# We don't need "training" in EMS



## thegreypilgrim (Sep 20, 2009)

We need _*education*_. 

For those of you who don't think there's a difference, I think a little thought experiment will show you that you actually do.

What if all the middle schools in the country decided that 7th graders were no longer going to receive Sex Education, but instead were going to receive Sex _*Training*_? Imagine the homework assignments for that...

So there's the difference. The _training_ one needs for work in EMS is minimal compared to the _education_ one ought to have.


----------



## MMiz (Sep 20, 2009)

I disagree.  We need education _and_ training.  Education is associated with learning done in a classroom or school, whereas training is usually associated with learning and mastering a skill.  In order to be a great EMT you need both a solid education and exceptional training.


----------



## thegreypilgrim (Sep 20, 2009)

MMiz said:


> I disagree.  We need education _and_ training.  Education is associated with learning done in a classroom or school, whereas training is usually associated with learning and mastering a skill.  In order to be a great EMT you need both a solid education and exceptional training.


Yeah that's compatible with what I asserted in the OP. My point was that skill-set training is minimal compared to the clinical education we ought to have so that we can actually be proficient and competent in our skills. Any monkey can be shown how to intubate, but knowing when someone needs to be intubated and when they don't and why requires something else entirely.


----------



## Lifeguards For Life (Sep 20, 2009)

While i agree that Education is important, and should be a required trait in the field, i think the manner within which it is consistently discussed in this forum, takes away from the quality and appeal of the site. when so many forums turn into "get an education bashes", it diminishes the appeal to post comments/guestions.
Everyone has the right to be new, most people recognize the need for a college education. What is wrong with beginning a career, and getting my degree while working in the field? My paramedic Program is an A.S. program. When I finish the paramedic certificate portion, I will have 54 college credits, over half way there to an A.S degree. Do many employers not recognize the fact that you are working toward a college degree?
Most patients will never know nor be able to tell what sort of college education you hold.


----------



## JPINFV (Sep 20, 2009)

Lifeguards For Life said:


> Everyone has the right to be new, most people recognize the need for a college education. What is wrong with beginning a career, and getting my degree while working in the field? My paramedic Program is an A.S. program. When I finish the paramedic certificate portion, I will have 54 college credits, over half way there to an A.S degree. Do many employers not recognize the fact that you are working toward a college degree?
> Most patients will never know nor be able to tell what sort of college education you hold.



You need the education before you start training. There's a reason why the first two years of medical school focus mostly on science (while also teaching the basics of medicine) and the rotations (where the science is first applied) after the education. Similarly, there's a reason why medical student orders have to be cosigned. Only following medical school are physicians licensed (either fully or under a limited 'resident' license) and able to fully write their own. Experience is built on of training, training is built on of education, and education is the base.


----------



## Lifeguards For Life (Sep 20, 2009)

JPINFV said:


> You need the education before you start training. There's a reason why the first two years of medical school focus mostly on science (while also teaching the basics of medicine) and the rotations (where the science is first applied) after the education. Similarly, there's a reason why medical student orders have to be cosigned. Only following medical school are physicians licensed (either fully or under a limited 'resident' license) and able to fully write their own. Experience is built on of training, training is built on of education, and education is the base.



Does Paramedic school not count as education? You don't "need" history, upper level math classes, foreign language classes to do the skills required of paramedics, hince they are not required. I intend to pursue these goals, but in all seriousness, how much do you believe they effect patient care?


----------



## Burlyskink (Sep 20, 2009)

Lifeguards For Life said:


> Does Paramedic school not count as education? You don't "need" history, upper level math classes, foreign language classes to do the skills required of paramedics, hince they are not required. I intend to pursue these goals, but in all seriousness, how much do you believe they effect patient care?



What about A&P and classes actually oriented toward healthcare? Im not in medic school but as far as I know you do not learn things that those classes provide.


----------



## Lifeguards For Life (Sep 20, 2009)

Burlyskink said:


> What about A&P and classes actually oriented toward healthcare? Im not in medic school but as far as I know you do not learn things that those classes provide.



In my paramedic program, they give you the anatomy and phsyiology classes, In short paramedic class teaches you what you need to know to be a Paramedic(same as EMT school teaches you to be an EMT), A college education(if thats even the education this thread is reffering to) while desirable, i do not believe will play a large roll in your day to day duties as a paramedic. Your patints will most likely not know nor care what your college education details, as long as you provide competent, effectionate patient care, all of which can be leared in a reputable, accredited paremedic program.


