# "What's in a name?" Dr. Bledsoe's article



## VentMedic (Jun 24, 2009)

*What's in a name?*
*June 22, 2009*
http://www.ems1.com/Columnists/bryan-bledsoe/articles/504848-Whats-in-a-name


> EMS has an identity problem. The public is often unsure of our education, roles, and capabilities. In fact, many EMS providers are unsure about who does what in the industry because certification levels often vary from state to state. Is part of the problem in the names we have chosen? As EMS has developed, government leaders and others have chosen the term "emergency medical technician (EMT)" to describe EMS workers. Around the same time, in certain regions of the country (particularly the West coast) the term "paramedic" became the moniker of choice used to describe emergency medical providers.





> Over a year ago, I watched a video produced by Acadian Ambulance where it proposed that all EMS providers be called "medics" based on the history of medics in the military. While I don’t think "medic" is the proper word, perhaps "paramedic" is. The new scope of practice has four recognized levels: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), and Paramedic (EMTP). For simplicity, let’s call the Emergency Medical Responder "First Responder" or "Emergency Medical Responder," but call everyone else a "paramedic." This seems to be the model that the public accepts. Nurses are called "nurses" despite the fact that there are two levels of nurses (registered nurses and licensed practical or vocational nurses). Firefighters are called "firefighters" despite varying levels of certification and education. Police officers are called "police officers" (or cops) despite the fact that there are varying levels of certification.


 
http://www.ems1.com/Columnists/bryan-bledsoe/articles/504848-Whats-in-a-name



> Whether you are an EMT, paramedic, firefighter, or private-based provider, you are still an EMS professional. It makes little difference whether you climbed down from a fire engine or exited an ambulance. You and your colleagues share a common goal and role with other EMS providers — providing quality patient care.


 


> Along the same lines, EMS needs to get away from this idea of Basic Life Support (BLS) versus Advanced Life Support (ALS). Every level of EMS provider primarily provides BLS.


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## WuLabsWuTecH (Jun 24, 2009)

BLS vs ALS is a big difference.  A good portion of calls are ALS aorund where I live.  Can't see where he's going with that last quote.


Agreed thought that the wording is confusing.  Some friends (not in EMS) call me a paramedic and I've just stopped correcting them.  I've had an ER Doc (who was a professor of a class I was taking) introduce me to someone as his student in the classroom, but also a paramedic in the real world.

Calling everyone a paramedic would solve the issue for the layperson, but how do we differentiate between them on a professional level?  Instead of EMT-B, -I, -P  should we go with Paramedic-1, Paramedic-2, Paramedic-3?

That would allow us to call everyone a medic for the soundbyte on the 6 o'clock news, and allow us to distinguish professionally the difference?  We could still keep truck names the same under this system with Squads, Advanceds, and Medics respectively.  Although i've always hated the Advanced designation, it makes it sound more advanced than the medic.  Also on the fireground it causes a lot of confusion.  
"Advanced 99 on the scene."  Advanced what?  Is the truck with the bigger ladder here?  Is the Assistant Chief here?


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## Shishkabob (Jun 24, 2009)

WuLabsWuTecH

Does every single patient, or even 51% of them, get an IV or intubated?  Or do most get basic interventions?



That's what he means.


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## daedalus (Jun 24, 2009)

Bledsoe struck a nerve, pointless juvenile bickering on EMS social networking websites? I would like to think that we are not children fighting over silly edumacation. I would like to think that some of us are effective EMS advocates who will not let their guard down against EMTs who push for lowering educational standards.


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## Sasha (Jun 24, 2009)

Linuss said:


> WuLabsWuTecH
> 
> Does every single patient, or even 51% of them, get an IV or intubated?  Or do most get basic interventions?
> 
> ...



I took it as a move to eliminate confusing levels and have everyone just "provide" the same consistent level of care. No differentiated basic life support or advanced life support, just life support across the board.

But, eh, I could be reading too far into it, haven't read the article yet, just scanned the quotes.


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## JPINFV (Jun 24, 2009)

In terms of eliminating "BLS and ALS," I think he's getting at the use of BLS and ALS to characterize interventions into two seperate groups.


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## daedalus (Jun 24, 2009)

I see his point with respect that both RNs and LVNs are called nurses, but the difference in their education is about a year, and LVN cannot be obtained in 2 weeks like EMT.

Having an 2 week wonder EMT called a paramedic after I will have worked 13 months plus pre reqs for the title annoys me. Call it juvenile if you will, but doctors are having the same debate about NPs being called doctor, so I see this debate on both sides.


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## Sasha (Jun 24, 2009)

> Call it juvenile if you will, but doctors are having the same debate about NPs being called doctor, so I see this debate on both sides.



Ohhh please don't start that again.


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## Shishkabob (Jun 24, 2009)

daedalus said:


> I see his point with respect that both RNs and LVNs are called nurses, but the difference in their education is about a year, and LVN cannot be obtained in 2 weeks like EMT.
> 
> Having an 2 week wonder EMT called a paramedic after I will have worked 13 months plus pre reqs for the title annoys me. Call it juvenile if you will, but doctors are having the same debate about NPs being called doctor, so I see this debate on both sides.



Kind of high-horse, isn't it?


Difference between a fast track EMT and fast track Medic is what, 20 weeks?

Heck, difference between a college EMT and college medic is still only a year.  So why is it acceptable to you to call a LVn and RN both nurses, being a year apart, but EMT's can't be called medics, having even less time separation.


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## Chelle (Jun 24, 2009)

Where can you get your EMT-B in 2 weeks???


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## Scout (Jun 24, 2009)

Whats an NPs


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## Shishkabob (Jun 24, 2009)

Scout said:


> Whats an NPs



NP = Nurse Practitioner.


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## VentMedic (Jun 24, 2009)

Oh yes, he wants to do that again. 



daedalus said:


> Call it juvenile if you will, but doctors are having the same debate about NPs being called doctor, so I see this debate on both sides.


 
I will soon be able to use the term "doctor" in my title. We have professors, Physical Therapists and a whole host of other medical and non-medical people that use the term "doctor". Have you not ever been to a college and noticed the titles of the educators? Even in college EMS programs there is usually someone over the department that has a doctorate degree although it is usually a nurse. 

The DNP has been around for almost 2 decades and it has not been an issue until a couple of doctors wrote an article once the NPs confirmed they were raising their entry level education. Out of the thousands of other doctors, this has not be a problem for them. In fact, most enjoy having those who work in their offices to have advanced education since it could only serve to improve patient care. Believe it or not that is the argument other healthcare professions have also used when petitioning for higher standards. They didn't say "cause we want more money". They said "as a profession we would like to be able to better serve the patients". 

Maybe some should become familiar with the titles of higher education. As well, some should read about how other professions have advanced their education. NPs have been planning their next move since 2004 to take in effect 2015. RT did a 10 year plan for their Associates degree with 5 years to implement and 5 years to grandfather. They also have plans for the Bachelors degree and are awaiting a couple of Bills to pass in Washington, D.C. before they precede with the future. PT has made the Doctorate their recommended education for practice.​ 


> In 2004, the American Association of Colleges of Nursing recommended a shift in preparing all advance practice nurses, including NPs, to the doctoral level by 2015 with the title of nursing practice or DNP.


 
http://www.aanp.org/NR/rdonlyres/59523729-0179-466A-A7FB-BDEE68160E8E/0/NPCurriculum.pdf

From the AANP website:



> [FONT=TimesNewRoman,Bold][FONT=TimesNewRoman,Bold]*Utilization of the Title "Doctor" by Nurse Practitioners*[/FONT][/FONT]​
> [FONT=TimesNewRoman,Bold]1. The title "Doctor" represents an academic credential, and is not limited to professional programs.
> Graduate educational programs in colleges and universities in the United States confer academic degrees, which permit graduates to be called "doctor". No one discipline owns the title "doctor".​
> 2. In the health care field, the term doctor is not limited to medical doctors. Other health care professions use their academic title: e.g. Doctor of Osteopathy, Doctor of Pharmacy, Doctor of Podiatry, Doctor of Psychology, Doctor of Physical Therapy and others.​
> ...


 
Just like the handful of doctors that took offense to nurses gaining another degree, EMS will meet the same opposition from others if they ever start to advance. EMS has already encountered these arguments and many have just taken the low road to education. Unfortunately most of the opposition has come from within EMS. There are perceived enemies of EMS providers in other healthcare professions but much of that is a myth.


