipment, and planning for staff absenteeism due to illness.

    * Serve as an advisor to Governor Schwarzenegger’s administration on emergency medical response
    * Administer the HavBed system, in conjunction with the Department of Public Health and the U.S. Health and Human Services Agency, to evaluate the availability of hospital facilities statewide.

    * Prepare to deploy “Strike Teams”—Cal-MAT, Disaster Medical Strike Teams, Ambulance Strike Teams— upon request.  

    * Administer the Disaster Healthcare Volunteers system, in partnership with Cal Volunteers, to identify and pre-certify health and medical professionals to work in case of an emergency.

    * If needed, deploy and manage Mobile Field Hospitals

    * *Provide authority and training to enable paramedics to administer vaccinations under local medical control and as part of the organized emergency medical system.*

    * Gather situational surveillance information from local EMS agencies regarding call volumes and issues of concern._

And there you have it. It was part of California public health's plan to have this done, so I don't know where you're coming from when you say that RN's are merely trying to uphold the law by arguing against paramedics being able to do this.



> If you really understand this why are you complaining about the "RNs won't let us"?


I never said it was an issue of RN's "not letting us" do this. They have no legal authority to make that decision, it's not their call. However, as of yet no EMS service has any paramedics administering H1N1 vaccines. Why is that? Getting to the bottom of this requires a basic understanding of how lobby groups work. You know what those are don't you? Well, here in the golden state, nursing associations wield considerable lobbying power. So, even though it's not a case of "RN's won't let us do it", it kind of is because their lobby groups have been able to use their political capital to block this from happening. Get it now?



> A review for what? Not that many Paramedic programs in California require college level A&P. You stated yourself you took A&P after the Paramedic program The little book used as a supplement to even the college Paramedic programs is a job. The Paramedic mills such as AMR's is also a joke with their "Everything to know about A&P for the Paramedic in one easy week". Remember the minimum for California is only a little over 1000 hours of training.


Yeah, I know but regardless of this fact that's what the authors of the book intended it to be.



> This thread isn't about advancing EMS at all but about you getting your feeling hurt by a nurse.


Thanks for the psychoanalysis Dr. Freud. I didn't realize that in addition to your duties as a respiratory therapist you moonlighted as a clinical psychologist. You have no idea what my motivations are for anything I do, and it would behoove you not to speculate about such things. For the record though, I like nurses - as I've stated _ad nauseam_ previously.



> Many EMS providers in other states do know their role for disaster management and pandemic including vaccinations.  If they are not used for the vaccinations, they find out what other situations they will be utilized in instead of whining about ONE "skill" although important, it isn't the end of the world if Paramedics in California aren't giving vaccinations.   With the shortage of the H1N1 vaccine in that state, there are more than enough RNs to give out what little there is.


Go back and read some of the very links you provided me and you'll see what public health authorities are considering as the paramedics role in disaster medicine and pandemic management. Also, I'm not really going to lose any sleep over whether or not we do end up helping out with vaccinations. I merely am using this as an example of yet one more problem people who want to advance EMS face, and you're blowing it out of proportion.


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## VentMedic (Nov 26, 2009)

daedalus said:


> Why the hostility? I think greypilgrim is a breath of fresh air in the southern california culture of idiots leading the blind that is EMS.


 
No hostility. I just hate whiney Paramedics who grumble about one skill and miss the big picture or the roles that EMS should be taking. If EMS has NEVER considered this participation in this one area, they either have other plans on their plate or some just didn't feel it was worth justifying taking EMT(P)s out of service to give vaccines.

Just because you can doesn't always mean you should. LPNs and MAs are not utilized in the innoculation process for a variety of reasons. However, they might be used in other areas. Just because a Paramedic can stick a needle into someone's arm doesn't mean that is the job they should be doing.

When Public Health statutes are formed, allocation of resources are considered. If all the FFs and Paramedics are tied up at clinics giving shots, who is transporting patient where there will be an increased call volume. As well, in times of disaster such as the hurricanes, we learned that even though the Paramedics were capable of giving vaccinations by statute that was not were they were needed. Some just need to look at the bigger picture of their state especially in California which could have another major earthquake. Would it not be better to allocate EMS to where they are needed in Public Health for that state? It might be different in Kansas or Oklahoma. Thus, those who just keep spouting at random really need to get involved in their state's planning committees for EMS to see where the budget, resources and other Public Health concerns lie. 

He actually posted this from the link and I still believe he doesn't understand the greater roles of EMS and other providers.


_*



EMSA Role in the H1N1 Response:

Click to expand...

*_


> _** Provide guidance to local EMS agencies on airborne infectious diseases, personal protective equipment, and planning for staff absenteeism due to illness.*
> 
> ** Serve as an advisor to Governor Schwarzenegger’s administration on emergency medical response*
> ** Administer the HavBed system, in conjunction with the Department of Public Health and the U.S. Health and Human Services Agency, to evaluate the availability of hospital facilities statewide.*
> ...



It does NOT mean giving vaccines is the sole responsibility of EMS. Thus the reason I provided the links for him. He is also welcome in Sacramento for an EMS advisory panel if he would like to see just how his state functions. I would seriously hope he can see the bigger picture and see that EMS has other functions to concern themselves with that they might be more qualified for. If their education was increased and their state protocols were expanded there might be more opportunities. 



> Thanks for the psychoanalysis Dr. Freud. I didn't realize that in addition to your duties as a respiratory therapist you moonlighted as a clinical psychologist. You have no idea what my motivations are for anything I do, and it would behoove you not to speculate about such things. For the record though, I like nurses - as I've stated _ad nauseam_ previously.


 
I don't have to speculate on much as I have been a Paramedic and in EMS for 30 years. I have also been active in government issues and have heard all the same whining that you are doing right now. You talk and talk on an anonymous forum but have probably done little beyond that. I am also lucky that I do have experience as an RRT and do work with RNs both in EMS and in the hospital. I also have participated in a few disasters. Believe me when I tell you that there is much more to EMS than one or two skills that you seem to be so upset about. Don't let that paralyze you from seeing what else EMS is capable of or should be doing. Whining about an IM injection is not a sign of you understanding your own roles that are needed in a pandemic or disaster. 



> I know that I have covered these topics in microbio, a&p, and paramedic school enough to know much more about H1N1 than a MA. It seems logical than, that I should be able to vaccinate people as well.


*daedalus,*
Of course you have had those classes. You are going for med school. However, as an EMT in the state of California, you are still held to the standards of that patch and unfortunately that of the lowest 110 hour denominator. An MA does have many more hours of training and patient contact than that.


