# If I were the boss of EMS....



## mcdonl (Aug 7, 2011)

If I were the boss of EMS, I would allow students to go through the entire educational program and get their medic *certificate* but need to get their *LICENSE *in increments. So, you go to medic school, get certified and then hit the road as basic for a predetermined about of hours/calls, step to intermediate and do the same there and then become a practicing medic. 

If I were the boss of EMS I would not allow someone to maintain their MEDIC licence unless they practice medicine as their primary source of income.

What would YOU do if you were the boss of EMS?


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## CollegeBoy (Aug 7, 2011)

mcdonl said:


> If I were the boss of EMS, I would allow students to go through the entire educational program and get their medic *certificate* but need to get their *LICENSE *in increments. So, you go to medic school, get certified and then hit the road as basic for a predetermined about of hours/calls, step to intermediate and do the same there and then become a practicing medic.
> 
> If I were the boss of EMS I would not allow someone to maintain their MEDIC licence unless they practice medicine as their primary source of income.
> 
> What would YOU do if you were the boss of EMS?




So the problem that I see here is that most people are gonna forget their advanced skills before they get to the medic level.

As for not allowing someone to be a medic unless they do it full time, I don't know about you, but where I am from there is a severe medic shortage.


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## Leafmealone (Aug 7, 2011)

mcdonl said:


> If I were the boss of EMS I would not allow someone to maintain their MEDIC licence unless they practice medicine as their primary source of income.



I kind of understand where you are coming from, but I must disagree. around where I live, we have about 6 major volunteer corps, and they only have a few paid crew supplementing their runs. That would put a lot more strain on the career crews, who are already spread thinner than they would like some days.


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## mgr22 (Aug 7, 2011)

mcdonl said:


> If I were the boss of EMS, I would allow students to go through the entire educational program and get their medic *certificate* but need to get their *LICENSE *in increments. So, you go to medic school, get certified and then hit the road as basic for a predetermined about of hours/calls, step to intermediate and do the same there and then become a practicing medic.
> 
> If I were the boss of EMS I would not allow someone to maintain their MEDIC licence unless they practice medicine as their primary source of income.
> 
> What would YOU do if you were the boss of EMS?



Does that mean I should lose my medic license if I earn more from a non-EMS source of income for, say, a week? A month? A year?


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## mcdonl (Aug 7, 2011)

My concern with the volunteer medic is the risk. As a basic or an intermediate, sure... you could kill someone by failure to do something but so could a lay person.... A MEDIC can kill someone with their actions. And, if you only practice once or twice a month it is risky.

But, thats why I am not the boss of EMS.


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## mcdonl (Aug 7, 2011)

mgr22 said:


> Does that mean I should lose my medic license if I earn more from a non-EMS source of income for, say, a week? A month? A year?



Ok, maybe primary source of income is a bad measure... perhaps there should be a minimum number of calls/hours/shifts a year to go along with the training.


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## mgr22 (Aug 7, 2011)

mcdonl said:


> Ok, maybe primary source of income is a bad measure... perhaps there should be a minimum number of calls/hours/shifts a year to go along with the training.



Perhaps. I think it would be very hard to come up with a formula for that, though. What if we focused on results instead of experience? I know of at least one way to do that.


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## medichopeful (Aug 7, 2011)

If I were the boss of EMS, I'd drastically increase the educational requirements to get your EMT-B.


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## Chief Complaint (Aug 7, 2011)

mcdonl said:


> If I were the boss of EMS, I would allow students to go through the entire educational program and get their medic *certificate* but need to get their *LICENSE *in increments. So, you go to medic school, get certified and then hit the road as basic for a predetermined about of hours/calls, step to intermediate and do the same there and then become a practicing medic.
> 
> If I were the boss of EMS I would not allow someone to maintain their MEDIC licence unless they practice medicine as their primary source of income.
> 
> What would YOU do if you were the boss of EMS?



That is how my volunteer agency works.  I am a medic but I first have to run calls as a Basic and Enhanced before running as a Medic.


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## fortsmithman (Aug 7, 2011)

I'd change the education requirements.  As I have posted in previous threads I'd require that EMT have between 2yrs or 4 years education and paramedic requiring at least 2 years more education than EMT for a total or 4 to 6 years education.  As for the OP's idea of banning people who do nbot derive most of their income from medical such as fire medics and volly's (that statement alone may get this thread locked if it turns into another paid vs volly thread so let's keep this thread civil).  I\ve seen some paid EMS who were highly professional and I've seen some paid crews who were not behaving in a professional manner.  I have seen volly's who are highly trained and professional and I have seen vollys who weren't.  It all depends on the personal character and integrity of the individual medic or EMT.  I would also have one national registering and licensing body.


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## mcdonl (Aug 7, 2011)

fortsmithman said:


> I'd change the education requirements.  As I have posted in previous threads I'd require that EMT have between 2yrs or 4 years education and paramedic requiring at least 2 years more education than EMT for a total or 4 to 6 years education.  As for the OP's idea of banning people who do nbot derive most of their income from medical such as fire medics and volly's (that statement alone may get this thread locked if it turns into another paid vs volly thread so let's keep this thread civil).  I\ve seen some paid EMS who were highly professional and I've seen some paid crews who were not behaving in a professional manner.  I have seen volly's who are highly trained and professional and I have seen vollys who weren't.  It all depends on the personal character and integrity of the individual medic or EMT.  I would also have one national registering and licensing body.



Just to be clear. I was only stating that to be a licensed medic you would need to be in the patient care business.... Er tech, fire/ems, nursing, etc....


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## CheifBud (Aug 7, 2011)

I'm sorry but as an EMT-B and based on what I am allowed to even perform I would need to make a hell of a lot more to even justify EMT-B classes for two to four years.  That being said why would you go to school for 6 years to be a Medic when you can tack another year and half to two years of schooling on it and become, I don't know, a doctor and make 10000X as much, be able to do 10000x as much and drop the M.D. bomb to catch hot tail. Not to mention with tuition cost these days being so incredibly low why not force those already in need of money (hence them going to school for a job) to spend 4-6 times as much money on schooling  when frankly I feel like I learned soooo much more than I am even allowed to perform or required to know in my short amount of schooling for EMT-B.

Now... If we are also talking about expanding the scope of practice accordingly with the amount of schooling and pay scale then forget everything I just said.... but I don't need 4 years of school to work an AED or to be able to count 30 compression and then ventilate.


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## RocketMedic (Aug 7, 2011)

The trends towards higher education levels are rediculous. Should EMS as an industry expand its educational requirements? Yes, but do we need two years of schooling to perform current BLS? Not at all. 500 hours of school is plenty to teach the basics.

For advanced providers, there does need to be more education, probably equivalent to an Associates. However, the nature of education needs to be considered. Does a paramedic really need to sit through art and psychology to do our jobs as they stand? Of course not.
EMS needs two things to professionalize: a set definition of our roles with advanced Scopes of practice that allow us to make critical decisions and a standardized education system that emphasizes hands-on and practical learning over tangentially associated topics. 

Every suggestion in this thread to date serves to raise the barrier to an EMS career t an unreasonable level that would only result in a massive shortage of wholly qualified personnel. Why would a student give 4 to 6 years for a job that pays far less than other batchelors required careers for a job that you can learn in a year and learn most of the same interventions we do in the field already.

EMS is pretty easy to learn if you're smart and motivated. It takes a very long time to master.