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## ResTech (Jun 24, 2009)

While I don't agree with everything said in Dr Bledsoe's article I do think he made some really good points. EMS has way too many certification titles and provider levels. While I don't agree calling everyone a Paramedic is the correct approach, some sort of National standard should be adopted. 

Daedalus, how long have you been an EMT yourself? Have you paid your dues in EMS? Ever spent holiday's away from your family providing coverage for your community? Or missed meals with your family because a EMS call came in?


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## VentMedic (Jun 24, 2009)

This is an interesting quote from one of the posters below the article at

http://www.ems1.com/Columnists/bryan-bledsoe/articles/504848-Whats-in-a-name



> Abraham Lincoln is quoted as asking, "If you call his tail a leg, how many legs does a dog have?" The answer is, of course, four, because simply calling a tail a leg does not make it a leg. Likewise, changing the names of our lowest common denominator does nothing to actually raise that lowest common denominator. And if we are doing nothing to actually improve anything, what is the point? Why -- with all of the forty year-old problems facing EMS -- are we squabbling over semantics? This is akin to rearranging the deck chairs on the Titanic.


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## daedalus (Jun 24, 2009)

Vent and Sasha, this time, you are 180 degrees off. I said that even doctors have hissy fits over their titles. Did I say that I agreed with them?

In fact, Sasha will tell you that I have moved on from the DNP thing and have adopted a policy of live and let live. I have far to many things to worry about right now other than who is getting called doctor and who is not. As long as DNP schools push for more than 4 units of pathophysiology, fine.

However, to back up my statement that doctors are indeed fighting over the use of the word doctor, here is the American Medical Association statement on the issue. Like I have said, I have no opinion.
http://www.ama-assn.org/ama1/pub/upload/mm/471/303.doc

Where I live and work, you will be hard pressed to find a 20 week paramedic school. Questa College, NCTI Santa Barbara, and Ventura College are all year long programs and all three have transferrable college units recognized by the community college system. There is no comparison between an AS degreed paramedic and a two week first aid cert EMT. Sorry.


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## Sasha (Jun 24, 2009)

> In fact, Sasha will tell you that I have moved on from the DNP thing and have adopted a policy of live and let live.



Actually, I wont. You are contradicting yourself all over the place!


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## daedalus (Jun 24, 2009)

ResTech said:


> While I don't agree with everything said in Dr Bledsoe's article I do think he made some really good points. EMS has way too many certification titles and provider levels. While I don't agree calling everyone a Paramedic is the correct approach, some sort of National standard should be adopted.
> 
> Daedalus, how long have you been an EMT yourself? Have you paid your dues in EMS? Ever spent holiday's away from your family providing coverage for your community? Or missed meals with your family because a EMS call came in?



Why may I ask are you calling for an inventory of my EMS experience?  BTW, I do not miss meal with my family because I get a call. I am a paid EMT and therefore spend my shift at station, not at home. 

I have multiple Christmas's, many birthdays and other family events. I have worked in Public Health for uninsured residents of my county for 5 years and EMS for 2 and a half.


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## downunderwunda (Jun 24, 2009)

WuLabsWuTecH said:


> BLS vs ALS is a big difference.  A good portion of calls are ALS aorund where I live.  Can't see where he's going with that last quote.



All good ALS begins with BLS, Is not the maintenence of Airway, Assistance of Breathing & Assistance in Circulation BLS BEFORE it becomes ALS? Airwaymaintenance through a simple jaw thrust, or an OPA can be effective, BVM is not an ALS skill, but is effective, CPR is not an ALS skill.





> Agreed thought that the wording is confusing.  Some friends (not in EMS) call me a paramedic and I've just stopped correcting them.  I've had an ER Doc (who was a professor of a class I was taking) introduce me to someone as his student in the classroom, but also a paramedic in the real world.
> 
> Calling everyone a paramedic would solve the issue for the layperson, but how do we differentiate between them on a professional level?  Instead of EMT-B, -I, -P  should we go with Paramedic-1, Paramedic-2, Paramedic-3?



I think that the US needs to look at the definition of the term Paramedic in order to answer this bit. The Cambridge dictionary defines it as



> paramedic    Hide phonetics
> noun [C]
> a person who is trained to do medical work, especially in an emergency, but who is not a doctor or nurse



This is a universal name & just about every country other than the US has no difficulty with it.



> Agreed thought that the wording is confusing.  Some friends (not in EMS) call me a paramedic and I've just stopped correcting them.  I've had an ER Doc (who was a professor of a class I was taking) introduce me to someone as his student in the classroom, but also a paramedic in the real world.
> 
> Calling everyone a paramedic would solve the issue for the layperson, but how do we differentiate between them on a professional level?  Instead of EMT-B, -I, -P  should we go with Paramedic-1, Paramedic-2, Paramedic-3?



There is also an option to further distinguish internally using these numbers. We have ICP, as well as ECP here, Intensive Care & Extended Care, but to the public, we are all the same. 



> That would allow us to call everyone a medic for the soundbyte on the 6 o'clock news, and allow us to distinguish professionally the difference?  We could still keep truck names the same under this system with Squads, Advanceds, and Medics respectively.  Although i've always hated the Advanced designation, it makes it sound more advanced than the medic.  Also on the fireground it causes a lot of confusion.
> "Advanced 99 on the scene."  Advanced what?  Is the truck with the bigger ladder here?  Is the Assistant Chief here



Use car numbers that are unique. Who really cares?


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## daedalus (Jun 24, 2009)

Sasha said:


> Actually, I wont. You are contradicting yourself all over the place!



No, I haven't. I have said to you that I respect and admire the education process for RNs and NPs, because I have seen people I know go through it.

The only reason I mentioned the conflict between MDs and NPs is because I wanted to show that EMS is not the only profession fighting over titles. I will say it again, I do not mind who and who does not use the title "doctor" in the clinical setting. It does not concern me yet, as I have not advanced to that level and when I get there, I will have to see how I feel.

VentMedic is certainly entitled to use the title doctor, because in academia, a PhD is generally considered a higher doctorate than a first professional degree like an MD or DNP. It is a huge accomplishment and I would be the first to congratulate her.


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## VentMedic (Jun 24, 2009)

daedalus said:


> Vent and Sasha, this time, you are 180 degrees off. I said that even doctors have hissy fits over their titles. Did I say that I agreed with them?
> 
> In fact, Sasha will tell you that I have moved on from the DNP thing and have adopted a policy of live and let live. I have far to many things to worry about right now other than who is getting called doctor and who is not. As long as DNP schools push for more than 4 units of pathophysiology, fine.
> 
> ...


 
The doctorate degree has been awarded for a couple of centuries to many professions. Yes it can get confusing but do you restrict the education of an entire profession to accomondate a handful of complainers that can't keep up with the advancements? BTW, did you read the links to the AANP which also contains the letters to the AMA telling them NPs are still moving on with their education plans? And, the 4 units of Pathophysiology is at a doctorate level. NPs will have had pathophys in undergrad and grad schools prior to entrance into a doctorate program just like the other healthcare professions. 

In California, it only takes 1090 hours to be a Paramedic with only 40 ALS patient contacts. Some schools are able to cram those hours within a few months especially if ALS engine sleepovers are allowed.


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## VentMedic (Jun 24, 2009)

daedalus said:


> VentMedic is certainly entitled to use the title doctor, because in academia, a PhD is generally considered a higher doctorate than a first professional degree like an MD or DNP. It is a huge accomplishment and I would be the first to congratulate her.


 
Thank you.

And yes, I have had a few semesters of pathophysiology to get to this point.


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## daedalus (Jun 24, 2009)

VentMedic said:


> The doctorate degree has been awarded for a couple of centuries to many professions. Yes it can get confusing but do you restrict the education of an entire profession to accomondate a handful of complainers that can't keep up with the advancements? BTW, did you read the links to the AANP which also contains the letters to the AMA telling them NPs are still moving on with their education plans? And, the 4 units of Pathophysiology is at a doctorate level. NPs will have had pathophys in undergrad and grad schools prior to entrance into a doctorate program just like the other healthcare professions.
> 
> In California, it only takes 1090 hours to be a Paramedic with only 40 ALS patient contacts. Some schools are able to cram those hours within a few months especially if ALS engine sleepovers are allowed.



I have read their position statement. The AMA can whine all they want, but it seems that the nursing profession has made up their minds. Like I have said, I am in no place to criticize anyone because I simply do not have enough health care exposure to do so at this point, and fighting other people's battles is too much when I have my own education to worry about.