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## daedalus (Nov 26, 2009)

> daedalus,
> Of course you have had those classes. You are going for med school. However, as an EMT in the state of California, you are still held to the standards of that patch and unfortunately that of the lowest 110 hour denominator. An MA does have many more hours of training and patient contact than that.


This is true. I also never considered taking medics off the rigs, and in Ventura that would leave little in the way of available paramedics. Perhaps in the future, the FD station might be a place the public can get their BPs and lipids checked, and vaccines administered. Since we all face economic hardship and cannot pay to staff a paramedic engine on every corner anymore just to have them BBQ and watch movies, maybe when they are not on calls they could be doing public health duties.


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## Aidey (Nov 26, 2009)

VentMedic said:


> Again you blame the RNs for following the law. Guess who would have to supervise the Paramedics at the Public Health clinics? The RNs. Even at the places here where the Paramedics did give the flu shots, the Public Health RNs oversee the whole process and were responsible for the education. It falls on their RN licenses when they are in that role of supervising others during this process regardles of what title you hold. Thus, RNs have every right to get pissy if they are given people who do not have the proper training or by law, do not have the right.



Um. Wrong, sorry. Where I worked Paramedics did not practice under the RNs license, we practiced under our own license or under the Doctor's license. The RN running the clinic may be legally responsible as a supervisor, but not medically. As I already stated, when they looked deeper into it, it was already legal for Paramedics to participate, it wasn't against the law at all, so I'm really not sure what law you keep blathering on about.


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## VentMedic (Nov 27, 2009)

Aidey said:


> Um. Wrong, sorry. Where I worked Paramedics did not practice under the RNs license, we practiced under our own license or under the Doctor's license. The RN running the clinic may be legally responsible as a supervisor, but not medically. As I already stated, when they looked deeper into it, it was already legal for Paramedics to participate, it wasn't against the law at all, so I'm really not sure what law you keep blathering on about.


 
READ the post before you just flap your fingers.



> Originally Posted by *VentMedic*
> 
> 
> _Again you blame the RNs for following the law. Guess who would have to *supervise *the Paramedics at the Public Health clinics? The RNs. Even at the places here where the Paramedics did give the flu shots, the Public Health RNs oversee the whole process and were responsible for the education. It falls on their RN *licenses* when they are in that role of supervising others during this process regardles of what title you hold. Thus, RNs have every right to get pissy if they are given people who do not have the proper training or by law, do not have the right. _


 
Do YOU not understand the word supervise? Your medical director may be whose license you are working under but the RN's license will be in question if they allow you to do something to the patient that can cause harm while in their supervision.  You would also be functioning under a Department of Public Health Act which can also change quite a few things. Things can changes and when you are asked to participate in a Disaster, it may not be the protocols of YOUR medical director that you will be functioning under. 

If you have an EMT working on your truck that you know is not properly trained or is doing something wrong, YOU are responsible for that EMT if you were a Paramedic. If harm comes to a patient while this EMT is under your supervision, you may be reprimanded by the rules and regulations of your license as well as disciplined by your medical director. In fact, it will probably be your medical director that may ask the state to step in through a report that may need to be filed. 

This thread is going nowhere because some here do not understand their own license, state statutes and their own limitations when it comes to supervision, Public Health and disaster management. 

Wouldn't it be nice if some could actually carry on a conversation by mentioning their own EMS statutes, duties, officials, legislative committees and meetings that are held in their area that addresses what they could be doing or have ideas that could change what their role? Instead some insist upon bashing and blaming everything on nurses or whatever other medical professional they see fit and most of their facts come from "hearsay". How many even discuss such issues as a group with their own medical director and agency manager to see what resources and funding is available to do such jobs? Who pays you while you are giving the shots and where will your company get the reimbursement? A couple of FDs in FL have been giving flu shots but they are paid through the taxes of the people and will also get some extra funding later in a different budget. Now if you wanted to carry on a conversation about this, great. But, to just go on and on about issues you really have not investigated but just want to rant about how wronged you feel by everyone and how ENTITLED you believe you are to be given something you don't even know the process of how you should get it is just ridiculous. 

And to bash me for trying to get some to see how much is involved in disaster/pandemic preparedness and management is just as ridiculous. Expand you knowledge and find out how EMS actually works within your state. Don't just do the superficial name calling of other professions and rant about things that really do not affect what your own leaders in EMS are doing. EMS is a lot more than your little protocol book.


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## VentMedic (Nov 27, 2009)

Besides your own state's EMS and Public Health Department site, there are also many websites that can give you an idea about how various issues are being put in through the government pathways. Other professionals have some political offices on speed dial and the email addresses flag. Some state EMS offices do have a email alert or newsletter to inform their providers of impending actions. But, how many take time to read all which looking just like a "bunch of political stuff"? 

http://www.nasemsd.org/

You can also watch the websites of the IAFF and state or local FF associations. 

Many Bills get passed because there are too few EMS providers that are even aware of them. Then, this becomes a source for complaining but yet few do their homework on how this happened or where it originated.   Some complain about the FDs but yet many probably do not know how they obtained and keep obtaining some of their strength or what bills got passed to quietly divert funding to special interest groups which can also include corporate run ambulances for huge contracts.   I bet many here do not know their what stance their State Representatives, Senators and Governors have on EMS, Public Health and Safety issues. 

It is like grumbling about the President if you did not even vote. If you at least sent your opinion out to some political offices or participated in some regional meetings to voice your concern, others would know there is a voice out there.


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## VentMedic (Nov 27, 2009)

A couple more sites:

http://www.capwiz.com/naemt/home/

http://www.capwiz.com/naemt/issues/

http://www.advocatesforems.org/pageContent.aspx?id=2&titleID=9


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## Level1pedstech (Nov 27, 2009)

daedalus said:


> This is true. I also never considered taking medics off the rigs, and in Ventura that would leave little in the way of available paramedics. Perhaps in the future, the FD station might be a place the public can get their BPs and lipids checked, and vaccines administered. Since we all face economic hardship and cannot pay to staff a paramedic engine on every corner anymore just to have them BBQ and watch movies, maybe when they are not on calls they could be doing public health duties.



 BBQ and watch movies, is that what you really think?. I should probably stop now but what the hell, you need some educating. Do you have any idea what goes on at a firehouse in the course of a twenty four hour shift or do you and the others just tow the anti fire line. Maybe try a ride out and you will see that alot gets done before downtime activities like BBQ's and movie watching. Training,drilling,house duties and PT are just a few things that come before downtime activities. By the way during the day the public is always welcome to pop in for a BP check. It would be hard to have the fire department function as a walk in clinic and do more public health duties because they have to be able to do this little thing called responding to calls. I don't think leaving a house full of public health recipients while the crew responds to a call is going to go over real well with the white shirts.