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## adamjh3 (Aug 7, 2011)

medichopeful said:


> If I were the boss of EMS, I'd drastically increase the educational requirements to get your EMT-B.



Wait... there's education requirements for your Basic? 

...oops


I would go as far as having IFT be a completely separate education standard, at least at the basic level. 

I've used maybe 10% of what I learned in EMT class on the job. The rest I picked up here, through co-workers, and on my own. There was so much emphasis on trauma and that makes up maybe 2% of my calls, none of them severe, most of them are already stabilized. Out of EMT school, I knew nothing about psych and next to nothing about dialysis patients and geriatrics when that makes up the other 98% of my call volume. 

I heard this mentioned on here somewhere, what about going to an apprenticeship kind of "education" at least for the BLS side of things? That's pretty much what it is now, anyway. There's a very minimal baseline learned in the classroom, the majority of a new EMTs learning occurs in the field. I still get calls at least once a day from the newer guys at my station (who have all been working for about 3 months now) with questions.


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## CheifBud (Aug 7, 2011)

Rocketmedic said:


> For advanced providers, there does need to be more education, probably equivalent to an Associates. .



Is there any way of getting an associates just for EMS or Paramedic?  I don't know of any but I would be more than happy too if there was.


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## HotelCo (Aug 7, 2011)

CheifBud said:


> Is there any way of getting an associates just for EMS or Paramedic?  I don't know of any but I would be more than happy too if there was.



Unless you're going to get a pay raise for it, why bother? If you're set on learning more, pick up some books, but don't waste your money on a degree, if you won't get any benefit at work from having it.


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## JPINFV (Aug 7, 2011)

CheifBud said:


> I'm sorry but as an EMT-B and based on what I am allowed to even perform I would need to make a hell of a lot more to even justify EMT-B classes for two to four years.
> 
> ...
> 
> Now... If we are also talking about expanding the scope of practice accordingly with the amount of schooling and pay scale then forget everything I just said.... but I don't need 4 years of school to work an AED or to be able to count 30 compression and then ventilate.


Increased education would mean an appropriate increase in the scope of practice for an EMT. As it stands now, an EMT isn't appropriate for much more than a first responder role.


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## JPINFV (Aug 8, 2011)

adamjh3 said:


> I would go as far as having IFT be a completely separate education standard, at least at the basic level.
> 
> I've used maybe 10% of what I learned in EMT class on the job. The rest I picked up here, through co-workers, and on my own. There was so much emphasis on trauma and that makes up maybe 2% of my calls, none of them severe, most of them are already stabilized. Out of EMT school, I knew nothing about psych and next to nothing about dialysis patients and geriatrics when that makes up the other 98% of my call volume.



[thisthisthisthisthis.jpg]

EMS and IFT should be separate, not because one is better than the other (however, I'd argue that as an aggregate, interfacility transport is much more important to the health care system than prehospital emergency care), but because they are different jobs which require completely different skills because the status and make up of the patients invovled are totally different. Non-emergent IFT and prehospital emergency care stops being similar once we get past a gurney and a van that can carry said gurney.


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## usalsfyre (Aug 8, 2011)

Rocketmedic said:


> The trends towards higher education levels are rediculous. Should EMS as an industry expand its educational requirements? Yes, but do we need two years of schooling to perform current BLS? Not at all. 500 hours of school is plenty to teach the basics.


Part of expanding education is bringing things that really matter (pain management, 12 lead EKG interpretation, recognition of CHF, CPAP, ect) to the basic level.



Rocketmedic said:


> For advanced providers, there does need to be more education, probably equivalent to an Associates. However, the nature of education needs to be considered. Does a paramedic really need to sit through art and psychology to do our jobs as they stand? Of course not.
> EMS needs two things to professionalize: a set definition of our roles with advanced Scopes of practice that allow us to make critical decisions and a standardized education system that emphasizes hands-on and practical learning over tangentially associated topics.


If you want that "critical decision" making ability you need well rounded people (which we have far too few of in EMS currently). There's a reason physicians sit through "art and psychology". Part of being able to make those decisions is understanding the social, psychological and economic factors driving the patient. Way too many people currently in EMS have no idea about some of the social issues of poverty, and basically equate poor with stupid. It's not so, and understanding that they're may be cultural, ethnic and economic factors at play enhances your care. 



Rocketmedic said:


> Every suggestion in this thread to date serves to raise the barrier to an EMS career t an unreasonable level that would only result in a massive shortage of wholly qualified personnel. Why would a student give 4 to 6 years for a job that pays far less than other batchelors required careers for a job that you can learn in a year and learn most of the same interventions we do in the field already.


Another part of increasing educational requirements means we don't need what we think of as a paramedic on every truck. The folks that have a B.S. in Paramedicine would comprise maybe 10-20% of the workforce. Does it mean not everyone gets to do "cool skills"? Yep, but tough crap, we need to get away from the patch and skills mentality anyway.


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## usalsfyre (Aug 8, 2011)

adamjh3 said:


> I heard this mentioned on here somewhere, what about going to an apprenticeship kind of "education" at least for the BLS side of things? That's pretty much what it is now, anyway. There's a very minimal baseline learned in the classroom, the majority of a new EMTs learning occurs in the field. I still get calls at least once a day from the newer guys at my station (who have all been working for about 3 months now) with questions.



What's needed is real clinical requirements. Not 48 hours standing in the corner at an ER and 5 runs on a unit where the crew ignores you. I'd put the minimum at 50-75 runs, with a real preceptor who evaluates you, not just whoever is there that day.


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## usalsfyre (Aug 8, 2011)

JPINFV said:


> EMS and IFT should be separate, not because one is better than the other (however, I'd argue that as an aggregate, interfacility transport is much more important to the health care system than prehospital emergency care), but because they are different jobs which require completely different skills because the status and make up of the patients invovled are totally different. Non-emergent IFT and prehospital emergency care stops being similar once we get past a gurney and a van that can carry said gurney.



Very, very well said. I am, through a lot of studying and education, well equipped to pick up grandma when her CHF is acting up, or care for her when she is moving from a primary to a tertiary facility during the acute phase being actively medicated, ect. I am ill equipped on the other hand, to take her to dialysis every Monday, Wednesday and Friday simply because NOTHING in my education spoke to this role.


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## Flightorbust (Aug 8, 2011)

CheifBud said:


> Is there any way of getting an associates just for EMS or Paramedic?  I don't know of any but I would be more than happy too if there was.



http://www.ppcc.edu/programs/emergency-medical-services/aas-ems-paramedic-degree/

Im sure other Community Colleges have programs as well


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## Shishkabob (Aug 8, 2011)

Though, some could argue that much of 911 IS IFT due to the public at large being uneducated / false ideas about what EMS truly is....


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## usalsfyre (Aug 8, 2011)

Linuss said:


> Though, some could argue that much of 911 IS IFT due to the public at large being uneducated / false ideas about what EMS truly is....



But again, real education could mean treating those folks at the house and getting reimbursed for it instead of being a taxi so the provider gets paid...


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## JPINFV (Aug 8, 2011)

Linuss said:


> Though, some could argue that much of 911 IS IFT due to the public at large being uneducated / false ideas about what EMS truly is....