I will continue to criticize programs in California that can be equated to medic mills. However, at least California law required all of our programs to be accredited long before the Nation Registry decided it was needed, which is much more than a lot of other states can say for themselves. 

I will not however back down from my statement that an EMT can be equated to a Paramedic. I will fight that to my grave.


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## daedalus (Jun 24, 2009)

downunderwunda said:


> All good ALS begins with BLS, Is not the maintenence of Airway, Assistance of Breathing & Assistance in Circulation BLS BEFORE it becomes ALS? Airwaymaintenance through a simple jaw thrust, or an OPA can be effective, BVM is not an ALS skill, but is effective, CPR is not an ALS skill.
> 
> 
> 
> ...


There is no BLS before ALS. There is only medicine.


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## Ridryder911 (Jun 24, 2009)

Brian must be having a hard time of coming up with articles to write. Same old stuff to stir the pot. I respect and admire Bledsoe for his contributions and usual "dig" to get us in EMS thinking but alike discussed, most M.D.'s and even D.O.'s are the first to dismiss the title "Dr" to anyone without a license as a medical physician. I remember, it was not that long ago even D.O.'s  were not really considered "real doctors". About two decades or so, I remember the first D.O. that was allowed to work in one of our major city ER's. Gasp!

In regards to nurses, very few introduce themselves as "nurse" if they are RN.'s. That is one of the running jokes is when someone tells you they are a nurse, chances are they are a LPN or CNA, etc.... 

Please, please can we stop the B.S. of BLS before ALS, it really does demonstrate the reason separation and need for titles. 

R/r 911


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## ResTech (Jun 24, 2009)

How can anyone call the statement BLS before ALS improper? That statement serves to illustrate the critical importance of providing basic modalities first and foremost which will be of a great, life saving benefit to the pt. I believe very much in that statement and it offers a lot of truth.  

EMS isn't nursing or any other health profession... EMS is EMS!! period... and they're is a heritage to EMS like it or not which is where the BLS before ALS comes from. Yes, EMS needs some improvement in certain areas but it isn't as broken as some of you like to portray. Have we really been doing it that wrong from so long?? Call me a traditionalist when it comes to EMS... but I love EMS and what it stands for and where its come from. I'm all for progression and change for the better don't mistake me for that.... but I also believe that EMS is a realm of itself and needs to be regarded as such.


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## Sasha (Jun 24, 2009)

> EMS isn't nursing or any other health profession... EMS is EMS!!



EMS includes nursing and other health professions. EMS doesn't stop at the ER threshold and the body functions the same inside and outside of an ER. EMS is medicine, just like all those other health professions.


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## daedalus (Jun 24, 2009)

ResTech said:


> How can anyone call the statement BLS before ALS improper? That statement serves to illustrate the critical importance of providing basic modalities first and foremost which will be of a great, life saving benefit to the pt. I believe very much in that statement and it offers a lot of truth.
> 
> EMS isn't nursing or any other health profession... EMS is EMS!! period... and they're is a heritage to EMS like it or not which is where the BLS before ALS comes from. Yes, EMS needs some improvement in certain areas but it isn't as broken as some of you like to portray. Have we really been doing it that wrong from so long?? Call me a traditionalist when it comes to EMS... but I love EMS and what it stands for and where its come from. I'm all for progression and change for the better don't mistake me for that.... but I also believe that EMS is a realm of itself and needs to be regarded as such.


When an Emergency Medicine PA inserts a nasal airway and bags a patient, it is medicine. We are no different. No other medical field separates BLS and ALS. There is no such thing as basic medicine and advanced medicine, and VentMedic can tell you there is miles of pages on respiratory physiology that go into bagging a patient.


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## VentMedic (Jun 24, 2009)

ResTech said:


> Call me a traditionalist when it comes to EMS... but I love EMS and what it stands for and where its come from. I'm all for progression and change for the better don't mistake me for that.... but I also believe that EMS is a realm of itself and needs to be regarded as such.


 


> EMS isn't nursing or any other health profession... EMS is EMS!!


So tell us about your EMS tradition, what EMS stands for and where EMS comes from as you see it. Tell us why you don't believe EMS is a healthcare profession.   Why is EMS so different from your point of view except for the environment it is performed in?


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## ResTech (Jun 24, 2009)

Its obvious your not able to speak from experience. In EMS, as of today, there are BASIC and ADVANCED level treatment modalities that providers perform. They are categorized that way for a reason based on the several different provider levels and distinguishment for legal and billing purposes based on how the EMS system is CURRENTLY set up. 

Like I said earlier... EMS is EMS!!! its not respiratory therapy and its not nursing. Many of the dynamics present within EMS are NOT present in respiratory therapy or nursing. 

And yes, I'm very aware of the physiology and pathophysiology of the respiratory system and what constitutes effective ventilations. I don't need "miles and miles of pages of respiratory physiology" to be able to ventilate my patients effectively. I'm also well aware of the role of a Paramedic and am not out to make it into something it isn't. If I want to dive deep into the respiratory system then after Paramedic school I will go on to become a RRT. I take my education as a Paramedic very seriously and continually read and learn all that I can beyond the minimum required. But at the same time I am very humble and acknowledge the role of the Paramedic.   

It sounds like being a Paramedic isn't for you Daedalus.... I think you would be better suited for a PA program or med school... seeing how everything in EMS is wrong and were all under educated and can't ever do ne thing right like those nurses, PA's, and Docs.


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## ResTech (Jun 24, 2009)

I didn't say EMS isn't a health profession because it is. But EMS is served up with dynamics not present in other health professions which makes it vastly different. EMS is of a very unique nature. When speaking clinically, the bar for care is at the very top. 

There are certain elements to EMS that cannot be learned in a class room or in an ED. They are only appreciated, learned, and that clinical intuition developed while working in the street. That is all I am saying. Quite a few talk like they are so much better then the rest of us and heaven forbid we hang onto any bit of the EMS heritage or "tradition".


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## VentMedic (Jun 24, 2009)

ResTech said:


> Its obvious your not able to speak from experience.


 
Yeah I guess 30 years working as a Paramedic in one of the areas where "EMS" got some of its roots doesn't count. 



ResTech said:


> In EMS, as of today, there are BASIC and ADVANCED level treatment modalities that providers perform. They are categorized that way for a reason based on the several different provider levels and distingusment for legal and billing purposed based on how the EMS system is CURRENTLY set up.
> 
> Like I said earlier... EMS is EMS!!! its not respiratory therapy and its not nursing. Many of the dynamics present within EMS are NOT present in respiratory therapy or nursing.
> 
> And yes, I'm very aware of the physiology and pathophysiology of the respiratory system and what constitutes effective ventilations. I don't need "miles and miles of pages of respiratory physiology" to be able to ventilate my patients effectively. I'm also well aware of the role of a Paramedic and am not out to make it into something it isn't. If I want to dive deep into the respiratory system then after Paramedic school I will go on to become a RRT. I take my education as a Paramedic very seriously and continually read and learn all that I can beyond the minimum require. But at the same time I am very humble and acknowledge the role of the Paramedic.


 
So again I ask you why EMS is not a healthcare profession from your point of view? 

In my world which is the state of Florida, we only provide ALS to the citizens of this state because we believe everyone deserves a medical assessment at that level and any treatment associated with it.



ResTech said:


> I didn't say EMS isn't a health profession because it is. But EMS is served up with dynamics not present in other health professions which makes it vastly different. EMS is of a very unique nature. When speaking clinically, the bar for care is at the very top.
> 
> There are certain elements to EMS that cannot be learned in a class room or in an ED. They are only appreciated, learned, and that clinical intuition developed while working in the street. That is all I am saying. Quite a few talk like they are so much better then the rest of us and heaven forbid we hang onto any bit of the EMS heritage or "tradition".


 
My question still stands. 

Why is it so different?

In all areas of medicine experience helps to perfect what has been learned in the classroom.

Are you a FF?


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## daedalus (Jun 24, 2009)

Med School application is about 2 years away, actually. 

I am not using paramedic as a stepping stone, but it actually solidified my desire to go to med school because I feel like I am just not getting enough in medic school. I want to know more than just autonomic nervous system pharmacology, I want more than 10 pages on the immune response, etc.

I plan on becoming a medical director if I go the med school route, and pushing my system to new heights.