  I know you want more education and that's great,you can increase standards and education for prehospital providers all you want but who is going to do the job for 15,00 p/hr. Your never going to get the pay or respect out of the privates. Why do you think scab outfits like AMR manage to hold on, its because they are able to function mostly with medics that cant get on with fire. Why would you work for 25,000 p/yr with a private when you could work for 60,000 plus with fire. I'm sorry I just don't get it, maybe you could explain to us how your going to get the privates to step up and offer decent wages and benefits (like fire) to these folks after they get this great education you are proposing. 

 I understand not everyone wants to go fire but many would if they could do something as simple as passing the physical ability portion of the process. If chairman maobama and the rest of his party have their way and succeed in destroying our health care system, you after spending all those years in school might find yourself begging for a job as good as a firefighters. I will close by saying I think your a sharp kid and I know your going to go on and do great things but you and the other higher education folks really need to think things through and figure out how you are going to reward people for putting in years of education..


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## daedalus (Nov 27, 2009)

Dude above me, you should quit while your ahead. I have spent a lot of time inside of Los Angeles County Fire stations. I have massive respect for firefighters, but I know what they do on their down time and I also know that it is not fair to the taxpayers. 

Yes. BBQs and movies. That is what southern california firefighters (which is the geographic area this thread is about) really do. Just ask forum user "atropine" if you do not believe me.

PS, I have done rideouts. I have hung out at the FD station while on shift with the ambulance. I have stopped by. I know. You work in an ER.


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## reaper (Nov 27, 2009)

Level1pedstech said:


> BBQ and watch movies, is that what you really think?. I should probably stop now but what the hell, you need some educating. Do you have any idea what goes on at a firehouse in the course of a twenty four hour shift or do you and the others just tow the anti fire line. Maybe try a ride out and you will see that alot gets done before downtime activities like BBQ's and movie watching. Training,drilling,house duties and PT are just a few things that come before downtime activities. By the way during the day the public is always welcome to pop in for a BP check. It would be hard to have the fire department function as a walk in clinic and do more public health duties because they have to be able to do this little thing called responding to calls. I don't think leaving a house full of public health recipients while the crew responds to a call is going to go over real well with the white shirts.
> 
> I know you want more education and that's great,you can increase standards and education for prehospital providers all you want but who is going to do the job for 15,00 p/hr. Your never going to get the pay or respect out of the privates. Why do you think scab outfits like AMR manage to hold on, its because they are able to function mostly with medics that cant get on with fire. Why would you work for 25,000 p/yr with a private when you could work for 60,000 plus with fire. I'm sorry I just don't get it, maybe you could explain to us how your going to get the privates to step up and offer decent wages and benefits (like fire) to these folks after they get this great education you are proposing.
> 
> I understand not everyone wants to go fire but many would if they could do something as simple as passing the physical ability portion of the process. If chairman maobama and the rest of his party have their way and succeed in destroying our health care system, you after spending all those years in school might find yourself begging for a job as good as a firefighters. I will close by saying I think your a sharp kid and I know your going to go on and do great things *but you and the other higher education folks really need to think things through and figure out how you are going to reward people for putting in years of education.*.



Why is it that FF's always look for the reward in advancing? Yes, over time the pay will increase, as more are pushed to higher education. Why can you not go out an increase your education, for the personal satisfaction of knowing that you are now a better provider?

Do you think teachers get advanced degrees for the awesome pay?


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## VentMedic (Nov 27, 2009)

Level1pedstech said:


> If chairman maobama and the rest of his party have their way and succeed in destroying our health care system, you after spending all those years in school might find yourself begging for a job as good as a firefighters. I will close by saying I think your a sharp kid and I know your going to go on and do great things but you and the other higher education *folks really need to think things through and figure out how you are going to reward people for putting in years of education*..


 
Those links I have posted from organizations that actually have advocates for EMS have considered the reimbursement status that is required to be at a professional level.  Again, if you read the earlier article I posted it clearly states that a lot of legislators would love to help out EMS in these issues but unless we can define the providers there is not much hope of establishing a professional definition as other professions have done.  When you present the nation's legislators with over 50 different titles and many of those using similar titles but totally different "hours of training", where is the standard.

Also for education, we are not talking about "years" of education to start.  Even a mere two year degree is very little but it is a start.  Other health care, business and education professsions would never consider hiring someone with so little education as that yet we trust people's lives to those with as little at 500 hours of training as a Paramedic. 

If a FF/Paramedic had decided to be a health care professional in CA instead, he/she would be making that $100k, that atropine keeps bragging about, while working a 36 - 40 work week or about 2080 hours/year instead of well over 3000.  If the Paramedic achieved similar professional recognition for professional services, the salaries would increase or at least the funding given to the FDs could be justified.


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## Level1pedstech (Nov 27, 2009)

daedalus said:


> Dude above me, you should quit while your ahead. I have spent a lot of time inside of Los Angeles County Fire stations. I have massive respect for firefighters, but I know what they do on their down time and I also know that it is not fair to the taxpayers.
> 
> Yes. BBQs and movies. That is what southern california firefighters (which is the geographic area this thread is about) really do. Just ask forum user "atropine" if you do not believe me.
> 
> PS, I have done rideouts. I have hung out at the FD station while on shift with the ambulance. I have stopped by. I know. You work in an ER.



 Yes I work in an ER where I have seen and helped to treat more critical patients than most EMTs with my amount of time in the field, nice shot but is that your best. I also have ten years of FF/EMT experience with two different departments one being a municipal combination paid/volunteer department. I only throw that in so that those who don't know me that might be following this thread will know I have my fire time in and know of what I speak when it comes to the fire side of things. Why am I not a paid full timer, simple I make 90,000 a year with an ultra nice benefit package as a teamster driving a truck. There was not much motivation to start back at square one and take a big cut in pay and benefits. You see I have a family and getting paid well for what I do is my goal in life. I see you passed right over the meat of my original post, how do you plan to get the privates to step up and offer pay to equal the increase in education you all seek. Do you really think these people are going to spend four years in school to come out making 15.00 p/hr, you my young friend have so much to learn.