Non-emergent medical taxi service for the general public and non-emergent taxi service for people currently admitted to some sort of health care facility (i.e. hospitals, SNFs, etc) are two completely different things. The average IFT provider needs more education in good body mechanics and transfers, a more nuanced understanding of infection precautions (i.e. the specifics of air born vs contact vs droplet instead of a "put everything on" type training), education on long term care issues like ulcers, and the list goes on. Heck, given the current education, simply giving a CNA a section on transport would probably yield a more appropriate provider for non-emergent IFTs than the standard EMT.


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## Shishkabob (Aug 8, 2011)

usalsfyre said:


> But again, real education could mean treating those folks at the house and getting reimbursed for it instead of being a taxi so the provider gets paid...



Which is why I can spend an hour at a house with a diabetic, yet get "talked to" by El-Kapitan because I "could have been to the hospital and back in that time".


:glare:


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## CheifBud (Aug 8, 2011)

That's just it, all I want is the degree.  I don't get a degree for myself no sir, I don't need a piece of paper telling me I know what I already know.  The sad part is now days without that piece of paper you're at a slight disadvantage in the employment pool against those who have that little piece of paper.

In short I'm going to Medic school but if you wanna take a little more of my money and in exchange let me throw an Associates Degree on my resume I'm OK with that pending the tuition increase merits said degree.

And thank you Flightorbust that's exactly what I'm talking about.


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## phideux (Aug 8, 2011)

CheifBud said:


> Is there any way of getting an associates just for EMS or Paramedic?  I don't know of any but I would be more than happy too if there was.



Where I went you come out with an Associates in Emergency Medical Technologies.


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## HotelCo (Aug 8, 2011)

phideux said:


> Where I went you come out with an Associates in Emergency Medical Technologies.



And did that give you more money when you got hired?


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## systemet (Aug 8, 2011)

Regarding a few points:

(1) In US / Canada it typically takes 6-8 years to get an MD, and then another 2-5 years to complete most residencies.  A first year resident makes around $35,000 (USD / CAD) in most programs.  At least as far as I'm aware.  Paramedic pay varies greatly across North America, and across the world.  But many medics I know make twice that without working extra shifts.  Granted, this pay rate is on the higher end for what most medics make in a global context, but it's still a lot more than a residency.  The pay definitely goes up as you complete residency years, and shoots up as soon as you've completed the residency program, but it takes a lot more than 6 years before the physician makes an income that outstrips a paramedic in some places.

(2) BLS pay is bad because the barrier to entry is low.  It's too easy to train as a basic EMT.  There's too many trained bodies, therefore there's a high demand for work, and a low supply of paid positions.  This doesn't provide an incentive for the employer to raise pay.  They don't have to to fill positions.  

There's definitely a chicken-and-the-egg argument that no one will want to go to a longer EMT program if they can graduate in a shorter time, and few people want to invest more time / expense in their education if the pay is low.  But it's hardly likely to go up any time soon if the barrier to entry for a BLS provider is < 6 months in many places, and 100 hours in others.

(3) You can train someone for 2 years just to provide good BLS.  I think at this point it would be reasonable to throw in a BIAD, CPAP, 12-lead interpretation and possibly aspirin and IM / SC epinephrine, maybe some ventolin, perhaps entonox.  There's no reason why an EMT can't have a decent education in physiology, pharmacology, pathophysiology.  

If I was king, 2 years to EMT, 4 years to paramedic, and a real 2 year certification for a higher end critical care level.  Someone who can fly or do critical LDT work, who can actually interpret x-rays, reduce dislocations, put in arterial lines, intelligently read bloodwork, manage a vent with ABGs, and manage electrolyte derrangements.  You could maybe even make an argument for this type of medic to work in a rural ER, although this is probably starting to overlap the PA role in the states.

There needs to be real EMS research.  There's very few programs right now, and very few people producing good data.  We need to more critically examine what we're doing well, what we're doing poorly, and how we can improve it.  We need to develop treat and refer protocols, and arrange billing in a way that encourages physicians to support this development.  There's plenty of patients that could be referred to a family physician, instead of being taken to the ER to wait for 8 hours in the waiting room.  It would be great to have a real-time ability to consult with a physician to direct some patients elsewhere.  

MPDS needs to go.  We need to find a system that works better.  We need to stop responding hot to every single abdominal pain just in case one of them is an AMI or a AAA.  There needs to be a rational system for dispatching based on clinical priority, instead of liability management.  We need to move away from the idea that someone with 24 hours of training and a ring binder is a professional.

There needs to be widespread amalgamation of EMS services and response areas, so that every little town doesn't have it's own service.  There needs to be an integration of EMS into healthcare and away from public safety.  There needs to be true national licensure and reciprocity.

In my opinion.


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## systemet (Aug 8, 2011)

Regarding a few points:

(1) In US / Canada it typically takes 6-8 years to get an MD, and then another 2-5 years to complete most residencies.  A first year resident makes around $35,000 (USD / CAD) in most programs.  At least as far as I'm aware.  Paramedic pay varies greatly across North America, and across the world.  But many medics I know make twice that without working extra shifts.  Granted, this pay rate is on the higher end for what most medics make in a global context, but it's still a lot more than a residency.  The pay definitely goes up as you complete residency years, and shoots up as soon as you've completed the residency program, but it takes a lot more than 6 years before the physician makes an income that outstrips a paramedic in some places.

(2) BLS pay is bad because the barrier to entry is low.  It's too easy to train as a basic EMT.  There's too many trained bodies, therefore there's a high demand for work, and a low supply of paid positions.  This doesn't provide an incentive for the employer to raise pay.  They don't have to to fill positions.  

There's definitely a chicken-and-the-egg argument that no one will want to go to a longer EMT program if they can graduate in a shorter time, and few people want to invest more time / expense in their education if the pay is low.  But it's hardly likely to go up any time soon if the barrier to entry for a BLS provider is < 6 months in many places, and 100 hours in others.

(3) You can train someone for 2 years just to provide good BLS.  I think at this point it would be reasonable to throw in a BIAD, CPAP, 12-lead interpretation and possibly aspirin and IM / SC epinephrine, maybe some ventolin, perhaps entonox.  There's no reason why an EMT can't have a decent education in physiology, pharmacology, pathophysiology.  

If I was king, 2 years to EMT, 4 years to paramedic, and a real 2 year certification for a higher end critical care level.  Someone who can fly or do critical LDT work, who can actually interpret x-rays, reduce dislocations, put in arterial lines, intelligently read bloodwork, manage a vent with ABGs, and manage electrolyte derrangements.  You could maybe even make an argument for this type of medic to work in a rural ER, although this is probably starting to overlap the PA role in the states.

There needs to be real EMS research.  There's very few programs right now, and very few people producing good data.  We need to more critically examine what we're doing well, what we're doing poorly, and how we can improve it.  We need to develop treat and refer protocols, and arrange billing in a way that encourages physicians to support this development.  There's plenty of patients that could be referred to a family physician, instead of being taken to the ER to wait for 8 hours in the waiting room.  It would be great to have a real-time ability to consult with a physician to direct some patients elsewhere.  

MPDS needs to go.  We need to find a system that works better.  We need to stop responding hot to every single abdominal pain just in case one of them is an AMI or a AAA.  There needs to be a rational system for dispatching based on clinical priority, instead of liability management.  We need to move away from the idea that someone with 24 hours of training and a ring binder is a professional.

There needs to be widespread amalgamation of EMS services and response areas, so that every little town doesn't have it's own service.  There needs to be an integration of EMS into healthcare and away from public safety.  There needs to be true national licensure and reciprocity.