EDIT: BTW, the EM PA comment was just to show that we are all providing the same medicine. It was not to show that paramedics are undereducated buffoons.


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## ResTech (Jun 24, 2009)

I'm really not out for an argument... just sat down to post a quick opinion... but I'll bite once more...

Vent, the experience comment was not directed at you. I know your a well seasoned and experienced provider well beyond myself. 



> In my world which is the state of Florida, we only provide ALS to the citizens of this state because we believe everyone deserves a medical assessment at that level and any treatment associated with it.



Awww... we're onto something... you make a great point! Florida residents have it great then... 24/7 all ALS coverage on the ambulance... must be nice... let me guess... mostly all County funded systems and residents pay for it through taxes... am I right???? Have you ever resided anywhere other then Florida where that type of system isn't the model????

Not all States are fortunate enough to have a system like that... In Pennsylvania... it is primarily VOLUNTEER... granted EMS was forced to be paid because of call volume increases and lack of volunteers to keep up with the demand. But do you know how these salaries and operations are paid??? Not by local government... they are paid by each department having Bingo, fundraisers, and through services provided which in some cases just break even or leaves little profit for investment. 

So you see... the equation isn't near as simple as some of you like to think. Great, pass the laws for 24/7 all ALS coverage with Paramedics... do away with EMT-Intermediates, and even EMT's.... now come up with the funding plan to pay for it because Bingo isn't gonna cover it and the majority of local government in small communities isn't going to either, and residents are gonna be a bit pissed off when taxes greatly increase too. 

Maybe you can tell the residents that their taxes need to be greatly increased so the EMS staff can read those "miles and miles of pages of physiology" on how to properly ventilate them because over the past 30 years we have been doing it so wrong and killing their loved ones with each response.

This is why we have "BLS before ALS" as a teaching point. You structure your educational programs and teaching methodology around the systems in which the providers are gonna be providing care and try to do it the best way that you can with the most optimum result which is what EMS has been exerting a good faith effort to do over the past 30 years. Not saying I totally agree with the approach... but its how it is. I am glad to see on a National level their is work being done to change this approach and have a more unified and systems wide approach to EMS delivery and not so much on a micro level. 

Vent, I have my State Firefighter cert but would never consider myself a Firefighter... I am strictly an EMS provider.


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## Ridryder911 (Jun 24, 2009)

ResTech said:


> How can anyone call the statement BLS before ALS improper? That statement serves to illustrate the critical importance of providing basic modalities first and foremost which will be of a great, life saving benefit to the pt. I believe very much in that statement and it offers a lot of truth.
> 
> EMS isn't nursing or any other health profession... EMS is EMS!! period... and they're is a heritage to EMS like it or not which is where the BLS before ALS comes from. Yes, EMS needs some improvement in certain areas but it isn't as broken as some of you like to portray. Have we really been doing it that wrong from so long?? Call me a traditionalist when it comes to EMS... but I love EMS and what it stands for and where its come from. I'm all for progression and change for the better don't mistake me for that.... but I also believe that EMS is a realm of itself and needs to be regarded as such.



Traditionalist? I don't think so. It's not that we have been doing it wrong for so long, we have of yet ever done it right! 

Are you sure you know the history of EMS? You do realize that prehospital care is one of the smallest divisions of EMS? Yeah, we are NOT solely the whole part of EMS.

The ONLY reason we ever hear or proclaimed the wording BLS is because of the lack of education to EMT's within EMS in the beginning. Yeah, everyone else that was beginning to be taught resuscitative measures went straight into just that. Resuscitative measures. There was no dividing line of this is BLS and this is ALS. All those divisions were made because of EMS half arse of not doing it right the first time. 

Let's change it to BLS before EMS. Since in the real reality, the public can generally perform the same level of care to a cardiac arrest patient as a EMT basic can do. So yeah, I agree BLS first... with the emphasis on public awareness, aware that many times that they should be receiving much better care that available

I am not really picking on you, but as a student, just how much time did you study about  EMS as a system? Now, that you acclaim to be traditionalist about EMS, what tradition are you wanting to secure? That many places of the U.S. are still being provided sub par emergency care. Even the t.v. show _Emergency_ that was filmed nearly 30+ years ago, provides more advanced care than those that provide "BLS" today. So is the "tradition" you are so proud of? One text book courses. The ONLY health care professional that does NOT require a degree for entry level. Instructors or educators are not required to have at the least a baccalaureate degree (even kindergarten teachers require that much). Sure let's keep up the tradition, shall we. We have progressed so far......not!  



.


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## Sasha (Jun 24, 2009)

> Awww... we're onto something... you make a great point! Florida residents have it great then... 24/7 all ALS coverage on the ambulance... must be nice... let me guess... mostly all County funded systems and residents pay for it through taxes... am I right????





> Maybe you can tell the residents that their taxes need to be greatly increased so the EMS staff can read those "miles and miles of pages of physiology" on how to properly ventilate them because over the past 30 years we have been doing it so wrong and killing their loved ones with each response.



Negative, sweetheart. We only have federal income tax, no state. We pay less taxes than most states.


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## ResTech (Jun 24, 2009)

Rid.. you do make some valid points I must admit.... I'm in no way saying we shouldn't step up... 'cause we definitely should... but let's be realistic and not so critical and recognize the many different components that exists within EMS that don't exist elsewhere in healthcare. This make it a more difficult and time consuming thing to accomplish. 

Sasha.. please share with how the entire State of Florida can provide funding for ALS coverage to all of their residents (as proclaimed) and not have County systems or tax payer funding. Curious as to where they drawl the funds for that.


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## Shishkabob (Jun 24, 2009)

Sasha said:


> Negative, sweetheart. We only have federal income tax, no state. We pay less taxes than most states.



And crap high property tax.




			
				Florida tex website said:
			
		

> The Property Tax Oversight Program oversees a local property tax system that in 2006 had more than 9 million parcels of real property and a just value of *$2.4 trillion...r.esulting in more than $30.4 billion in property taxes levied by local governments and taxing authorities.*




:wacko:


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## VentMedic (Jun 24, 2009)

The rest of my comments are not to be argumentative but rather informative for those who don't know the roots of EMS.



ResTech said:


> Vent, I have my State Firefighter cert but would never consider myself a Firefighter... I am strictly an EMS provider.


 
I made that comment because my roots are in a FD as a Paramedic. In the mid 1960s, Dr. Nagel started one of the birthplaces of today's EMS in FD in Miami. 

Here's his comments:
http://www.jems.com/news_and_articles/articles/q_and_a_with_dr_eugene_nagel.html



> *Question:* How can the "traditional" fire department better embrace EMS delivery?
> *Answer:* By understanding EMS expectations and limitations. This requires understanding how we got there and where we are going. Not an easy task.
> *Question:* How did you tap into the culture?
> *Answer:* *By trying to bring some of hospital medicine to the streets. *


 

Of course, one could look at "today's" EMS but one should also remember today's Paramedics were not the first to perform in an EMS compacity. 
On another thread, it physicians on ambulances were discussed. St. Vincent's in NYC did use Physicians starting in 1968 as did a few other cities including Miami and some used them well into the 1980s. 

http://www.angelfire.com/co/fantasyfigures/710history.html

If one wants to look at another "tradition" one could look at the Freedom House Ambulance which gave their Paramedic almost 3000 hours of training in 1967. That is over 3 - 4 times what many Paramedics get today. Unfortunately a couple of other "traditions" (not the pleasant ones) helped to end what appeared to be a good model for EMS.   It also was centered around medicine. 

http://www.freedomhousedoc.com/


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## VentMedic (Jun 24, 2009)

Linuss said:


> And crap high property tax.
> 
> :wacko:


 
But, do you know our tax base for some areas?


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## Sasha (Jun 24, 2009)

ResTech said:


> Rid.. you do make some valid points I must admit.... I'm in no way saying we shouldn't step up... 'cause we definitely should... but let's be realistic and not so critical and recognize the many different components that exists within EMS that don't exist elsewhere in healthcare. This make it a more difficult and time consuming thing to accomplish.
> 
> Sasha.. please share with how the entire State of Florida can provide funding for ALS coverage to all of their residents (as proclaimed) and not have County systems or tax payer funding. Curious as to where they drawl the funds for that.



Oh, they are a lot of county systems, didn't say that. But you imply that we must have to pay outrageous taxes for them, and we don't. There are poor and rural areas of florida, too, and even the poverty stricken areas somehow manage to have ALS.