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## EMSLaw (Nov 27, 2009)

Level1pedstech said:


> Yes I work in an ER where I have seen and helped to treat more critical patients than most EMTs with my amount of time in the field, nice shot but is that your best. I also have ten years of FF/EMT experience with two different departments one being a municipal combination paid/volunteer department. I only throw that in so that those who don't know me that might be following this thread will know I have my fire time in and know of what I speak when it comes to the fire side of things. Why am I not a paid full timer, simple I make 90,000 a year with an ultra nice benefit package as a teamster driving a truck. There was not much motivation to start back at square one and take a big cut in pay and benefits. You see I have a family and getting paid well for what I do is my goal in life. I see you passed right over the meat of my original post, how do you plan to get the privates to step up and offer pay to equal the increase in education you all seek. Do you really think these people are going to spend four years in school to come out making 15.00 p/hr, you my young friend have so much to learn.



Every increase in education necessarily creates a shortage of workers in the field, at least temporarily.  Look at what happened when Pharmacists went to a Pharm.D. - there was a period when, as a result, NO new pharmacists graduated.  The lack of a large, transient, and fungible pool of employees would force employers to pay better wages.  

That being said, I think it's a false comparison to compare the wages of any given field to public safety.  Police and firefighters, for a number of reasons - unions, the perceived danger of the work, etc. - are paid far more than other jobs with their same level of education.


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## Level1pedstech (Nov 27, 2009)

reaper said:


> Why is it that FF's always look for the reward in advancing? Yes, over time the pay will increase, as more are pushed to higher education. Why can you not go out an increase your education, for the personal satisfaction of knowing that you are now a better provider?
> 
> Do you think teachers get advanced degrees for the awesome pay?



 Speaking for myself I have spent many hours in classes increasing my education a while I was working 60-70 hours a week.  I increase my level of knowledge every time I shift in the ER. I am very satisfied with what I have been able to do in the last ten years. I also have plans for moving on with my education in the near future. 

 I don't think FF's are the only ones guilty of looking for a reward for time put into advancing their knowledge. Would you be happy working for garbage wages after putting in what some seem to think should be four years of school for paramedic? You could put in two and make twice the money working as an RN. The last RN student I know started as a brand new ER RN at 30.00 p/hr in a small level 3 hospital in rural Oregon.


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## reaper (Nov 27, 2009)

I further my education for my Pt's sake. I did not get into this job to make high pay. I knew this before I started 20 years ago. I do this job, because I enjoy it!

As more people increase the educational standards. The pay will increase with it. The same way it did for Rn's.


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## VentMedic (Nov 27, 2009)

Level1pedstech said:


> Speaking for myself I have spent many hours in classes increasing my education a while I was working 60-70 hours a week. I increase my level of knowledge every time I shift in the ER. I am very satisfied with what I have been able to do in the last ten years. I also have plans for moving on with my education in the near future.
> 
> I don't think FF's are the only ones guilty of looking for a reward for time put into advancing their knowledge. Would you be happy working for garbage wages after putting in what some seem to think should be four years of school for paramedic? You could put in two and make twice the money working as an RN. The last RN student I know started as a brand new ER RN at 30.00 p/hr in a small level 3 hospital in rural Oregon.


 
The lowest denominator for an RN in the U.S. is the Associates degree (2 - 3 years with prerequisites). 

The lowest denominator for EMS is either the 110 hours or 3 weeks worth of training for EMT-B or the Paramedic which can be as little as 500 hours in a couple of states or 3 months of training. While there are programs that offer two year degrees, few students finish them when given the option of a certificate at these colleges. Other professions got the word out that the requirements WOULD be increasing, not maybe, and that led the new students to get their degrees immediately. Those in the profession also already heard and started finishing their education. Thus when it was time to make the degree official, on a few people were without a degree. 

Again, no one is asking the Paramedic at this time to get a 4 year degree. But, some act like a mere Associates is that big of a deal. Hell most of Associates degrees for the Paramedic are A.A.S. and require no major extra classes like the regular college A&P. Thus, some colleges have even dumbed down the Paramedic degrees and yet there are few that go for them. 

An RN making only $30/hr? It is time to raise their education standard since the PTs, OTs and SLPs have passed up the RNs and RRTs, who only hold a mere Associates, in wages and bonuses. This is the reason why the RRTs have already petitioned for expansion of scope privileges, as it pertain to reimbursement, in other areas outside of the hospital such as clinics.


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## daedalus (Nov 27, 2009)

Level1pedstech said:


> Yes I work in an ER where I have seen and helped to treat more critical patients than most EMTs with my amount of time in the field, nice shot but is that your best. I also have ten years of FF/EMT experience with two different departments one being a municipal combination paid/volunteer department. I only throw that in so that those who don't know me that might be following this thread will know I have my fire time in and know of what I speak when it comes to the fire side of things. Why am I not a paid full timer, simple I make 90,000 a year with an ultra nice benefit package as a teamster driving a truck. There was not much motivation to start back at square one and take a big cut in pay and benefits. You see I have a family and getting paid well for what I do is my goal in life. I see you passed right over the meat of my original post, how do you plan to get the privates to step up and offer pay to equal the increase in education you all seek. Do you really think these people are going to spend four years in school to come out making 15.00 p/hr, you my young friend have so much to learn.


I skipped over the meat of your last post, as will I this one, because in my opinion it does not even deserve a response. I am a patient advocate first. I am currently a few months away from an A.S. in paramedic studies, and will probably be applying to Loma Linda's B.S. in Emergency Medical Care. I do this with the full knowledge that it by itself will not increase my salary. 

After having a AS and BS in EMS, I will make just as much as the guy with the certificate paramedic school education, who started working when I did.

Also, what does any of this have to do with adding public health responsibilities to southern california fire paramedics who make over 100,000 a year to sit at a station?


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## triemal04 (Nov 28, 2009)

<stops episode of hypergagging>  There.  Now maybe something constructive can come out of this instead of the sameoldsameold.  Want to change EMS for the better?  The solution is real easy; it's implementing that solution that is the hard part.

1.  Mandate that all state's adhere to a national standard for levels of EMS providers, preferably not more than 3 and maybe even 2, at least initially.  Benefits to this is it would allow people to move from one area to another without the difficulties we currently have, allow for more federal funding/reimbursement since it'd be much easier to understand what we are/do.

2.  Raise the educational standards and enforce them at the state and national level; 3-yr AAS degree as the entry level for a paramedic.  Benefits would be people in it for the thrill would be weeded out, and, with everyone having a degree the ability to get a higher reimbursement rate from medicare would become a reality.

2.5  Raise the pay for paramedics to an appropriate level.  More education equals more responsibility, and more education can, as seen above, equal more federal money which could be turned into higher wages.  Benefits would be people would stay for a career instead of leaving for better pay.