----------



## JPINFV (Sep 20, 2009)

How many paramedic schools require (either as a prereq or a part of the course) college level anatomy, physiology, chemistry, and physics (at a minimum mechanics)? I can easily find paramedic programs where the only requirment is a CPR card and an EMT-B certification and doesn't include those programs as a part of the program.


----------



## Lifeguards For Life (Sep 20, 2009)

JPINFV said:


> How many paramedic schools require (either as a prereq or a part of the course) college level anatomy, physiology, chemistry, and physics (at a minimum mechanics)? I can easily find paramedic programs where the only requirment is a CPR card and an EMT-B certification and doesn't include those programs as a part of the program.



I do not know. My school offers a full college level anatomy physiology course, and chemistry and physiology (while not there own classes), are discussed as they are relevant to the skill set of a paramedic. I get college credit for my paramedic course, though i do recognize that many Paramedic schools require and often teach the bare minimum, turning out mass quantities of paramedics who do not adapt well into the field


----------



## ResTech (Sep 20, 2009)

I believe heavily in more education for a more well rounded provider but at the same time I am also realistic. I see where Lifeguard is coming from. The day to day job of being a Paramedic consists of being in contact with a patient for an average of 20mins and delivering them to the hospital hopefully in better condition than you found them.... done deal.  

The field is just that... the FIELD. Only so much can and should be done. We all know what the ultimate goal is... to get the patient to the hospital. You can spend all the time in the world taking microbiology and advanced math, but is it really gonna allow you to provide care different than a Paramedic who didn't? No, its not. 

As Lifeguard said, a Paramedic program prepares you to be a Paramedic... not a physician.... its not Medical School. Pre-hospital care is meant to stabilize and relieve immediate pain and suffering... not to play wanna-be doctor.


----------



## JPINFV (Sep 20, 2009)

I guess PAs, NPs, RNs, or RTs don't need education since they aren't doctors either then. Either that, or EMS really is simply "you call, we hall, that's all" and deserves the low pay since it really is just a glorified taxi service regardless of if it's 911 or IFT. EMS can be more, but 110 or 1000 hours of technical training won't achieve that.


----------



## daedalus (Sep 20, 2009)

Attitudes like ResTechs are self limiting and will stunt your growth as a provider. "I only drive em to the ER".


----------



## Lifeguards For Life (Sep 20, 2009)

daedalus said:


> Attitudes like ResTechs are self limiting and will stunt your growth as a provider. "I only drive em to the ER".



I believe I fully understand both views, but i do not think ResTechs views are self limiting. He acknowledges education is important but he realizes its place in the field. I am not trying in any way to promote the ambulance driver image, I just don't agree with some of the views about the essentials of a college education. If you were to call 911 you would expect a paramedic to come to your aid, not your run of the mill college student. If that paramedic has a college education, thats great, but will the patient ever know? I believe furthering ones general knowledge database is a great thing, good marketability to employers, though due to the nature of the service we render, not a predominant factor in our service
I guess I got into this thread due to a comment earlier. If am a young paramedic, actively pursuing a college degree, everything else aside do you honestly think that my care could or would be less adequate than, a degree holding colleague?


----------



## Lifeguards For Life (Sep 20, 2009)

ResTech said:


> As Lifeguard said, a Paramedic program prepares you to be a Paramedic... not a physician.... its not Medical School. Pre-hospital care is meant to stabilize and relieve immediate pain and suffering... not to play wanna-be doctor.



Exactly. If you had a M.D in your ambulance, typical equiptment your ambulance carries, do you believe the vast majority of your calls would have a different outcome?


----------



## JPINFV (Sep 20, 2009)

Lifeguards For Life said:


> Exactly. If you had a M.D in your ambulance, typical equiptment your ambulance carries, do you believe the vast majority of your calls would have a different outcome?



If the ambulance only had a driver and a gurney, would the vast majority of the calls have a different outcome?


----------



## Lifeguards For Life (Sep 20, 2009)

JPINFV said:


> I guess PAs, NPs, RNs, or RTs don't need education since they aren't doctors either then. Either that, or EMS really is simply "you call, we hall, that's all" and deserves the low pay since it really is just a glorified taxi service regardless of if it's 911 or IFT. EMS can be more, but 110 or 1000 hours of technical training won't achieve that.