And we have lower taxes than a lot of other states, we don't pay state taxes, only federal.


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## Shishkabob (Jun 24, 2009)

VentMedic said:


> But, do you know our tax base for some areas?


Can't say that I do.

IT's been over 12 years since I lived there


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## ResTech (Jun 24, 2009)

That's a very interesting website and information on The Freedom House. Thank's for sharing that!


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## VentMedic (Jun 24, 2009)

Each county has a tax system or fee system to fund part of their EMS.  Some may have imposed a sales tax (usually a penny) to pay for their trauma system. The State has a tax statute for allocation of funds from various fees including property taxes to ensure not only the rich (Boca Ratoa, Palm Beach) but also the very poor regions are covered.   Of course some counties do struggle and it is a constant battle for funding in some areas as other services do compete for attention.  However, EMS is one area Florida has promised its residents.


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## VentMedic (Jun 24, 2009)

ResTech said:


> That's a very interesting website and information on The Freedom House. Thank's for sharing that!


 
If only EMS has followed this path I can only imagine how different things might have been.  It was just the wrong decade which is a very unfortunate part of our history in the U.S.


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## JPINFV (Jun 24, 2009)

ResTech said:


> How can anyone call the statement BLS before ALS improper?



Because medical care is medical care. Should a patient in obvious acute pulmonary edema due to CHF have to wait to see if a NRB would stabilize the patient before the paramedics go to nitro and CPAP? Alternatively, if the paramedics assessment indicates a need for nitro and CPAP, should the paramedic put 'ALS before BLS' and jump to nitro and CPAP instead of trying a NRB?


There's very few things that I've heard in EMS that are worse than the "BLS before ALS" cliche. Namely things like "Everyone gets a NRB (or really, any supplemental O2) because everyone needs O2 to live."


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## ResTech (Jun 24, 2009)

Don't miss the context of the statement. It is mainly geared towards explaining the importance of ensuring the basics of airway, breathing, and circulation. As an ALS provider with a bigger toy box, sometimes important modalities such as the immediate manual opening of the airway, or immediately inserting an OPA and getting good ventilation going with a BVM, etc. are overlooked in favor of the more "fun" advanced modalities. These are just two examples of what that statement serves to reinforce... and further it is intended to instill the importance of emphasizing good solid and basic but important supportive patient care.

It doesn't mean don't ever go straight to an ALS skill if indicated. It is more for illustrative purposes to reinforce a concept of priority thinking... I guess thats a good way to explain it.


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## Shishkabob (Jun 24, 2009)

JPINFV said:


> Because medical care is medical care. Should a patient in obvious acute pulmonary edema due to CHF have to wait to see if a NRB would stabilize the patient before the paramedics go to nitro and CPAP? Alternatively, if the paramedics assessment indicates a need for nitro and CPAP, should the paramedic put 'ALS before BLS' and jump to nitro and CPAP instead of trying a NRB?
> 
> 
> There's very few things that I've heard in EMS that are worse than the "BLS before ALS" cliche. Namely things like "Everyone gets a NRB (or really, any supplemental O2) because everyone needs O2 to live."



That's different. Pulmonary edema cannot be corrected by any normal BLS skill, only ALS.

However, when you go to an OR, some docs intubate, and some just do the good ole OPA, which is "BLS".

"Why go over what you have to to get the same results" is what the statement means.


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## Guardian (Jun 24, 2009)

I've been trying to make this point for years.  Hopefully, now that Bledsoe is on board, people will listen.  Large scale professionalism starts with a good job title.


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## VentMedic (Jun 24, 2009)

Let's go back to the history lesson again.

In the 1960s, some MDs saw a need for trained providers to do more than what a basic first aider was already doing and providers who could provide a better response time than the nurses and doctors from the hospital. Thus the concept for modern day Paramedics was formed. 

This was the concept of bringing medicine to the people to improve survival until they got to the hospital. 

Every ALS provider does "BLS" but not every BLS provider does ALS. As with the issues from long ago, a severe problem was not recognized because of the limitations of a BLS provider and nor could treatment be provided at a higher level. 

We have had "BLS" trained providers with many of the civilians who were morticians and provided ambulance service, veterans who were trained in first aid and many factory/coal mine workers were very well trained in first-aid. These workers also actually had more hours of first aid training than today's 110 hour EMT. 

Thus, it is time to get out of that ALS/BLS way of thinking and approach it as medicine as Dr. Nagel and Dr. Nancy Caroline promoted 40+ years ago. Canada and other countries have managed to do this very well. For the U.S., some in EMS are just holding on to the BLS vs ALS to justify their jobs and make excuses for not moving forward with their own education. It puzzles me even more when some Paramedics also use it as an excuse to not do a full assessment and turf the patient to a BLS truck so they can return to their station. 

As a note, Florida has still just maintained two certs, EMT and Paramedic. It has tried to stay with the concept of providing EMS as it was originally intended. You can use both Freedom House and Miami as examples of that. Of course there was Seattle that had a role also.


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## paccookie (Jun 24, 2009)

Linuss said:


> Kind of high-horse, isn't it?
> 
> 
> Difference between a fast track EMT and fast track Medic is what, 20 weeks?
> ...



Well, EMTs and medics are both EMTs...just as LVNs/LPNs and RNs are both nurses.  But calling an EMT-B or I a paramedic is just not the same.  I spent a year for EMT-I, two years for core classes and another year for medic classes.  That's four years.  I worked hard for my title.  I'm sure others would agree.  It may seem petty or silly or "high horse" or whatever.  Call it what you will.  I understood that the system was being renamed soon, but I thought it was going to be something like First Responder, EMT and Paramedic, cutting out the B and I differentiation.  That makes a lot more sense than just calling everyone medics.


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## daedalus (Jun 24, 2009)

paccookie said:


> Well, EMTs and medics are both EMTs...just as LVNs/LPNs and RNs are both nurses.



Well, not anymore. Paramedics are no longer EMTs. Both the National Registry and new provider levels have removed EMT from Paramedic, because paramedics are not supposed to be techs, but real providers.


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## paccookie (Jun 24, 2009)

VentMedic said:


> Oh yes, he wants to do that again.
> 
> 
> 
> ...



Congrats on getting your doctorate!!!  There are many doctors of various types that absolutely deserve the title.  MDs and DOs are NOT the only type of doctor worthy of being referred to as "doctor."  

You are correct that most of the opposition in advancing EMS education comes from within EMS.  It's sad to see this, but people are so resistant to change.  Changes have to start at the bottom, from within, before the rest of the world will recognize EMS as a reputable profession.  Unions would be a good first step, along with raising the requirements for all EMS programs - Bs, Is and Ps.  Mandating degrees for Ps would be a huge step.  Look at what nurses have done - they've required degrees as a starting point in their profession and their pay has risen along with the respect of the medical community.


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## paccookie (Jun 24, 2009)

daedalus said:


> Well, not anymore. Paramedics are no longer EMTs. Both the National Registry and new provider levels have removed EMT from Paramedic, because paramedics are not supposed to be techs, but real providers.



Has that gone into effect already?  I hadn't heard, just that it was planned.


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## Ridryder911 (Jun 25, 2009)

paccookie said:


> Has that gone into effect already?  I hadn't heard, just that it was planned.



Been in affect for a while. Most states just have not adopted it yet. 
So yes, you will see Paramedics that *NEVER *was an EMT. 

R/r 911


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## CAOX3 (Jun 25, 2009)

:deadhorse:


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## Aidey (Jun 25, 2009)

Rid, do you mean never were an EMT as in they went straight from layperson to Medic, or that there will be Paramedics who never had the title EMT-P? (Sorry, I'm just a bit confused). 

I think the point about LPNs and RNs both being called "nurse" is a good one, however I'm not sure you can apply it to EMS providers for one main reason. People often encounter EMTs and Paramedics at the same time, in the same place. ie an EMT and Medic show up on an ambulance. Calling them both Paramedic when they can't do the same things I think would cause a lot of confusion. Say the titles were changed to Basic Paramedic and Advanced Paramedic, I bet people would just end up being referred to as "basic" and "advanced" rather than paramedic. 

In the cases of LPNs and RNs in my experience you don't usually encounter them at the same place at the same time. ie, I've always seen RNs in the ED, and LPNs when I've gone to the doctor. You don't expect the nurse at your private MDs office to be able to do the same thing as the nurse in the ED. Or at least I don't. 

Imagine how confusing it would be for patients if there were both LPNs and RNs working in an ED, and both were called nurses. 