3.  Create both a union for paramedics, and a national body that also works for the advancement of the profession; think IAFF (union) and NFPA (nat'l org).  Both have done wonders for the fire service...think maybe it could also be done for EMS?  Benefits would include the ability to lobby at the state/national levels, have people actively working to advance and protect EMS, and have the ability to bargain for contracts and be protected as an employee.

4.  Remove non-emergency transports from being associated with EMS in anyway; use it as a 911 service and emergency transport service only.  Benefits would be, again, people would be able to understand what we do without the current fragmentation, people starting out would not be exposed to things that burn them out and turn them into poor providers, and the various levels of providers would be used in the appropriate way.

Those are just the most obvious, and all have many more benefits that I've listed here.  Unfortunately, as I've said, it's not coming up with a solution that's hard, it's implementing it.


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## triemal04 (Nov 28, 2009)

VentMedic said:


> An RN making only $30/hr? It is time to raise their education standard since the PTs, OTs and SLPs have passed up the RNs and RRTs, who only hold a mere Associates, in wages and bonuses. This is the reason why the RRTs have already petitioned for expansion of scope privileges, as it pertain to reimbursement, in other areas outside of the hospital such as clinics.


As an aside, and playing a bit of devil's advocate, but do you think it's appropriate for someone fresh out of school to be making $30/hr (last RN I met started at $32)?  With everyone involved in healthcare wanting, justifiably or not, to make great money and have a high paying job, how much do you think that contributes to the problems we have today with healthcare; the high cost of it I mean?


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## VentMedic (Nov 28, 2009)

triemal04 said:


> As an aside, and playing a bit of devil's advocate, but do you think it's appropriate for someone fresh out of school to be making $30/hr (last RN I met started at $32)? With everyone involved in healthcare wanting, justifiably or not, to make great money and have a high paying job, how much do you think that contributes to the problems we have today with healthcare; the high cost of it I mean?


 
New RRTs and RNs start at $28 - $32/hour in my area.  On the West Coast, specially in CA, they can start at $45/hour.  



> how much do you think that contributes to the problems we have today with healthcare; the high cost of it I mean?


 
I still don't make anywhere near what my techie or accounting friends make.   

If you believe that contributes to the high cost of health care then why support advancing the education of Paramedics and unions?  The increase in pay will eventually follow.   Are you also in favor of Paramedics walking off the job for every little labor dispute?   Everytime the RNs and RRTs walk off their jobs in CA for a union called strike, some RNs/RRTs from the other states get an all expense paid "vacation" to CA to make some incredible wages for 10 days.  How does that save money if Paramedics were to do the same thing for their strikes?  I sure there will be just as many wanting to do coverage for the bonuses just as the have for previous strikes in some areas. 

A strong national organization would be most appropriate.  I linked a couple of organizations earlier that could easily expand if EMT(P)s took an interest and they already have established links in government.


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## reaper (Nov 28, 2009)

I agree.

A National Organization is best. No need for a union.


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## triemal04 (Nov 28, 2009)

VentMedic said:


> New RRTs and RNs start at $28 - $32/hour in my area.  On the West Coast, specially in CA, they can start at $45/hour.
> 
> I still don't make anywhere near what my techie or accounting friends make.
> 
> ...


There's loads more jobs that pay more than anything in healthcare, but this isn't about them right now.  I don't really know how much, if any the high pay contributes to the high cost of healthcare, like I said, a lot of this is devil's advocacy; I want to know what others think.  And I'm for increasing the pay for paramedics because it's not at appropriate levels, and, if educational standards were increased it'd definitely not be at an appropriate level (for many places, not all currently).  But, be honest.  If it was shown that the compensation paid to healthcare workers was high enough that it contributed to the high cost of healthcare, what would you suggest doing?

Personally I'd like to see EMS run the same as fire/police; as a publically funded service.  Of course, that generally entails them being prohibited from striking, but...oh well.  That type of thing is a last resort anyway, and, in this line of work, would do more harm than good.  There's better options to explore before even considering that.

Yes, things like NAEMT would be able to do more...if they had more support.  But like I said, coming up with the solution isn't the hardest part, it's implementing it.  And really, before anybody was to even consider lobbying at the national level, EMS needs to become a standardized group, which...could be an issue.


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## VentMedic (Nov 28, 2009)

triemal04 said:


> Yes, things like NAEMT would be able to do more...if they had more support. But like I said, coming up with the solution isn't the hardest part, it's implementing it. And really, before anybody was to even consider lobbying at the national level, EMS needs to become a standardized group, which...could be an issue.


 
Advocates for EMS and the physcian/state officials/educators organizations have decent representation.

With any luck the new education levels will chop away at the 50+ certs among the states. 

I just wish some would show more interest at the state and national conferences. These conferences might even attract more heavy hitters for the legislative issues. However, unless placed on the main floor of the conference rather than an obscure break out session as some are now and often in the managerial track, the attention is not there.

I also believe the education level for instructors should be increased before anything else. There will of course need to be educators with higher education if standards are ever increased. The lack there will be what may hold EMS back from obtaining the goal of a 2 year degree.


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## triemal04 (Nov 28, 2009)

VentMedic said:


> Advocates for EMS and the physcian/state officials/educators organizations have decent representation.
> 
> With any luck the new education levels will chop away at the 50+ certs among the states.
> 
> I just wish some would show more interest at the state and national conferences.  These conferences might even attract more heavy hitters for the legislative issues.   However, unless placed on the main floor of the conference rather than an obscure break out session as some are now and often in the managerial track, the attention is not there.


It's not just having people sign up, but having the ability to get your voice heard and effectively lobby people/groups at all levels that makes an organization effective, having people out working on it; once it's determined that you do represent the group you claim to, do know what you are talking about, and are working to better not just your constituents but laypeople as well, it get's much easier; look at the NFPA.

I have been following along what happens in EMS at the state level, and, (I will almost guarantee that this will apply to many states as well) the new EMS standards won't fix a damn thing.  There is nothing that mandates that the new standards are followed; as long as a state doesn't care about NREMT status, there is nothing to prohibit them from keeping their own levels.  Personally I think a better way to have done this was make it so that medicare/Medicaid would only reimburse services that followed the new levels (course currently you'd have to allow exceptions for states that exceed the new standards) and that federal monies for EMS would only go to states that followed the standards.  That's a pipe dream though.

Anyway. Not trying to be a ****, but I am curious.  Do you think that the high payrates for healthcare employees contributes to the high-cost of healthcare?  And if so, what should be done to fix it? 