No, Paramedics need education, and they receive that education in paramedic school. Not that EMS is as simple as "you call we haul that's all", they do call and we do haul. We can and do provide Advanced Life Support, but isn't the ultimate goal still the same as an EMT-B, to stabilize and get the patient to definitive care at the hospital? now we do have considerably more resources, training, and education than the EMTB. While I really would love to see advancements in the field of prehospital emergency medicine, at this point in time, I just do not see holding a college degree, affecting patient care.
I actually do support prerequisites into Paramedic school, and into our field. But right now there are few, if any in most areas in place. So I do not see anything wrong with the path i have chose. I do not hold a college degree at this point, but I will, and degree or not, with the current scope of practice for the paramedic, I do not see the degree playing a large roll in the quality of my patient care.


----------



## Lifeguards For Life (Sep 20, 2009)

JPINFV said:


> If the ambulance only had a driver and a gurney, would the vast majority of the calls have a different outcome?



Yes. transporting with only a gurney and driver would be the definition of you call we haul. The scenario you posted above is pretty much how EMS got its roots. 
But we as Paramedics, have much more tools and resources than just a gurney, and use them to fullfill the job description. In general field paramedicine is short term care, not the same as nursing.


----------



## JPINFV (Sep 20, 2009)

Lifeguards For Life said:


> Yes. transporting with only a gurney and driver would be the definition of you call we haul. The scenario you posted above is pretty much how EMS got its roots.
> But we as Paramedics, have much more tools and resources than just a gurney, and use them to fullfill the job description. In general field paramedicine is short term care, not the same as nursing.



The question presented was 'does a physician make a difference in the majority of the calls over a paramedic?' I'm simply presenting a similar question. Does having even an attendant make a difference in the majority of calls? Now the question is, do we educate and train ourselves for the majority of calls, or to be able to handle those rare calls where a patient is truly acutely ill?


----------



## Lifeguards For Life (Sep 20, 2009)

JPINFV said:


> The question presented was 'does a physician make a difference in the majority of the calls over a paramedic?' I'm simply presenting a similar question. Does having even an attendant make a difference in the majority of calls? Now the question is, do we educate and train ourselves for the majority of calls, or to be able to handle those rare calls where a patient is truly acutely ill?



Which is a good point. I believe we should strive for excellence in patient care, so yes we should train for the scenario where a patient is truly accurately ill(still not entirely seeing basic college education helping here). Now I ask you as a medic with your current SOPs, protocols, rules and regualtions what would you do differently for a patient with a commonly occuring illness that you may be able to fairly accurately predict in the field, as opposed to the obviously ill patient that can not possibly be diagnosed in the field, and may be hard to diagnose in the hospital setting. Ultimately would you treat a chronic bronchitis patient any different than a Fabry disease patient, in terms of prehospital care?


----------



## JPINFV (Sep 20, 2009)

Lifeguards For Life said:


> No, Paramedics need education, and they receive that education in paramedic school. Not that EMS is as simple as "you call we haul that's all", they do call and we do haul. We can and do provide Advanced Life Support, but isn't the ultimate goal still the same as an EMT-B, to stabilize and get the patient to definitive care at the hospital?


I would argue that EMS should be definitive _emergency_ care for most patients. Hopefully, by the time the patient reaches the hospital, the acute emergency is over in most cases. Now I'm not advocating being able to do surgery or mobile cath labs, but if a patient needs to be intubated, I'd prefer that the provider is educated and trained on a wide variety of techniques and tools to achieve that and to be able to pick the right tool in the first place. This requires looking at interventions in a separate light than just steps in a protocol.  




> now we do have considerably more resources, training, and education than the EMTB. While I really would love to see advancements in the field of prehospital emergency medicine, at this point in time, I just do not see holding a college degree, affecting patient care.


How can you justify doing more without an educational base to work off of? It's easier to add roles to a provider that has an educational foundation to work off of than a training foundation to work on. 



> I actually do support prerequisites into Paramedic school, and into our field. But right now there are few, if any in most areas in place. So I do not see anything wrong with the path i have chose. I do not hold a college degree at this point, but I will, and degree or not, with the current scope of practice for the paramedic, I do not see the degree playing a large roll in the quality of my patient care.



Do you see yourself still on the street in 10, 20, or 30 years? What about becoming involved in training, education, administration, or other patient care levels (e.g. Wake Forrest's advanced practice paramedics)? I could see a lack of education as being a road block for those (not directed at you since you are looking at completing a degree) not seeking to advance their education.


----------



## JPINFV (Sep 20, 2009)

Lifeguards For Life said:


> Which is a good point. I believe we should strive for excellence in patient care, so yes we should train for the scenario where a patient is truly accurately ill(still not entirely seeing basic college education helping here). Now I ask you as a medic with your current SOPs, protocols, rules and regualtions what would you do differently for a patient with a commonly occuring illness that you may be able to fairly accurately predict in the field, as opposed to the obviously ill patient that can not possibly be diagnosed in the field, and may be hard to diagnose in the hospital setting. Ultimately would you treat a chronic bronchitis patient any different than a Fabry disease patient, in terms of prehospital care?