In my opinion.


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## Flightorbust (Aug 8, 2011)

CheifBud said:


> And thank you Flightorbust that's exactly what I'm talking about.



No prob. I like that its only 3 extra classes and they are ones that make sence to get your AAS


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## RocketMedic (Aug 8, 2011)

Increases in our scope of practice and salaries justify higher education. It also provides better care. However, it also shrinks the pool of providers. Good for us, bad for grandma when fher local agency can't keep a crew employed. The national EMS system would have to be able to afford commisurate wages, which is not a sure thing. Additionally, we need to keep our students in the field and learning. Anyone can be good in school, but in the fields a different world.
1 year of education for emt, 2 for intermediate with pharmacy and a&p, 4 for this proposed 'supermedic'. 3-4 is what most paramedics have invested now anyways from the word 'go'.
Usaffyre, there's no reason I need to sit through art or psych to know that Grandma is poor and lonely. Common sense and autonomy are prerequisites for EMS and what seperates us from nursing. Forcing employees to redundant education is only going to make them more expensive.


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## systemet (Aug 8, 2011)

Rocketmedic said:


> Anyone can be good in school, but in the fields a different world.



Did going to EMT school make you a worse EMT?  Did going to medic school make you a worse medic?

Would you have been a better medic if your program was half the time?  

So why would going to school longer make a worse medic?




> Common sense and autonomy are prerequisites for EMS and what seperates us from nursing.



Are you sure?  Because I've witnessed a lot of behaviour from EMS providers that falls well outside of the boundaries of what most people would consider "common sense".  

I also don't remember ever being tested for "common sense", or for "autonomy".  It's true that a paramedic has more autonomy than the average nurse, but can we really claim to have a monopoly on "common sense"?  I think a lot of RNs might take issue with that.




> Forcing employees to redundant education is only going to make them more expensive.



Probably.  But isn't one of the biggest complaints on this site that basic EMTs don't get paid enough?  Or that it's too hard to find a job?  Or even that in many places medics make much much less than RNs?  Don't we all want to get paid more?  

Isn't more education a good way to get there?  And improve the care that we deliver?


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## mcdonl (Aug 8, 2011)

I guess when I started this thread I was looking to see what the OTHER changes would be to EMS but I guess education and scope is about the biggest issue.


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## adamjh3 (Aug 8, 2011)

What can be changed without first addressing those issues? 

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## mcdonl (Aug 8, 2011)

adamjh3 said:


> What can be changed without first addressing those issues?
> 
> Sent from my Droid using Tapatalk



I agree. It is a major issue.


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## Shishkabob (Aug 8, 2011)

adamjh3 said:


> What can be changed without first addressing those issues?
> 
> Sent from my Droid using Tapatalk



Pay.  Easily.



Not hugely, but yes, it can be.


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## JPINFV (Aug 8, 2011)

Linuss said:


> Pay.  Easily.
> 
> 
> 
> Not hugely, but yes, it can be.



How can we address supply of supply/demand with what is virtually no barrier to entry without addressing education?


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## Shishkabob (Aug 8, 2011)

Up your pay, up your standards of who you hire.


Basic business management 101.


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## usalsfyre (Aug 8, 2011)

Linuss said:


> Pay.  Easily.
> 
> 
> 
> Not hugely, but yes, it can be.



I hate to say it but...

Why pay us more when we're willing to do the job for what they pay us now?


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## Shishkabob (Aug 8, 2011)

usalsfyre said:


> I hate to say it but...
> 
> Why pay us more when we're willing to do the job for what they pay us now?



If you're not willing to pay more, don't expect more.




The adage "You get what you pay for" holds true in salaries as well.


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## usalsfyre (Aug 8, 2011)

Linuss said:


> Up your pay, up your standards of who you hire.
> 
> 
> Basic business management 101.



But when your managers have the business sense of a rock, what do you expect?


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## Shishkabob (Aug 8, 2011)

usalsfyre said:


> But when your managers have the business sense of a rock, what do you expect?



Exactly.  It's a cycle.  


If you expect more, you pay more.  If you pay more, you can expect more.  If you pay crap, you'll get crap.  If you pay wonderfully, you can require all that you want to hire people.  So yes, this ALL does go back on the upper-management, and not on the individual provider as some would like to say.

I can get a BS in EMS, a PhD in Biology... and I'm still going to get the same pay as the Paramedic next to me.  Regardless of what I'd like, it makes no sense to get an advanced 4 year degree for a job where the average pay is $35,000 a year.


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## usalsfyre (Aug 8, 2011)

Linuss said:


> The adage "You get what you pay for" holds true in salaries as well.


Very true. Very, VERY true. But how many people you work with think they deserve more when they probably don't deserve what they get now?


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## Melclin (Aug 8, 2011)

systemet said:


> (3) You can train someone for 2 years just to provide good BLS.  I think at this point it would be reasonable to throw in a BIAD, CPAP, 12-lead interpretation and possibly aspirin and IM / SC epinephrine, maybe some ventolin, perhaps entonox.  There's no reason why an EMT can't have a decent education in physiology, pharmacology, pathophysiology.
> 
> If I was king, 2 years to EMT, 4 years to paramedic, and a real 2 year certification for a higher end critical care level.  Someone who can fly or do critical LDT work, who can actually interpret x-rays, reduce dislocations, put in arterial lines, intelligently read blood work, manage a vent with ABGs, and manage electrolyte derrangements.  You could maybe even make an argument for this type of medic to work in a rural ER, although this is probably starting to overlap the PA role in the states.
> 
> ...



You're pretty much describing our system. While I agree with you that these things are positive steps forward (I do like our system after all), they don't come without problems of their own.

You get this odd dichotomy of educational standards where on one hand the degree encourages independent thought and practice, research, academia etc, on the other hand, when it comes down to it, if you just apply the clinical guidelines with some degree of accuracy and take everyone to hospital, the job can basically be done by a trained monkey. The degree's curriculum is stuck between those two positions. People would complain when forced to learn a whole pile of stuff that wasn't in the clinical practice guidelines (CPG) or directly related to ambulance practice. But at the same time, without learning all of that extra stuff, you really can't safely say that you are qualified to be exceding your guidelines or doing things like leaving people at home/make more complex decisions about care pathways. 

Take a patient I went to this evening. Head ache, nausea and ear pain after a tumour was removed from her inner ear earlier in the week. She had called her specialist and he had called back telling her that if her pain was bad, simply to call an ambulance. Seeing her ENT specialist in approx 24 hours.

To decide whether or not a person is fine to stay at home and go to their appointment in the afternoon, there is a lot you have to know to make an informed decision beyond, "Meh, I'm sure she'll be fine, its only till morning". What problems could the presentation indicate? How will it be investigated in ED? What specialities are required? Will they be available at this time? How appropriate is her current PRN anagesia plan considering the procedure? But you try and teach a paramedic class here about the complications of inner ear surgeries or about indications for ED investigations and you get an uproar of "but there isn't a CPG for that, why do we have to learn it WAHHHHHH". The curriculum is then changed in response to "feedback" to become more “relevant”. So the unis end up failing to really provide a comprehensive and broad education, other than just a longer, more involved, more expensive version of the older vocational courses without any of the benefits of those older systems.