At this point the thread is so fragged it might as well go anywhere...

Edit:  Yeah, whoever is doing the teaching should be at least one step up on who they are teaching, that goes with increasing educational standards.  Want to teach an AAS course?  Better get a BA.  Teach a BA course(s)?  Get a masters, and so on.


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## VentMedic (Nov 28, 2009)

triemal04 said:


> Anyway. Not trying to be a ****, but I am curious. Do you think that the high payrates for healthcare employees contributes to the high-cost of healthcare? And if so, what should be done to fix it?


 
That is difficult to say especially with the U.S. health care system.  As well, the wages for RNs, RRTs and FFs in parts of FL and CA are barely a living wage even though they seem ridiculously high for some.  Health care professionals still can not always afford the nice homes that their accountant has. But then, the accountant entry level education is no less than a 4 year degree and usually a Masters.   Paramedics with SFFD make about $75K to start.  This is just at a minimum living standard in that area.  Those that work with lower paid services commute from areas less expensive. 

I would like to say yes but then I know that what the front line workers are making such as the RNs, RRTs, PTs, EMT(P)s is just a drop in the bucket compared to what others that control the companies they work for are making along with the many perks.   Health care is no different than the financial industry which benefited some but not the front line employees who sank with businesses.


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## MrBrown (Nov 29, 2009)

reaper said:


> I agree.
> 
> A National Organization is best. No need for a union.



Sure there is; industrial employer/employee relations are seperate from any national regulatory body; for example here the Police and Professional Firefigters Association's (police union) is seperate from the Police and Fire Service, respectively.



			
				VentMedic said:
			
		

> I also believe the education level for instructors should be increased before anything else. There will of course need to be educators with higher education if standards are ever increased. The lack there will be what may hold EMS back from obtaining the goal of a 2 year degree.



I agree.  You won't find an instructor on the paramedic degree here who doesn't have *at least* a Masters and often most have a PhD.


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## Level1pedstech (Nov 30, 2009)

triemal04 said:


> As an aside, and playing a bit of devil's advocate, but do you think it's appropriate for someone fresh out of school to be making $30/hr (last RN I met started at $32)?  With everyone involved in healthcare wanting, justifiably or not, to make great money and have a high paying job, how much do you think that contributes to the problems we have today with healthcare; the high cost of it I mean?



 Just for the record the new grad RN I was speaking of started at 30.00p/hr working in a small level 3 ER in a semi rural area between Eugene and Portland where the wages are historically lower. The cost of living is much less than it would be in the Portland or Seattle are. She seemed very happy with the money and the chance to work as an ER RN right out of school in the area where she wants to live, I call that a win/win situation. New grads are finding it hard to find any work and the chances of landing a position in the ER right out of school does not come up everyday.


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## Level1pedstech (Nov 30, 2009)

daedalus said:


> I skipped over the meat of your last post, as will I this one, because in my opinion it does not even deserve a response. I am a patient advocate first. I am currently a few months away from an A.S. in paramedic studies, and will probably be applying to Loma Linda's B.S. in Emergency Medical Care. I do this with the full knowledge that it by itself will not increase my salary.
> 
> After having a AS and BS in EMS, I will make just as much as the guy with the certificate paramedic school education, who started working when I did.
> 
> Also, what does any of this have to do with adding public health responsibilities to southern california fire paramedics who make over 100,000 a year to sit at a station?



 I'm sorry you don't consider my questions and concerns worthy of your response. This is a discussion board and your participation although welcomed is of course not mandatory but for the record I do value your input. Try as you may you have nothing to offer and I make an arguement that you cannot break. Let me take a stab at what I think you have in mind and lets see how close I get.

 In your world there should be a certain segment of the population that are willing to step up and put two to four years (or more) of time and money into their EMS education. After spending all the time and money they should in the name of patient advocacy accept what at least in the current market are far from family friendly wages. I mean if you really care about your patients why should you worry about providing a decent standard of living for yourself or your family. In the mean time while were waiting for all these "patient advocates" to step up and accept the challenge the system further deteriorates and quality of care sinks to an all time low. Once again its a solution that puts the horse before the cart and will not work.

 I have tried several time to get someone to provide some answers to the low wage question but all I see is "we need higher levels of education" and of course the few who have to chime in with  "it's not all about money". Both camps are living in a dream world and I suspect are made up largely by a segment of the population that are very young and have no real world experience. I am very careful to point out that I know there are some  "seasoned" people that contribute here and I respect and highly value their opinions. I admit there will always be people who are willing to do the job for less money for whatever reasons but you will not be able to attract the large number of high quality providers you need unless you come up with an answer to the the low wage question. I'm sure you will not find any of this worthy of your response, I understand you you have no answers but thanks for being a good patient advocate.

 On the subject of adding public health duties to the fire service. You say you hang out at LA County fire stations, have you brought the subject up with the guys around the kitchen table? I bet I know the answer to that one. It has taken years for the fire service to accept any type of "nurse" work, there are places where fire is fire and many believe there is good reasons for that but we don't want to start beating that horse now do we. I don't see it going over very well when you inform the line guys that they are now in the clinic business and will be "nurses" when their not running calls, I would love to be there when you present that idea to a room full of hardcore firemen. Nice try but I think not and I hope your able to run and run fast. Why do you have a problem with fire making 100,000 a year anyway, don't you think there are times when that money is truly earned like when their pulling one of those poor taxpayers out of their burning house or any of the many duties that put them at risk. I forgot we should all be advocates and should be happy doing what we do for as little as an employer is willing to offer, pass the free government cheese please!


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## VentMedic (Nov 30, 2009)

Level1pedstech said:


> I have tried several time to get someone to provide some answers to the low wage question but all I see is "we need higher levels of education" and of course the few who have to chime in with "it's not all about money".


 
This has been answered many times in many different threads. You also seem to make it sound like the Associates degree is equivalent in time to med school. It is just 2 years...not 4, not 6, not 12 years.

Once a standard of education is established, EMS can petition to be reimbursed as a professional rather then general tech level. This is what the other professions have done rather successfully. Right now with 50+ different EMS certs varying in a few different "hours of training" there is not concrete definition to even give legislators as to who or what EMS providers are since it can vary from one county to the next for what a Paramedic is even called or what test is recognized for certification.



> making 100,000 a year anyway, don't you think there are times when that money is truly earned like when their pulling one of those poor taxpayers out of their burning house or any of the many duties that put them at risk.


 
Due to improved construction, the numbers of fires have decreased dramatically over the past few years. Thus, FDs are scrambling to fine other ways to fill the void. Some leaders in the FDs actually see a time where some FDs may be slimmed down much more due the advancements in equipment and construction.