First let's be clear about what I am and where I'm heading. I'm an EMT-B with a masters degree currently in my first year of medical school. I am not a paramedic and would gladly yield patient care to a paramedic since a paramedic has completed their training (and hopefully education) and is better equipped (both physically and mentally [i.e. training/education]) to handle acutely ill patients. 

As a basic, I know I've picked up on patients being sicker than they outwardly appeared and picked up on patients being more stable despite looking like a train wreck (in terms of acute illness. Most SNF patients are train wrecks of the chronic illness type). I've treated patients with acute psychiatric disorders differently because of my education (book plug: The Man Who Mistook His Wife For A Hat: And Other Clinical Tales by Oliver Sacks. ISBN: 0684853949). I'd argue that my PCRs were better written in large part due to the several writing courses I was required to take (including an upper division biological sciences writing course). I'd argue that taking statistics helped to understand the studies when I'd occasionally pick through the Journal of Emergency Medicine.


----------



## Lifeguards For Life (Sep 20, 2009)

JPINFV said:


> First let's be clear about what I am and where I'm heading. I'm an EMT-B with a masters degree currently in my first year of medical school. I am not a paramedic and would gladly yield patient care to a paramedic since a paramedic has completed their training (and hopefully education) and is better equipped (both physically and mentally [i.e. training/education]) to handle acutely ill patients.
> 
> As a basic, I know I've picked up on patients being sicker than they outwardly appeared and picked up on patients being more stable despite looking like a train wreck (in terms of acute illness. Most SNF patients are train wrecks of the chronic illness type). I've treated patients with acute psychiatric disorders differently because of my education (book plug: The Man Who Mistook His Wife For A Hat: And Other Clinical Tales by Oliver Sacks. ISBN: 0684853949). I'd argue that my PCRs were better written in large part due to the several writing courses I was required to take (including an upper division biological sciences writing course). I'd argue that taking statistics helped to understand the studies when I'd occasionally pick through the Journal of Emergency Medicine.



Well it seems we have come upon an agreement of sorts. congratulations on medical school. I hope you did not take any of my posts personal, and I thank you for a respectful, clean cut debate, as many civilized debates on this forum escalate, turn to name calling and get locked. Good luck to you in School, i'm sure i'll see you in the chat room later on


----------



## ResTech (Sep 20, 2009)

> If the ambulance only had a driver and a gurney, would the vast majority of the calls have a different outcome?



Actually, it some cases and call types, the patient would fair out better! This has been proven. Again, to go along with my point... the field is just that and patients need the hospital no matter how many degrees you hold.


----------



## VentMedic (Sep 20, 2009)

ResTech said:


> Actually, it some cases and call types, the patient would fair out better!


 
I agree especially for medical transfers or dialysis. EMTs know very little about medical diagnoses or disease processes and get very complacent with these patients. The van driver that regularly sees his/her patients will often notice something isn't right immediately and go to the ED. Some EMTs have even brought dead patients to dialysis because they just thought the patient was sleeping.


----------



## ResTech (Sep 20, 2009)

> Attitudes like ResTechs are self limiting and will stunt your growth as a provider. "I only drive em to the ER".



Why is my take "self-limiting"? I am an advocate for increased educational standards and support them. I am even actively pursuing them in a degreed Paramedic program and plan on seeking a BS from George Washington University in EMS Management afterwards. If I didn't support education my plans for the future BS degree would not be in place... I would simply be happy with my Paramedic patch and be done with it.. but no.. I want the A.A.S degree AND the BS degree. Why? because I see the importance of a strong educational background not because I think my degree's will enable me to be smarter in cardiac emergencies or trauma, etc.  

I have been in EMS long enough to know what works. I really dont want to get on the education thing.... but I know first hand what it takes to be a good provider and someone not having micro, statistics, or geometry, isn't gonna make a bit of difference when it comes down to the actual clinical care. In fact, the majority of Paramedic's I have worked with over the years... did not have degree's and were great and very knowledgeable Paramedics. 

I'm just not willing to accept the condescending attitudes of you ppl towards Paramedics who do not have degree's or who think a non-degreed provider can not be as skilled.


----------



## ResTech (Sep 20, 2009)

No, Vent... I'm talking about trauma patients where you have Paramedics who **** off for way too long on the scene...