As I said, we do currently leave people at home/refer to doctors as you mention but its not without risk. There really isn't much in the way of formal frame work for doing so and there is no protection for those that do so and make innocent mistakes. If we make a mistake (and inevitably we do) then there is hell to pay, and all the same people who were fine with you leaving people at home before, start chanting, "Paramedics shouldn't diagnose, just drive to hospital". Where as if a GP buggers up (and they do more often than we do), there is a certain understanding that they're not perfect, mistakes happen and not everyone presenting with a little nausea needs an ED/ID referral. But if we go to Johnny Idiot with nausea and it turns out he has Ebola and we leave him at home, guess whose getting in trouble. If we're ganna use this extra education (which as I already said, is less than adequate), there needs to be some formal recognition of, and protection from, the fact that if we are to leave people at home/refer to LMO using a formal educational framework to inform our clinical decision making, we WILL make mistakes, just like everyone else and that eventually people will get hurt, but that’s the price of a healthcare system that accepts necessary risk.


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## thegreypilgrim (Aug 8, 2011)

(1) Convert all proprietary ambulance services to not-for-profit status, compensate investors for past investment.

(2) Convert all fire-based EMS to independent public agencies.

(3) Transfer federal oversight of EMS from NHTSA to HHS.

(4) Create a professional association representing EMS at national level which also sets professional standards.

(5) Eliminate the EMT and AEMT provider levels.

(6) Replace EMT and AEMT with _Paramedic_ and _Advanced Paramedic_ provider levels.

(7) Redesign educational curricula, transfer training programs to accredited universities.

(7a) Paramedic licensure requires completion of 4-year undergraduate degree.

(7b) Advanced Paramedic licensure requires at least 3 years experience and completion of 2-year graduate degree.

(8) Update Medicare billing standards for ambulance services to no longer require transport for reimbursement.


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## JPINFV (Aug 8, 2011)

Linuss said:


> Up your pay, up your standards of who you hire.
> 
> 
> Basic business management 101.




Increase your education level, legitimately increase the quality and scope of your services, demand more reimbursement from payers, increase pay. Basic economics 101. The problem is, as it stands now, there are more than enough people willing to work for the current pay level, or less, who meets the standards the trade currently sets.


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## Shishkabob (Aug 8, 2011)

usalsfyre said:


> Very true. Very, VERY true. But how many people you work with think they deserve more when they probably don't deserve what they get now?



A few.  (And they tend to be from the EMS of old...)  We should fire them and combine their salary with mine!



But I also know just as many who don't get paid their worth, too.


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## Shishkabob (Aug 8, 2011)

JPINFV said:


> Increase your education level, legitimately increase the quality and scope of your services, demand more reimbursement from payers, increase pay. Basic economics 101. The problem is, as it stands now, there are more than enough people willing to work for the current pay level, or less, who meets the standards the trade currently sets.




And it all comes back to Medicare, and the crap reimbursement they give, and the crap rules they have that you have to transport to be reimbursed.


Yeah, that's not holding back EMS at all...


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## JPINFV (Aug 8, 2011)

Linuss said:


> And it all comes back to Medicare, and the crap reimbursement they give, and the crap rules they have that you have to transport to be reimbursed.
> 
> 
> Yeah, that's not holding back EMS at all...



So prove to Medicare that paramedics are more than horizontal taxi drivers.


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## thegreypilgrim (Aug 8, 2011)

Linuss said:


> And it all comes back to Medicare, and the crap reimbursement they give, and the crap rules they have that you have to transport to be reimbursed.
> 
> 
> Yeah, that's not holding back EMS at all...


 The problem is you really have no grounds to negotiate any of these changes without an industry-wide trend toward higher education. It just can't happen.


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## Shishkabob (Aug 8, 2011)

JPINFV said:


> So prove to Medicare that paramedics are more than horizontal taxi drivers.



Kinda hard to when they pay you as one, and treat you as one.  

If you pay me to do cook food, and only to cook food, there's no incentive to do anything else in the kitchen, regardless of how much better it will make the restaurant run or the food taste.


They pay us to transport and nothing else.  They are what's perpetuating the idea of "You call, we haul, screw treating the patient on scene, 'we don't diagnose' "




thegreypilgrim said:


> The problem is you really have no grounds to negotiate any of these changes without an industry-wide trend toward higher education. It just can't happen.



We DO have a trend going on right now... and to be honest, it IS moving at a faster pace than other, more established, healthcare fields did at the same age.


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## JPINFV (Aug 8, 2011)

Linuss said:


> Kinda hard to when they pay you as one, and treat you as one.



...except no one is going to pay you more, and then hope that you deliver better quality goods.


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## nwhitney (Aug 8, 2011)

I like the idea of increasing the educational requirements for Basic.

I would also implement "No Pants Wednesdays"


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## thegreypilgrim (Aug 8, 2011)

Linuss said:


> We DO have a trend going on right now... and to be honest, it IS moving at a faster pace than other, more established, healthcare fields did at the same age.


 Really? Paramedics are all going to university and getting degrees in paramedicine en masse? This is something that's not happening in a haphazard, inconsistent manner but is an actual recognized standard for the profession? There's a standardized set of core concepts/principles universities can use to develop curricula from?


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## Shishkabob (Aug 8, 2011)

I'm starting to agree with the people who say EMS must fail in order to succeed.



I say Jan 1, 2012, we give the people exactly what they expect.  If Medicare physicians, the news, and the bystanders that call 911 think we're a ride to the hospital and nothing else, let's do that.

We'll stock ambulances with bandages.  No drugs.  No EKGs.  No airway supplies.  No BVMs.   There will be no STEMI alerts, there will be no stroke alerts... if you have an MI or a stroke and the cath lab is at home sleeping, sucks for you.    There will be no pain control.  Break your leg?  Tough it out until you get to the hospital.    While we're at it, let's cut back on ambulances.



Should be an enlightening year, no?


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## JPINFV (Aug 8, 2011)

nwhitney said:


> I like the idea of increasing the educational requirements for Basic.
> 
> I would also implement "No Pants Wednesdays"


 

We could wear skirts...
http://emtlife.com/showthread.php?t=24171


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## usalsfyre (Aug 8, 2011)

At some point the impetus has to be on us, as stewards and guardians of the field, to push change and recognize that education may not pay divedens now, but will in the future. 

However, try telling average joe paramedic who a)got his medic to go into the fire service, b)is doing this because it's easy c)is immature this and you'll be met with howls. I honestly think the reason most good providers leave EMS is less about the pay (not that much less than teachers really) and more about the ungodly hours EMS is expected to work.


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## Shishkabob (Aug 8, 2011)

usalsfyre said:


> and more about the ungodly hours EMS is expected to work.



To get said pay.




Honestly, what I make isn't BAD.  Not what it should be, not what I'd like it to be, but I know people older than me who work in retail who make less.


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## usalsfyre (Aug 8, 2011)

Linuss said:


> To get said pay.
> 
> 
> 
> ...



I could live modestly on what I make, hell, I do. With the hours I'm working now I make good money really. But 171 hours a pay period isn't sustainable when your UHU is above 0.5.


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## RocketMedic (Aug 8, 2011)

A poster earlier wanted us to be able to perform a lot of intensive care. Time consuming work. With equipment that is rare in EMS.

Why not professionalize our existing profession before we become nurses?


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## usalsfyre (Aug 8, 2011)

Rocketmedic said:


> A poster earlier wanted us to be able to perform a lot of intensive care. Time consuming work. With equipment that is rare in EMS.
> 
> Why not professionalize our existing profession before we become nurses?