"Hey nurse, can I have some more nausea medicine please?"
 "Oh yeah sure, let me go get the other nurse who can give it to you". 
"But you are a nurse"
"Not the right type of nurse" 

Direct example, but I'm trying to be clear about what I'm saying.

I've also noticed that the scope for LPNs varies by state, for example some allow LPNs to start IVs and others don't. Whereas the scope for RNs is much more generalized and more likely to be restricted by where the RN works rather than their state (an ICU RN is going to have a different scope than an RN at an nursing home is what I'm talking about).  

Anyway, hopefully I've made some sense with what I've been trying to say.

I personally don't like the EMT designation, I think it's a misnomer for the current scope of practice for EMTs. Right now I'm failing to think of anything that would be a decent replacement. 

To be brutally honest, most of the health care designations annoy me. There multiple groups that provide similar levels of care, and all have different names. For example, the CNA vs MA vs LPN**** There are also some names, like Physician's Assistant, which really don't do the profession justice, are misleading, and are unclear. 


**** Where I used to work an MA had a larger scope than an LPN, not sure if it's like that anywhere else.


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## VentMedic (Jun 25, 2009)

Aidey said:


> I've also noticed that the scope for LPNs varies by state, for example some allow LPNs to start IVs and others don't. Whereas the scope for RNs is much more generalized and more likely to be restricted by where the RN works rather than their state (an ICU RN is going to have a different scope than an RN at an nursing home is what I'm talking about).


 
The same is true for EMT(P)s. A Paramedic working a BLS transport truck won't be doing the same as one one an ALS truck or 911. There will also be a differernce for CCT and Flight. 

In CA, the EMT-Bs work the CCTs with RNs and not the Paramedics.

An EMT(P) working in a hospital might only use their cert as a proof of some medical training and then work under an entirely different title or scope. An LPN or RN will not have to change their profession license titles. 

Actually the nursing designations are fairly clear as are their scope of practice. It is how they are utilized and the structure of the organization.
LVN/LPN: Licensed *Practical* Nurse, Licensed *Vocational *Nurse
Both tites designate a tech school training. 

MAs are only certified and hold no licensure in the states. 
LVN/LPNs do hold a license and their scope has been utilized in critical care units. MAs rarely work in a hospital setting due to their lack of licensure under the title of MA. If they meet the requirements to be a PCT, then they can work under that title.
An EMT(P) may also be in the same situation when in a hospital and may work under a different title with the hospital's designated job description as allows by the regulations for unlicensed staff. 

Hospitals do not approve of a mish mash titles or of anyone with a cert working under whatever job description they feel entitled. They have guidelines for what licensed, certified (those recognized by hospitals) and unlicensed persoonel can do. Professions such as nursing, RT, PT, OT and SLP also have guidelines for professional scope of practice both in and out of the hospital as well as a reimbursement structure that makes their profession appealing to various agencies. EMT(P)s have not defined their titles and do not always have the same appeal when it come to employment scope/limitations and reimbursement.


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## Ridryder911 (Jun 25, 2009)

What I meant is that some may enter Paramedic school but unless required to take the EMT examination, may never ever have been an EMT. True most schools require some form of license or certification while in Paramedic school, but I know of ideas of possibly removing this as well. In comparrision to those of other allied health care professionals where there is not step stone levels, rather to enter and complete the program as designed. 

R/r 911


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## VentMedic (Jun 25, 2009)

In Florida one can state Paramedic school without an EMT cert but may be required to take the exam before the first semester clinicals.  I see that changing also in the future.

An RN does not need a CNA cert to prove he/she knows how to take a BP.    

To clarify some of my previous post, other professions don't need the 50+ individual skills certifications designated by the states as EMS has established.   Their scope of practice covers the skills and then it is up to the employer to determine their job description.    The EMT-B needs to be elevated to match education with skills to include those if their MD sees it is appropriate.  There should not be all the different EMT-A-B-C-D-E-F stuff each time someone adds just ONE skill.  

For nursing, the LVN/LPN has faded into the background. Few hospitals believe their level of training and education is appropriate to work in the EDs and units.  Nursing is continuing to advance and will eventually eliminate their lowest common denominator.    RT is also in the process of doing that and have established the education and requirements for their lowest entry level.  The same with all the other heathcare professions.


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## Melclin (Jun 25, 2009)

We've got a few paramedics here that have (and a few more who are close too) PhDs in the field. Not MDs or doctrates of anything else....literally Drs of Paramedicine. I wonder how they'll go in the field.

Granted they don't tend to do many shifts now days with their academic commitments but I would be interested to see how they fare turning up to an ED and introducing themselves as Dr...LOL

We've spent a bit of time looking at various documents significant to the history of EMS, the (US) National EMS research agenda being one of them. How has the development of EMS "investigators" and academics come along since publication?


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## Ridryder911 (Jun 25, 2009)

VentMedic said:


> The same with all the other heathcare professions.


Well all but one. Oh, that's right we are Public Safety workers!.... 

R/r 911


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## VentMedic (Jun 25, 2009)

Melclin said:


> We've got a few paramedics here that have (and a few more who are close too) PhDs in the field.


 
Many of the Ph.D.s, like the one I have been working on, is in education. There few if any programs that are actually "Paramedicine" by degree at that level.

The higher education will be benefiicial in pushing for educators and not just instructors who only have the same certificate level of education they are teaching. Example: EMT teaching EMT students. Medic mill grads teaching more medic mill student.

As the education level of the "instructors" increases, it will bring about a different role model. Now, in some places, it is Bubba teach by what Bubba does and this is how Bubba does it and Bubba don't know why it works but sometimes it works for Bubba. 

Also, right now in the college programs, many of the chairs or department heads are RNs. This is also true in some of the state EMS offices where education is still regarded with importance to obtain a position.

The field of research could also be given more credibility as more Paramedics with higher education take an interest to spur on more studies and to keep everyone on their team interested in the hows or whys the academic side is just as important as the "skill".


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## bstone (Jun 25, 2009)

> Paramedic Maurice White Jr., a paramedic with the Creek Nation EMS Service who was recently assaulted by an Oklahoma State trooper,



It's clear where Dr Bledsoe stands on this.


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## Shishkabob (Jun 25, 2009)

bstone said:


> It's clear where Dr Bledsoe stands on this.



Even the best of us can be wrong once in a while


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## Aidey (Jun 25, 2009)

Thanks for clarifying that Rid. The only issue I see with that is field internship time. For insurance/state purposes wouldn't the students need at least some level of EMT? (I don't know much about that side of things, I'm just thinking out loud here.)

Vent, it may be clear to you and I, but I don't think it's that clear to laypeople. Where I used to work people would get confused between the LPNs and ANPs. My point is that at generally you find all those different designations at different places, making it less easy to confuse them. Where as EMTs and Paramedics are often found at the same place at the same time. 

I was also comparing CNAs to MAs and LPNs on a functional level, not necessarily comparing the details of how each profession is managed. ie if all 3 of those work in an primary care office, they will likely all have the same scope.  

I agree that it's silly some states have 8 different EMT levels because they have EMT Defib or EMT IV. I also agree that there should be set scope taught, and Employers can allow skills within that scope as they see fit. 

I think the issue arises when an employer wants someone to do something outside of their designated scope. If individual employers and individual medical directors expand the scope who is ensuring those people really know what they are doing? The state is. When I worked under and expanded scope as a Paramedic our standing orders and training program had to be approved by state medical board. We didn't get a special designation, but I can see where states would want to create designations so there is one set training and testing standard without them having to individually assess each case. 

I'm not sure there is going to be a way to stop that from happening unless things change on a national level, and there are nationally designated pre-hospital responder levels and scopes of practice that are applied to all states.


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## VentMedic (Jun 25, 2009)

Aidey said:


> Vent, it may be clear to you and I, but I don't think it's that clear to laypeople. Where I used to work people would get confused between the LPNs and ANPs. My point is that at generally you find all those different designations at different places, making it less easy to confuse them. Where as EMTs and Paramedics are often found at the same place at the same time.


 
Patients don't always need to know every detail of what everybody on scene is supposed to do. That patient may have a need for a Paramedic in another county where that person might be functioning under a very limited scope of practice. Also an EMT might intubate in Ohio and not in Indiana. Or, they might intubate in one county in TX and not in another.