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## Level1pedstech (Dec 1, 2009)

VentMedic said:


> This has been answered many times in many different threads. You also seem to make it sound like the Associates degree is equivalent in time to med school. It is just 2 years...not 4, not 6, not 12 years.
> 
> Once a standard of education is established, EMS can petition to be reimbursed as a professional rather then general tech level. This is what the other professions have done rather successfully. Right now with 50+ different EMS certs varying in a few different "hours of training" there is not concrete definition to even give legislators as to who or what EMS providers are since it can vary from one county to the next for what a Paramedic is even called or what test is recognized for certification.
> 
> ...



  I want daedalus to give me my answer, he seems to have the whole thing figured out. I do know the years involved with the various degrees and what a person should expect in the way of (fair) compensation. Asking for people to spend four years in school and then expecting them to work for 15.00 p/hr is a joke. You will never get the privates to pony up the wages at least not without union representation. I do know of a few privates with good city contracts that pay a livable wage but they had those contracts negotiated by the teamsters. Like the union or not they do get results..

  I was told by daedalus earlier in this thread to quit while I was ahead, whats that supposed to mean. Is he going to pull out the books he sitting on to reach the keyboard and start throwing them at me. I have grown tired of the condescending tone that comes with many of this "patient advocates" posts, I know there are others that feel this way but they don't have the stones to step up.  Listening to someone with a head full of fresh text book material and very little real world experience drone on about how much the system needs fixing and what suffering our patients must be enduring due to our lack of education is just unbearable. I don't have as many years in as you vent but I have enough to know how to deal with people in a tactful and nurturing manner. Talking down to people with less education than you is rude and really unproductive. Not everyone is in the position to spend 2-4 years in school especially those in the volunteer ranks.  If he is so bothered about the lack of education with us EMT's and the possible negative effects it could have on our patients maybe he should stay off this board and go to a site that's more accommodating to his educational pedigree. I have paid compliments to daedalus and I applaud his efforts and wish him no ill will but no one tells me to quit while I'm ahead especially not some snot nosed rookie.


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## triemal04 (Dec 1, 2009)

Well this has gone downhill in a huge hurry and is leading up to yet another episode of hypergagging due to the same old BS that comes around again and again.  But before that happens-

Level1pedstech-  Yes, I do agree that having a union to represent the employees is definitely a way to help increase pay, benefits, safety, standards, etc etc; wouldn't belong to one if I didn't.  But, while increasing educational standards isn't the only thing needed to change pay rates, it will help.  Continue for more.

Say the standard for a paramedic becomes a 2-yr degree (nationwide).  With that requirement, people will most likely not be willing to work for lousy wages; if a service doesn't have any prospective employees, then eventually the wage will rise.  Not overnight, but it will happen.  Look at Oregon; while the average starting pay isn't where it should be, it's higher than in many places, and many of the places starting at low rates are tiny services.  

With a degree as the minimum education it'll become easier to get full reimbursement from medicare for services rendered; right now the average is medicare paying between 30-40% of the bill nationally.  That's not good, especially when medicare accounts for a huge (roughly 75% in my area) part of how pt's pay.  More money coming in means there is more ability to pay medics more; right now a true 911 only service doesn't make a lot of profit.

With a degree it becomes easier to demand more money from larger corporations/services; the whole "we know more thus do more thus deserves more argument."  Easier to back up when you have some letters after your name.  

These are just a couple of examples, there are more out there.  Is that a bit clearer?


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## jgmedic (Dec 1, 2009)

Level1pedstech said:


> BBQ and watch movies, is that what you really think?. I should probably stop now but what the hell, you need some educating. Do you have any idea what goes on at a firehouse in the course of a twenty four hour shift or do you and the others just tow the anti fire line. Maybe try a ride out and you will see that alot gets done before downtime activities like BBQ's and movie watching. Training,drilling,house duties and PT are just a few things that come before downtime activities. By the way during the day the public is always welcome to pop in for a BP check. It would be hard to have the fire department function as a walk in clinic and do more public health duties because they have to be able to do this little thing called responding to calls. I don't think leaving a house full of public health recipients while the crew responds to a call is going to go over real well with the white shirts.
> 
> I know you want more education and that's great,you can increase standards and education for prehospital providers all you want but who is going to do the job for 15,00 p/hr. Your never going to get the pay or respect out of the privates. Why do you think scab outfits like AMR manage to hold on, its because they are able to function mostly with medics that cant get on with fire. Why would you work for 25,000 p/yr with a private when you could work for 60,000 plus with fire. I'm sorry I just don't get it, maybe you could explain to us how your going to get the privates to step up and offer decent wages and benefits (like fire) to these folks after they get this great education you are proposing.
> 
> I understand not everyone wants to go fire but many would if they could do something as simple as passing the physical ability portion of the process. If chairman maobama and the rest of his party have their way and succeed in destroying our health care system, you after spending all those years in school might find yourself begging for a job as good as a firefighters. I will close by saying I think your a sharp kid and I know your going to go on and do great things but you and the other higher education folks really need to think things through and figure out how you are going to reward people for putting in years of education..



Dude, really? you think that AMR pays so low because they can function with medics who CAN'T get on with fire. Come on, they function at low pay because of all the medics who use it as a stepping stone to fire, which I totally understand, being as that is where the good pay and benefits are, but typecasting private medics as a bunch of fire wannabes is ridiculous. The privates don't have to pay because they know a majority of their employees are looking for the first way out.


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## Level1pedstech (Dec 3, 2009)

Over the last ten tears I have seen many medics rotate through my departments ALS transport agency as well as through the doors of the ED. Looking back at what I have seen I think I am comfortable with my statement. What about you, how many years have you been following trends in EMS. Have you ever talked to any AMR medics or maybe your an AMR medic and know I speak the truth. I never type casted anyone and am well aware that there are medics that are happy being private service medics but at least in my dealings they have been the exception not the rule. If you want to throw into the equation a handful of people that move on to better paying medic jobs that's fine.

  Not all fire service medics have fire suppression duties (the reason most folks avoid fire), there are agencies that have separate EMS divisions that offer the same great pay and benefits but you still have to get by that pesky PAT or its watered down little sister the CPAT. Have you ever tested out with any medics, they are a group that in general are not the picture of health and fitness. Its been several years for me so maybe things have changed but I doubt it. So yes I do think agencies like AMR are able to function in large part because they have many people who would move into fire if they could but for whatever reasons cant or wont make the transition.