Much of what we do already is considered critical care in other parts of medicine. 

EMS needs to get over comparing itself to nursing. I practice medicine of limited scope. Nurses practice nursing. Both are different, but important parts of the system.


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## Shishkabob (Aug 8, 2011)

Paramedics share a lot more in common with physicians than with nurses.


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## Sasha (Aug 8, 2011)

I'd paint all the trucks in bright pink.

Sent from LuLu using Tapatalk


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## medichopeful (Aug 8, 2011)

adamjh3 said:


> Wait... there's education requirements for your Basic?
> 
> ...oops



Nah, not really! h34r:


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## nwhitney (Aug 8, 2011)

Sasha said:


> I'd paint all the trucks in bright pink.
> 
> Sent from LuLu using Tapatalk



I'll go along provided it's done on "No Pants Wednesdays"


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## systemet (Aug 9, 2011)

usalsfyre said:


> At some point the impetus has to be on us, as stewards and guardians of the field, to push change and recognize that education may not pay divedens now, but will in the future.



This.

If we want EMS to become a true profession then we need to push the standards and quality of practice forwards.  Professional behaviour is more than polishing your boots, checking the unit first thing every shift, and avoiding swearing.  It also includes a responsibility to increase your personal knowledge, so that you're better able to take care of your patients.

This has worked out quite well for nursing.  I doubt there's many nurses today that would say moving towards a Bachelor's degree entry to practice has been a bad thing for them.


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## RocketMedic (Aug 9, 2011)

To elaborate on my earlier post, its unnecessary for our field to expand as far as giving long-term care in a prehospital environment. We work on the basis that 30 or so trucks can cover a city of millions. That model doesn't hold water everyday as-is in terms of response times or finance, and some would have us remain on scene for hours to manage electrolyte derangements and such? Why not transport them? Yes, we could perform all care that's likely at home, but its not smart to show up, push a bunch of meds, and leave, and its not feasible to quintuple every services size.

We need to stop worrying about scope and arbitrary educational levels. I meet plenty of EMs and Paramedics from the reviled online courses or academies- myself included - and for the moat part I feel like I learned enough to function. I'm getting better with every run. In the end, all any certificate gives you is the knowledge of how little you know.

Pushing a mandatory Bachelors isn't going to solve our problems, nor will expanding the scope. We just need to unite as as a profession, standardize what we are, and fix the semi-broken funding system.


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## systemet (Aug 9, 2011)

Rocketmedic said:


> To elaborate on my earlier post, its unnecessary for our field to expand as far as giving long-term care in a prehospital environment.



I agree.  There's already home care and palliative care to fill those roles.  But what EMS should be able to do, is show up to a home care, palliative care or long-term care patient, provide an initial assessment, liase with the physician and health care team that are looking after this person and determine whether transport to an ER is in their best interests.  I'm not advocating that EMS should try and take over those areas where functioning system exist, just that we should develop clinical pathways that don't end in "stat to the trauma center".

If we encounter a senior who's fallen, we should be able to assess for probable injuries, and if this seems unlikely, refer they for a home-care assessment.  We should be able to assess an isolated extremity injury and see if it meets criteria for radiography, e.g. Ottawa ankle / knee rules.  If that person's still mobile, perhaps some po analgesia, and a referral for x-rays and a family physician examination would be more effective than dumping them in a crowded ER at 3am, on the basis of "we don't diagnose".




> We work on the basis that 30 or so trucks can cover a city of millions. That model doesn't hold water everyday as-is in terms of response times or finance, and some would have us remain on scene for hours to manage electrolyte derangements and such? Why not transport them? Yes, we could perform all care that's likely at home, but its not smart to show up, push a bunch of meds, and leave, and its not feasible to quintuple every services size.



I'm not advocating we start providing ICU care in an urban setting with the aim of avoiding transport.  If someone's that sick, then the hospital is where they need to be.  This level is designed for critical care transport; ground or air.  There's plenty of areas where the nearest hospital with a CT might be 5+ hours by ground or an hour by air.  This is where this level would be most useful.  Or potentially working in a rural ER augmenting a family physician that lacks a comfort with emergency care.

A large part of what we are going to do in any future system is likely to be transport.  I'm just not sure that the default options need to be ER, cathlab and no transport.  I think there's some efficiencies to be gained by referring less acute patients to other services.

I agree that many of our current EMS systems are completely understaffed and over-utilised.  This is something else that also needs fixing.  But perhaps if EMS can provide savings by directing patients at contact to other services, the money saved to the healthcare system could be redirected towards EMS.  



> We need to stop worrying about scope and arbitrary educational levels. I meet plenty of EMs and Paramedics from the reviled online courses or academies- myself included - and for the moat part I feel like I learned enough to function. I'm getting better with every run.



I'm not saying paramedics who went to a shorter or on-line(?) course are bad people.  Or that they don't care about their patients.  Or that someone who has gone to school for four years for a degree is going to automatically be better.  I'm just saying that if you extend the training time the level of the average provider is going to increase.  It's hard for me to see why it wouldn't.

If you look at what we do in the field, we have a huge amount of responsibility.  We choose when to RSI people, or when to do medication facilitated intubations.  This should be a very difficult decision, as it comes with incredible risk to our patients both with the initial procedure, and the long-term management.  We're treating tachyarrhythmias, bradyarrhythmias, running cardiac arrests (as futile as this may largely be).  Doing conscious sedations.  Interpreting 12-leads and diagnosing infarcts, providing lysis or referring patients to PCI.  

There's no where else in the health care system that people are doing this with 2 years of education.  This barely gets an LPN any more, or a lab technician.



> In the end, all any certificate gives you is the knowledge of how little you know.



And that's a good thing, right?  And so if a little education gives you a better understanding of the risks of what you're doing, and a little more respect for how little you know, doesn't it follow that a longer education might gives you a better understanding of these risks?  And perhaps ensure that while you'll be aware that there's more things you don't know, at least the things you don't know are now a little more complicated?



> Pushing a mandatory Bachelors isn't going to solve our problems, nor will expanding the scope.



It would go a long way to solving our educational problems. 

As to scope, are the public going to care?  Probably not.  Are other health care professions going to care?  To the extent that they feel threatening, which realistically, isn't going to be much.  If you talk to the average person and tell them a paramedic makes too little, they're not going to care whether you can do a CABG using a coat hanger, upside down in a ditch in car half filled with water while being attacked by mutant ninja dinosaurs with lasers for eyes -- they're going to ask, "well how long does it take to become a paramedic?".  And they're going to compare the income to similar professions with a similar training time.  A lot of the time that doesn't work out too great.




> We just need to unite as as a profession, standardize what we are, and fix the semi-broken funding system.



I agree that we need to do all these things.  But I also believe that a major step in that direction is increasing our educational standards, and that these are currently too low -- particularly at the BLS level, but also at ALS.


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## RocketMedic (Aug 9, 2011)

Most education in EMS is on-the-job. If we start pushing a 2 or 4 year degree to even start working, we either need to massively increase payroll or get ready for a shortage.


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## firetender (Aug 9, 2011)

*Take it back to the Drawing Board*

Everything has changed.

EMS started as a movement to send trained personnel to the scenes of accident or injury; to essentially take the ER TO the patient.

Unfortunately, when we got there a whole bunch of other people hopped into our ambulances!

We became an OUTLET, and in many areas, the outlet of choice (theirs, not ours!)