The patient just needs to know who you are at that moment and what you can do for them. They don't need to know your entire autobiography. I have seen many NPs and even MDs appear at a bedside to answer a call light and do something a CNA might do and not go into detail about their title because it wasn't relevant. Sometimes we educate one patient at a time and may sometimes have to choose that time wisely. 

Whenever I introduce myself to a patient I give my name, title and a very brief description of who, what and why. Any other details will be on the relevance and situation with enough info to make them comfortable with me. It is about their emergency or illness and not about my life story. 

Nurses also like to keep things uncomplicated and sometimes just the title "nurse" will do even if there is a Ph.D. behind their names. Many nursing educators do have Ph.D.s but when in the clinical settings, they respond to the word "nurse" also when a patient calls and may not feel the need to flash anymore education if it is to just give a patient a sip of water. 

Once EMS figures out and get over their own identity crisis as well as insecurities, then they can educate the public. 

RT has actually made their profession easier while eliminating the "tech" word. They raised the education to a degree and only have 2 credentials: Certified and Registered Respiratory Therapist. The education now qualifies them for the Therapist title but they must meet additional national testing requirements to make Registered. Thus, two board exams and a clinical simulation to get to that credential. The difference is who is then allowed to work in the ICUs or on specialty teams.


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## triemal04 (Jun 25, 2009)

VentMedic said:


> Whenever I introduce myself to a patient I give my name, title and a very brief description of who, what and why.


Unfortunately, it's here that problems could arise and potentially contribute to the general public having even less understanding of what a paramedic (or EMT for that matter) can do.  I'm all for removing the vast majority of state certs out there and mandating that there are only 3 nationally (maybe 4 but that's a stretch), but there does still need to be a difference in the names, if only to avoid confusion (I know, good luck with all the variables in EMS from region to region) on the public.  Look at Canada; while everyone is a "paramedic," there are still primary, advanced, and critical care paramedics; couldn't get away from differentiating between the levels.  

The perfect example of why would be a pt that is seen several times; first by paramedic A (a paramedic by today's standards) who treats their problem as thoroughly as they can and next by paramedic B (an EMT by today's standards) who can't do more for them than place them on O2.  Think it might confuse the pt a little and lead to further misunderstanding of EMS?

Not to get into the middle of that debate (doesn't bother me either way), but the same could be applied to the NP with a PhD calling themself "doctor."  You have to figure, that if you are in a hospital/clinic, and someone walks up to you and introduces themselves as "Dr. So and So," that the natural assumption is that they are an MD, or DO.  Despite having earned the right to call themselves doctor, depending on the situation, it might not be the best choice of introductions.  Of course this could change if more and more NP's reach that level and continue to provide increasing amounts of primary care, but right now...

Forgetting all that, Bledsoe is right, names aside, the final goal should be to be providing appropriate medical care, no matter if you are a paramedic, EMT, paramedic 5, advanced EMT 2 or so on and on and on.


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## VentMedic (Jun 25, 2009)

In the hospital, the average patient will see more than 50 DIFFERENT healthcare providers of various levels and titles and still manage to get through their stay very well.  Some here are placing too much emphasis on what to be called and appear to be easily offended if a little elderly lady doesn't automatically know they are a Paramedic.  

Florida has used only EMT and Paramedic for at least 4 decades and have managed to keep the confusion to a minimum when petitioning for tax reforms.  Simplify the levels to just 2 - 4 different ones and then worry about someone who mistakenly calls you an ambulance driver.   

Most in EMS are clueless at to the titles of the people in the hospital.  Few can tell the difference between a certified Phlebotomist or a Lab Technologist with a Masters or Ph.D.   As from the various conversations here, few in EMS understand various titles of nursing.


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## Aidey (Jun 25, 2009)

Vent, it's not about being offended, and we aren't talking about when the designations are EMT and Paramedic. I'm talking about if we renamed everyone Paramedic. That is what I was referring to in my post, not if there were two different designations.


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## TransportJockey (Jun 25, 2009)

To do away with all of this name game, part of the problem is EMS being so intertwined with volunteers and FDs. A bachelor's of science in Paramedicine should be the entry level requirement for our field. No basic, advanced, or intermediate EMTs.


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## Aidey (Jun 25, 2009)

I don't think we need to do away with EMTs entierly, that may be a bit excessive.


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## TransportJockey (Jun 25, 2009)

Aidey said:


> I don't think we need to do away with EMTs entierly, that may be a bit excessive.



Why not? Staff trucks as dual medic units.


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## Aidey (Jun 25, 2009)

Dual medic units, depending on the area aren't necessary. On an ambulance that only has 3-4 runs a shift do they need 2 medics and the additional cost that comes with that? What about a BLS IFT truck? 

On a busy ambulance that runs 10 or 12 calls a shift 2 medics makes more sense because they can divide the runs between them, preventing either from being totally buried. 

I think nearly every other level of provider has a lower level that works in the assistant capacity, I don't see why Paramedics should be any different.


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## JPINFV (Jun 25, 2009)

Well, in low call volume areas do you really need a truck and an engine at the fire department?

Why not just throw a few ladders on the engine and do away with the truck?


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## VentMedic (Jun 25, 2009)

jtpaintball70 said:


> Why not? Staff trucks as dual medic units.


 
Exactly.  Some areas have been running two Paramedics on a truck since the 1960s.


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## fortsmithman (Jun 25, 2009)

jtpaintball70 said:


> To do away with all of this name game, part of the problem is EMS being so intertwined with volunteers and FDs. A bachelor's of science in Paramedicine should be the entry level requirement for our field. No basic, advanced, or intermediate EMTs.



In Sept 2010 The paramedic program I will be applying to will lead to a BSc in paramedicine.  The program is a joint program by Centennial College and the University of Toronto.


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## Aidey (Jun 25, 2009)

JPINFV said:


> Well, in low call volume areas do you really need a truck and an engine at the fire department?
> 
> Why not just throw a few ladders on the engine and do away with the truck?



You need both if they don't have hydrants. 

That aside, different trucks are for different jobs, so I don't think it's an equal comparison. The way I see it, we have different levels for different roles, which makes sense to me.


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## Shishkabob (Jun 26, 2009)

jtpaintball70 said:


> No basic, advanced, or intermediate EMTs.



Horrible idea.

Basics, while the education is lacking, are invaluable.  Can still be used as first responders by FD.  Can do BLS IFTs, as mentioned.  What about areas of the country where it's next to impossible to entice a medic to go out there, let alone 2 for a single shift, and 6 to cover 24/7?



If anything, up the education of EMT, but it'd be naiive to say they are useless and get rid of them throughout the country.  Heck, Canada, who everyone "looks up to" for EMS, still has an EMT-B equivalent.


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## VentMedic (Jun 26, 2009)

Aidey said:


> I don't think we need to do away with EMTs entierly, that may be a bit excessive.


 
Why do you argue to keep the EMT-B at the level it is now? Is it to make yourself as a Paramedic look better? Or, would you be jealous that they might have as much if not more education than you do now and might be able to do the same skills?

Nursing also used these arguments initially when the CNAs wanted to get certs as PCTs which is about another 500 - 700 hours in addition to the CNA. The RNs felt alittle challenged by having the CNAs increase their skills and understanding.  They also used the argument of supervising unlicensed staff. That was over 15 years ago and most hospitals now encourage their CNAs to upgrade to PCT.  What the RNs found was those with more education and training were less of a worry because they now understood some of what they had been doing as a CNA.   You won't hear an RN tell a CNA not to advance although many will tell them it is best to go the whole route to RN but just the same they will not tell someone to stay with the little education and skills a CNA has. 

Why should EMS be any different? Why do we continue to tell EMT-Bs to stay just as you are with 110 hours of training? 

And for additional training/education I am also not talking about a 3 hour inservice with 3 passes on an intubation dummy as advancement. In all honesty, the additional skills and letters tossed at EMTs with 110 hours of training is just another way of keeping some happy so the cheap labor can continue. 

So why do some continue to argue to keep the EMT-B at such a low level? It is definitely not for their benefit. If one wants to raise the professional standards of EMS they should include the EMTs also. Imagine if all the EMT-Bs had their education/training raised to a comparable level in Canada. That by itself would make medic mills and two weeks EMT farms a thing of the past.


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## VentMedic (Jun 26, 2009)

Linuss said:


> Heck, Canada, who everyone "looks up to" for *EMS, still has an EMT-B equivalent*.


 
But as pointed out in OPALS, the "BLS" for EMS in Canada had almost a year of education and training, not 110 hours.