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## daedalus (Dec 3, 2009)

> I want daedalus to give me my answer, he seems to have the whole thing figured out.


You place too much faith in me, sir. You asked for a response, and one you shall receive:

Fire Departments will be slimmed down and streamlined to be able to provide at least some sort of response to most areas of their districts. I would imagine most departments would lose around 90 % of their workforce and operational capacity under the daedalus-all-figured-out-plan. I would fire the fire fighters. EMS would take direct control of remaining fire operations, and the firefighters would be under the command of a paramedic with no cross training. Eventually we will phase out the fire operations altogether and just put fire extinguishers on all ambulances instead. After the firefighters are all finally laid off, I would bring a massive lawsuit against all of them to require them to pay back all wages earned plus interest back to the public, and use most of this money to hire new paramedics.


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## firetender (Dec 4, 2009)

*A Dinosaur's Perspective*



Akulahawk said:


> Nursing is an old profession. It has been around for a long time. EMS has also been around for a long time, longer than some/most of the other allied health care professions. What was it that got nursing and those other professions going like gang-busters to increase _their_ educational standards and professional recognition?




I've been waiting for a good topic to chime in on for my 500th post, and this is a big BINGO! I've read every post in this thread, though not every word, but let me start with the above.

Modern day nursing was established by Florence Nightingale in 1854 during the Crimean War. That is generally acknowledged as the starting point of the profession.

In 1909 the first BS program for Nursing was established by the University of Minnesota. That's 55 years of development to get to that stage!

The first paramedic programs were established during (roughly) the early 1970's. _*Emergency Medicine for M.D.s did not become a specialty until 1979*_; YES 9 years AFTER paramedics were in business!

When Florence Nightingale began, "nurses" were lower caste women doing remedial care (gruntwork; though sanitarily which changed the course of ALL medicine) and often, in order to make ends meet, prostituting themselves on the side. The first wave of paramedics (on the East Coast, anyway) were "hacks" usually initially employed as hearse drivers who, as a "courtesy service" had to pick up the occasional live transport. 

The first wave of medics, of whom I was one, were societally marginal at best (the book will be out within a month), as well.

_*PARAMEDICINE IS IN ITS INFANCY!

*_I would imagineour history now is not much different than the early history of Nursing: It really wasn't a profession. Most of the people involved were transient due to rotten working conditions and lack of respect by other agencies. There was neither a career track (as in specialties to pursue), nor equitable pay. 

We actually got BS programs off the ground within about 20 years, which ain't bad, but still, there hasn't been a strong enough movement (spelled d-e-s-i-r-e) to actually BUILD a profession WITH each other to make it stick.

_*PARAMEDICINE IS LIMITED IN SCOPE*_

Let's face it, the vast majority of our calls are relatively routine transports and a couple or a few times a day we dip into our bag of tricks for about a half-hour and then, we're spent! We are FIELD based and all about TRANSPORTATION to a facility where, well, the Nurses take over (under direction of the Docs, of course!). 

Even there, most of what the R.N.s do is maintenance, but because it's much more long-term involvement, the scope of knowledge and application of it is much more complex.

And, as the name states, most of what we are are Emergency Medical TECHNICIANS. We are prepared to be Flesh Mechanics, and we can get pretty good at it, but to do what must be done in the limited amount of time it takes to get someone to the hospital in STABLE (not healed) state, honestly DOES NOT require that much sophistication.

*THE NATURE OF THE WORK = BURNOUT*

And that's the biggest part of the problem in my point of view. The educational and physical challenges of the profession are secondary to the intangibles of learning how to manage yourself as a human being amidst all the assaults you're subject to. People don't quit because of lack of knowledge; they quit because they can't "take it" anymore.

Look at this site. How many people who were here in 2005, when I first got involved, are still here? Many, many people are interested and enthused in the beginning, but what is the proportion of people who have ten years under their belts? Five years? One year? The math speaks for itself.

Paramedicine is as intense a job as you can find. The stakes are life and death. It is largely meant for young people, full of piss and vinegar, who can give everything they have for a couple years and then move on.

Why? SELF-PRESERVATION. You have to be an extremely unusual individual to both subject yourself to and work with the steady assaults of the profession; let alone maintain your functionality. (_*You read the posts on this site from the people who've been around for years and you will find out just how much work they had to do and continue to do to stay involved!*_)

*PARAMEDICINE IS LARGELY AN INDUSTRY*

I'm not current with the numbers, but I imagine that most EMS services are still businesses. They COUNT ON the transience of their workers; that's what they are to them, replaceable drones.

Some comments were made about Unionization. I was part of the team that established (to the best of my knowledge) the first Union for EMS personnel West of the Mississippi (1983 - California Paramedic's Association, Santa Barbara, CA; affiliation with Local 399 AFL/CIO). This was the logical conclusion of five years of battles with the County and their contracted companies to provide some sort of stability to the burgeoning profession.

My biggest hurdle was overcoming the apathy of the medics to get involved. I honestly do not believe they saw (nor do I believe today that they see) themselves as "in it for the long term".

I think that's why people like Guardian and Ris and VentMedic feel like they're driving themselves nuts trying to get people to even LISTEN to their insistence on professional development.



Akulahawk said:


> Those groups banded together, acknowledged that they needed to increase their standards to improve their level of care, and here's the kicker: they _also _formed/became powerful lobbying groups to get the State Legislatures to write laws and regulations to more specifically define their scopes.



In this Akulahawk is right on the money! But what I'd like to see included in this thread is conversation about how YOU see yourselves IN the profession. Is this short or long term? What do you see around you?

Once we come to terms with that we can begin to decide if we have what it takes to mold this into a true profession as opposed to what it is now, a *Technical Job Description*.


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## atropine (Dec 6, 2009)

daedalus said:


> You place too much faith in me, sir. You asked for a response, and one you shall receive:
> 
> Fire Departments will be slimmed down and streamlined to be able to provide at least some sort of response to most areas of their districts. I would imagine most departments would lose around 90 % of their workforce and operational capacity under the daedalus-all-figured-out-plan. I would fire the fire fighters. EMS would take direct control of remaining fire operations, and the firefighters would be under the command of a paramedic with no cross training. Eventually we will phase out the fire operations altogether and just put fire extinguishers on all ambulances instead. After the firefighters are all finally laid off, I would bring a massive lawsuit against all of them to require them to pay back all wages earned plus interest back to the public, and use most of this money to hire new paramedics.



Hey cool guy, LA City used to use single role medics and then phased them out, because it's cheaper to cross train for staffing reasons. You are too much, but funny non the least stay cool.


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