Today, EMS is a reflection of the ABSENCE of viable alternatives for the patient. We need to have places to bring a lot of these people to. Right now, we take the poor into overpriced facilities that make people poorer and don't necessarily get the job done; primarily because there's no follow-up to PREVENT more rides to the ER.

We need to make this a profession. That means, IMHO:

    #1) Deal with the burnout issue -- until that's tackled (and if you really look you'll see that many of the issues around it are a direct result of the crazy-making behind so many people to treat with only one place to send them), the transience of our personnel will doom us to eternal purgatory.

   #2) Medics need to be trained in the Art of Handling Humans. That means a much more broad education on servicing the people we actually service. That means a minimum Associate's level to get on the rig.

   #3) We need mid-level facilities (like sub-specialty pediatric and elderly evaluation and "holding" facilities) to bring people to.

   #4) ...or, preferably, a system set up where emergency ambulances are not tied up in the transport of minor ailments.

   #5) Staffing must reflect the needs of our population such that as first response, trained medics get there but have the TIME to appropriately make sure the patients get to their next level of care.

   #6) THEN let's get to the life-saving stuff and make sure there's at least a Bachelor's degree involved, and...

   #7) the system is designed into tiers. Until a better way is found, or intermediate facilities established, the more highly trained medic needs to be first response and the decision for a lower tier to transport must be made. In that sense, EMS needs to be re-designed so that rapid, safe response occurs first, evaluation done on-scene (with life-saving measures immediately initiated) and THEN appropriate transport arranged.

I guess that's just for starters.


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## Tigger (Aug 9, 2011)

Rocketmedic said:


> Most education in EMS is on-the-job. If we start pushing a 2 or 4 year degree to even start working, we either need to massively increase payroll or get ready for a shortage.



I think OTJ education is massively important in EMS. However, without a solid foundation to start from, the OTJ education component isn't really education. It's not about the "why" in EMS. When you get trained on the job, it's all scenario based. A patient presents a certain way and you are shown how to deal with the presentation. But rarely does this lesson seem to include why a certain intervention is actually taking place. All you get out of this style of education is "the patient looks like this so I do that." That isn't going to further EMS, I don't think. 

Most healthcare degrees include a significant degree of patient contact during the program. However, no one ends up practicing in the field until they have a solid background in education. The clinical time in EMS education needs to come on line with the rest of the medical world as well. The idea that a provider's clinical time is based around only performing a minimum number of procedures and interventions is inherently flawed. I would like to see clinical time move towards a more flexible timeframe. Dropping five tubes during clinical time does not indicate with any degree of certainty that a provider is proficient at intubating does it? Instead, it would be nice if a preceptor type person could make the call when a person is proficient in a certain skill. 

I don't have much experience in internships and residencies, but I know that in dietetics programs that the internee is constantly being evaluated by a preceptor figure, and that person determines the intern providers competency, not a check sheet.

I would also like to see higher level classroom education occurring in a more informal degree during the internship phase so that students could receive critical and constructive feedback about their performance in the field while not actually in the field.


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## fortsmithman (Aug 9, 2011)

Rocketmedic said:


> Most education in EMS is on-the-job. If we start pushing a 2 or 4 year degree to even start working, we either need to massively increase payroll or get ready for a shortage.



Here in Canada namely the province of Ontario  In order to work in an ambulance you need to be a Primary Care Paramedic.  The education required is a 2 year college diploma.  There in even a 4 year Bachelor of Science degree in Paramedicine, and that only lead to BLS level.  If you want to work ALS then it\'s another year of school above an beyond the Primary Care Paramedic programs.   As well in Australia and I believe New Zealand  You need at least a bachelor degree to work in an ambulance.


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## the_negro_puppy (Aug 9, 2011)

fortsmithman said:


> Here in Canada namely the province of Ontario  In order to work in an ambulance you need to be a Primary Care Paramedic.  The education required is a 2 year college diploma.  There in even a 4 year Bachelor of Science degree in Paramedicine, and that only lead to BLS level.  If you want to work ALS then it\'s another year of school above an beyond the Primary Care Paramedic programs.   As well in Australia and I believe New Zealand  You need at least a bachelor degree to work in an ambulance.



Almost correct, some states in Australia still employ paramedics with a diploma (equal to half a bachelors degree) I am going through the diploma program, however I already have a BSc and a Masters not related to health. Very soon it will be degree level minimum for paramedic, with post-graduate qualifications for intensive care paramedic (already)


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## RocketMedic (Aug 9, 2011)

Another flaw in our education system is the tremendous ease with which many programs drop students. Miss a test day? Goodbye. Miss a payment? Goodbye. We need to build our system to allow people to learn and retain some flexibility.

Another recurring problem is funding. In the US, its becoming increaingly clear that the economy and federal spending cannot continue to expand, and new taxes are difficult both fiscally and politically. Why expand funding so massively for EMS on the governments dime?
The best way to improve our profession is to keep EMS as an organic, easy-to-enter arm of medicine. I joined the Army to afford paramedic school at CSN Las Vegas, but lucked out and earned it in El Paso. Having to make that choice sucks. We will do ourselves a disservice if we drastically increase the entry requirements.
We need to standardize who we are on a national level. Concurrently, our employers need to partner new medics with experienced medics whenever possible- say, make an initial recertification involve a reasonable amount of calls and an honest evaluation by a senior medic preceptor and or medical director.
we should modestly increase time requirements for education- 600 hours or one year for EMT and 4000 and three years or so for paramedics. We will need to provide scholarships or financial aid for the paramedics unless pay goes up a lot.

Call me dumb, but I think the current system works pretty well. We don't do this for money. More would be nice, but I'm doubtful that the same things nursing used to secure better wages will work for EMS...nor should it. On some level, a lot of us need to accept that we will be unable to provide service if our customer communities can't support us. We need to determine what our communities can pay before we set these education requirements.


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## usalsfyre (Aug 9, 2011)

Rocketmedic, to respectfully disagree, the LAST thing EMS, and especially EMS's patients, need to be is an easy to enter arm of medicine. EMS, at the paramedic level, is very often far more autonomous than say nursing or respiratory therapy. In fact, we have more in common with mid-level providers such as PAs and NPs than other allied health providers. If you look at the Webster's definition, we practice medicine. Granted, it's of very limited scope, but it's still the practice of medicine. No other arm of medicine would dream of placing providers in this position with as little as 700 hours of didactic training. 

Again, we need to stop relying on the government and other parties for professional improvement. The push needs to come from within, and we need to take control of the profession. As for the salary, my gut says a needed contraction of paramedics would take place. Put "primary" paramedics on the transport trucks and save the four year medics for high level responses and primary care type decisions.


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## RocketMedic (Aug 9, 2011)

It does not take two years to learn BLS, nor should it take 4 years and a batchelors to run as a primary care paramedic. I'm all for increases in scope requiring educational increases- but I am warning against setting the baseline for entry as high as some want it.


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## Handsome Robb (Aug 9, 2011)

I agree with upping the standards. However, we can't go from nothing to a Bachelor's with the snap of a finger. 

I can see an AAS required for ALS, then eventually a BS, but it's not something thats going to happen overnight. Possibly something similar to an AAS for ALS then a year-long, paid internship at the ILS level before being promoted to an ALS provider if that makes sense.


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## fortsmithman (Aug 10, 2011)

Rocketmedic said:


> It does not take two years to learn BLS, nor should it take 4 years and a batchelors to run as a primary care paramedic.