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## Aidey (Jun 26, 2009)

Woah there Vent, I never ever said to keep the EMTs at the same level they are now, or that they don't need more education or anything like that. I just said that the position, in some form is needed. Please stop trying to make me out to be the bad guy here.


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## Shishkabob (Jun 26, 2009)

VentMedic said:


> But as pointed out in OPALS, the "BLS" for EMS in Canada had almost a year of education and training, not 110 hours.



And I said ours is inadequate and needs to be upped.


Where are we disagreeing?


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## VentMedic (Jun 26, 2009)

The part which I bolded.  The Canadian view of BLS EMS is not the same as that in the U.S.

(Apologies if you were actually meaning that.)

As well, for IFT in the U.S., how many of these patients need "first-aid"?  Most IFT patients have medical problems and the U.S. EMT-B is not properly prepared to do a medical assessment.


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## Shishkabob (Jun 26, 2009)

It's at the first part of the paragraph you edited ^_^



> If anything, up the education of EMT


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## Melclin (Jun 26, 2009)

VentMedic said:


> The part which I bolded.  The Canadian view of BLS EMS is not the same as that in the U.S.
> 
> (Apologies if you were actually meaning that.)
> 
> As well, for IFT in the U.S., how many of these patients need "first-aid"?  Most IFT patients have medical problems and the U.S. EMT-B is not properly prepared to do a medical assessment.





Here, IFT or Non-Emergency Patient Transport (NEPT) as we call it is handled by Patient Transport Officers (they essentially have BLS skills in case a patient crashes, and I think they have a diploma in 'paramedic science' or 'NEPT') and private companies, its a completely different sector. The state ambulance service does still fill the gaps, esp in rural places, and handles the Emergency/CC transports. PTOs nor the private companies they work for are never 000 (our 911).


*All our 000 trucks here are dual medic, state run and have nothing to do with the fire department * (although our medics are somewhere in between what you would consider I and P) and backed up by dual ICPs if needed. All medics have a bachelors degree or have done the degree conversion course (for the older medics). The three years of university is not about training in skills that we can then be told to perform by medical control (which we don't have). The time is about developing us as medical practitioners, about giving us the underlying knowledge to make sound decisions. While out in rural areas (with low call volumes) there are many variations of first responder teams, but they don't transport. A dual medic team goes to every case, not necessarily because they're ALS skills are needed but because they have the education to make sound clinical decisions on treatment and transport. I realize I'm bias, and maybe it seems like I'm bragging, but I can't help but feel this is the best level of care. 

The thing that strikes me so strongly about American EMS is the focus on skills and licenses but not on the knowledge needed to know when and when not to use them.


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## TransportJockey (Jun 26, 2009)

Melclin said:


> Here, IFT or Non-Emergency Patient Transport (NEPT) as we call it is handled by Patient Transport Officers (they essentially have BLS skills in case a patient crashes, and I think they have a diploma in 'paramedic science' or 'NEPT') and private companies, its a completely different sector. The state ambulance service does still fill the gaps, esp in rural places, and handles the Emergency/CC transports. PTOs nor the private companies they work for are never 000 (our 911).
> 
> 
> *All our 000 trucks here are dual medic, state run and have nothing to do with the fire department * (although our medics are somewhere in between what you would consider I and P) and backed up by dual ICPs if needed. All medics have a bachelors degree or have done the degree conversion course (for the older medics). The three years of university is not about training in skills that we can then be told to perform by medical control (which we don't have). The time is about developing us as medical practitioners, about giving us the underlying knowledge to make sound decisions. While out in rural areas (with low call volumes) there are many variations of first responder teams, but they don't transport. A dual medic team goes to every case, not necessarily because they're ALS skills are needed but because they have the education to make sound clinical decisions on treatment and transport. I realize I'm bias, and maybe it seems like I'm bragging, but I can't help but feel this is the best level of care.
> ...



I would love to work under a system like that. I agree that most EMS in the US is way to focused on skills and not on education.


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## downunderwunda (Jun 26, 2009)

daedalus said:


> There is no BLS before ALS. There is only medicine.



So my learned colleugue, if there is no BASIC life support, do you immediatley commence drug therapy with a patient before a proper assessment, considering patient assessment is a BASIC skill that we, regarless of medical qualification, perforem, as is our secondary survey, do you give morphine sulphate to every patient with 'pain' or do you consoder doing something as BASIC as using posture first?

I am sorry to correct you, but there is no ALS without BLS.


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## downunderwunda (Jun 26, 2009)

jtpaintball70 said:


> I would love to work under a system like that. I agree that most EMS in the US is way to focused on skills and not on education.



I am afraid it is not only skills people are worried about.

Siren Malfunction

& here

Dumbest thing you have been asked

& here :unsure:

Will my weight...

I could continue, but i would be here all night


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## VentMedic (Jun 26, 2009)

downunderwunda said:


> So my learned colleugue, if there is no BASIC life support, do you immediatley commence drug therapy with a patient before a proper assessment, considering patient assessment is a *BASIC skill* that we, regarless of medical qualification, perforem, as is our secondary survey, do you give morphine sulphate to every patient with 'pain' or do you consoder doing something as BASIC as using posture first?
> 
> I am sorry to correct you, but there is no ALS without BLS.


 
You use the term "BASIC" skill as in fundamental skill which is how it should be.. Unfortunately in the U.S. it may mean a skill performed by an EMT-B with 110 hours of training and not an assessment that would be similar to a Paramedic or nurse. The assessment by an EMT-B is very limited due to the lack of A&P or pathophysiology so it is a "Basic" assessment and that is what "BLS" refers to here. In true terms, as Bledsoe pointed out, every provider provides BLS as in basic life support as it was meant to be and not as in a title such as one referring to an EMT-B.


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## JPINFV (Jun 26, 2009)

downunderwunda said:


> So my learned colleugue, if there is no BASIC life support, do you immediatley commence drug therapy with a patient before a proper assessment, considering patient assessment is a BASIC skill that we, regarless of medical qualification, perforem, as is our secondary survey, do you give morphine sulphate to every patient with 'pain' or do you consoder doing something as BASIC as using posture first?
> 
> I am sorry to correct you, but there is no ALS without BLS.



There's proper assessment and treatment and improper assessment and treatment. Going directly to drug therapy without a patient assessment is improper and goes beyond the "BLS before ALS" cliche.


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## Ridryder911 (Jun 26, 2009)

Part of the confusion as well is the assumption that a lesser trained or educated person would ever be deemed in charge or responsible for patient care. 

For example, nursing tech or assistants has been referred to as well as LPN/LVN. The CNA would never be given the responsibility to assess for the primary focus of injuries, illness or wounds. Even the LPN/LVN who is licensed according to authorities are not educated enough to perform the primary assessment for patient care. Ironic since both of those levels are longer than EMT course and the LPN/LVN is usually equivalent in hours and training to those of the non-academic Paramedic programs. 

The lower level of nurses work within their own scope, but one of the major differences as well is that they also must work under the supervision of a Registered Nurse. Yes, physician may write the orders but it is the authority of the RN to whom will assign and monitor their treamtent and care. 

The only and sole reason for even the wording of BLS was to make a distinction for EMS providers. Most of the resuscitative measures involving what is now called ALS was performed by physician level providers. Unfortunately, it was assumed that as EMS matured that all providers would naturally go the highest and best level possible for patient care. Again, unfortunately as EMS usually does it placed a band-aid on an arterial bleed and made excuses. Developing titles and levels that was always compared to the gold standard of the Paramedic and describing .. "_well it's almost_" ...."the _best we can do, for now_"... All excuses, nothing more. There is* NO *reason for non-rural communities not to have providers that can actually provide true resuscitative measures as a Paramedic and not the so called BLS/common laymen methods. 

I can assure you, somewhere during the course of the past 40 years the community has purchased or funded other programs that exceeded the cost more than to provide true emergency health care. Again, it is the priority given and requirement attached that makes it either essential or luxurious. If healthcare insurance was pro-rated or industries received a tax deferment dependent upon the level of EMS, we would we see more ALS EMS. Alike we now see aggressive Fire Services due to ISO ratings. 

Yes, there is no true thing as BLS or ALS. It is either initial first-aid or medical care. All treatment has degrees of in-depth. Would performing an immediate CABG or immediate surgical intervention be Advanced Advanced Life Support or Superior Life Support?.... one could only imagine the levels. It is just simply providing medical care. Period. 

R/r 911


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