It is spelled Bachelor not Batchelor.


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## fortsmithman (Aug 10, 2011)

usalsfyre said:


> Rocketmedic, to respectfully disagree, the LAST thing EMS, and especially EMS's patients, need to be is an easy to enter arm of medicine. EMS, at the paramedic level, is very often far more autonomous than say nursing or respiratory therapy. In fact, we have more in common with mid-level providers such as PAs and NPs than other allied health providers. If you look at the Webster's definition, we practice medicine. Granted, it's of very limited scope, but it's still the practice of medicine. No other arm of medicine would dream of placing providers in this position with as little as 700 hours of didactic training.
> 
> Again, we need to stop relying on the government and other parties for professional improvement. The push needs to come from within, and we need to take control of the profession. As for the salary, my gut says a needed contraction of paramedics would take place. Put "primary" paramedics on the transport trucks and save the four year medics for high level responses and primary care type decisions.



I agree with the above statement.


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## systemet (Aug 10, 2011)

Rocketmedic said:


> Another flaw in our education system is the tremendous ease with which many programs drop students. Miss a test day? Goodbye. Miss a payment? Goodbye. We need to build our system to allow people to learn and retain some flexibility.



This should be fixed, as well, I agree.  I think that part of the problem is we have too many private training academies providing instruction.  They don't have to be as transparent or accountable for how they do business.  

If we move training programs away from private enterprise and into technical colleges or universities, I think this situation will improve.

The other thing that needs to change to support this, is the mentality of many EMS providers.  It seems like a lot of us believe that some people simply "don't have what it takes" to be an EMT / Paramedic, and others do.  Usually the ones that do are the ones we think are most like ourselves.  While I accept there's a percentage of people who aren't going to enjoy or thrive in a high stress job, I think most people are capable of becoming good EMTs or paramedics given the right support and training.  

Any time a preceptor or mentor feels it necessary to fail a student, they should take this as a personal failure to provide them with the necessary training.  Admittedly, sometimes this is the fault of the training institute for not giving the student a good enough base.  And sometimes it's practicum/employer policies that don't allow a preceptor or mentor to extend a student's training beyond a certain fixed time.  But I think sometimes we're too quick to throw away good people.




> Another recurring problem is funding. In the US, its becoming increaingly clear that the economy and federal spending cannot continue to expand, and new taxes are difficult both fiscally and politically.



I think that's a difficult issue.  It seems like there's no support for increasing the tax rates, despite the US being one of the least-taxed industrialised nations, and that healthcare funding is particularly divisive.  I'm sure it's hard in the current climate to argue taking funding dollars away from the armed forces and directing it to EMS.



> Why expand funding so massively for EMS on the governments dime?



I'd assume this would work if the majority of people in the states were willing to accept a trivial tax increase to pay for better health care.  Perhaps they are, perhaps they aren't.  I've always lived in countries with universal public healthcare, so I've never had to experience the public-private debate personally.  Right now though, isn't the US EMS system primarily funded at a municipal, not a federal level?

If we're going to increase EMS service levels then someone has to pay.  Perhaps more people in the US would prefer to see taxation in the form of user fees instead of income tax.  I don't know.  I think there would be some cost savings if we can direct people through the healthcare system in a more efficient manner, but whether they'd cover the cost is another matter.

For what it's worth, the cost of EMS for a given city is usually trivial compared to costs for fire, police services, parks & rec, city works, etc.




> The best way to improve our profession is to keep EMS as an organic, easy-to-enter arm of medicine. I joined the Army to afford paramedic school at CSN Las Vegas, but lucked out and earned it in El Paso. Having to make that choice sucks. We will do ourselves a disservice if we drastically increase the entry requirements.



I don't think I follow, why would this be bad?



> We need to standardize who we are on a national level. Concurrently, our employers need to partner new medics with experienced medics whenever possible- say, make an initial recertification involve a reasonable amount of calls and an honest evaluation by a senior medic preceptor and or medical director.



I think this is a good idea.  One of the places I worked used to give a 2-3 week academy (all classroom), then 4 tours (192hr) on the road for an EMT with a mentor, or 8-12 (768 hr), before you could work with another new hire.  Other places just showed you where the narcs were, gave you a map, and let you learn the hard way.  I preferred the first method.



> we should modestly increase time requirements for education- 600 hours or one year for EMT and 4000 and three years or so for paramedics. We will need to provide scholarships or financial aid for the paramedics unless pay goes up a lot.



I'd support that.  Right now, any increase in the standards is an improvement.  I see a bachelor's degree paramedic as a decent goal, you might not.  But 3 years is an improvement on the current situation.

I only paid about $3,000 / year for my medic program, but this was a while back.  I worked full-time as an EMT while I did my medic(2 year program, M-F 8 hrs a day; 1200h am practicum, 400 hr hospital) and took loans from the bank for another $12,000.  Paid it all off within a year.  I was lucky.

Perhaps the issue I'm not getting here is how expensive university education is in the states.  I've had free education for the last few years, but when I did my BSc.  I paid around $5,000-$6,000 / year.  It wasn't easy, but it was probably a lot cheaper.  




> Call me dumb, but I think the current system works pretty well.



I think I've seen a continuous improvement in the time I've been in EMS.  I don't think it's always felt like things are moving forwards. Often the change has been managed very poorly.  But if I look over time periods of a couple of years, the end result has been an improvement in the medicine.  

I'm not sure if I can say that the working conditions have got better.  I'd argue in the last place I worked in that they were getting worse.  

However, I definitely think there's a lot of room for improvement.  It's a young field.  I think we've all benefited from those who've come before us, but at the same time we have a responsibility to keep pushing things forward.



> We don't do this for money



I do.  Or at least I did, and will again (I haven't worked in EMS for the last couple of years).  It has to pay my mortgage, it has to support my wife working less than full-time, and it has to support my daughter, and hopefully future children.

Right now, for me, it's where I can make the most money.  I know a lot of people here think that medics don't make much, but I felt I was pretty well paid.  I know people with PhDs in hard scientific fields making $37,000 / year after 10 years of university.  I made that some years as an EMT.  Perhaps the area I worked in paid paramedics very well, and I should be grateful for that.  I felt I was well paid.  Perhaps even overpaid.

I was never able to understand the general dissatisfaction with salary where I worked.  We make 10-20% less than the RNs.  About the same less than the cops.  More than fire at the bottom end, but less at about 5 years.  The major problem was a lack of career mobility.  This is slowly improving, but it's not even close to those fields.  I thought that we made a lot of money for the amount of training hours we had.

[I should point out, in fairness, that I did EMS primarily for the satisfaction of helping people, the feeling of doing a job where I was having a positive impact on my community, making a difference in people lives, the changing workplace environments, and because of a deep interest in medicine.  I've missed those things, and look forward to going back.  It wasn't just about money, but at the end of the day, it does have to pay the bills.]  




> . More would be nice, but I'm doubtful that the same things nursing used to secure better wages will work for EMS...nor should it.



Why?  What do you think is different?  Why do you think increasing the education requirements allow the nurses to professionalise, but won't help us?



> On some level, a lot of us need to accept that we will be unable to provide service if our customer communities can't support us. We need to determine what our communities can pay before we set these education requirements.



Are you sure that's the right way around?  Isn't the responsibility more for us to prove that we're worth paying more?


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