----------



## VentMedic (Sep 20, 2009)

ResTech said:


> In fact, the majority of Paramedic's I have worked with over the years... did not have degree's and were great and *very knowledgeable Paramedics. *


 
What are you basing this on? Many EMT-Bs think the Paramedics are great because they "look good" or were really nice to them. With the limited medical knowledge you have as an EMT-B are you really able to QA these medics at that level? Have you read their patient reports and found their charting to be in order and that they actually gave the proper meds by a good field diagnosis? Or, are you basing your experience from a couple of cool codes? 





> I have been in EMS long enough to know what works. I really dont want to get on the education thing.... but I know first hand what it takes to be a good provider and someone not having micro, statistics, or geometry, isn't gonna make a bit of difference when it comes down to the actual clinical care.


 
Your remarks just show how difficult to stress the importance of education to someone who doesn't have the background. It also shows that the Parmaedics you believe are so knowledgable probably aren't because you have nothing to compare them with. 



> No, Vent... I'm talking about trauma patients where you have Paramedics who **** off for way too long on the scene...


 
Frankly I could care less what you were talking about since the same could be applied to many different situations by providers who don't have enough education. But, you and I already had this discussion where you believe the Paramedic doesn't need a bunch of book learnin'. Just a few skills and a recipe book will make you a great Paramedic to the eyes of an EMT-B.  But, when compared to even the health care professionals that have only a two year degree, what gives you credibility?

What a shame after 40+ years attitudes like yours still exist.


----------



## ResTech (Sep 20, 2009)

lol.. laughable at how you try to tear something apart to satisfy your own views. 

My college has both a degree option and a non-degree option... there are ppl in my class from both. So because one finishes with a degree and the other doesn't that means they are less able to apply their knowledge and skills in the field? Even though they were right there beside me hearing the same lectures and practicing the same skills? That makes no sense at all. 

It's one thing to promote education, just don't be ignorant while doing so... get my point?


----------



## VentMedic (Sep 20, 2009)

ResTech said:


> lol.. laughable at how you try to tear something apart to satisfy your own views.
> 
> My college has both a degree option and a non-degree option... there are ppl in my class from both. So because one finishes with a degree and the other doesn't that means they are less able to apply their knowledge and skills in the field? Even though they were right there beside me hearing the same lectures and practicing the same skills? That makes no sense at all.
> 
> It's one thing to promote education, just don't be ignorant while doing so... get my point?


 
Your arguments are so ridiculous about education, I am just astounded at what is working in the field sometimes.

Do you not think that those who are in the degree track and who have taken college level A&P and pharmacology don't process the information in Paramedic school differently?

There are reasons why every medical profession from RN to MD require prerequisites. 

Many health care professionals can do the exact same skills as the Paramedic and much more. They actually have no problem incorporating the skills later since they have a good educational foundation even if they didn't cover them in their college program. Example: RNs doing intubation and central lines. These are both "skills" that the RN can learn in a very short time as well as have no problem getting the hospital to allow clinical practice. How many hospitals are reluctant to now allow the poorly educated Paramedic students to even do a "stand there and don't touch" clinical.

You again are only for a recipe and a few skills.  That does not make a good clinician.


----------



## Flight-LP (Sep 20, 2009)

ResTech said:


> lol.. laughable at how you try to tear something apart to satisfy your own views.
> 
> My college has both a degree option and a non-degree option... there are ppl in my class from both. So because one finishes with a degree and the other doesn't that means they are less able to apply their knowledge and skills in the field? Even though they were right there beside me hearing the same lectures and practicing the same skills? That makes no sense at all.
> 
> It's one thing to promote education, just don't be ignorant while doing so... get my point?



O.k. lets try this from a different angle if you feel Vent is biased. Can you clarify the terminology "****ing off"? What specifically are these medics doing in your mind that is an unacceptable delay for transport?

Please do answer the very valid question she has. What basis of statistical coorelation can you present to back up your belief of these non degreed paramedics being "better" than other degreed paramedics? See, Statistics is a needed class! There is a damn good reason why it is required at the Bachelor's level in health care.

I fail to see how a promotion or acceptance of education can be remotely interpreted as ignorant. Was this a statement made in a moment of heated passion for your position, or do you have a valid argument? If its the latter, please present it, otherwise, lets move on to something productive....................


----------



## VentMedic (Sep 20, 2009)

Flight-LP said:


> Was this a statement made in a moment of heated passion for your position, or do you have a valid argument? If its the latter, please present it, otherwise, lets move on to something productive....................


 
He's had several of these "heated passion moments" as his stance against education has been consistent in several threads.


----------



## ResTech (Sep 20, 2009)

I swear I feel like I am typing to a wall sometimes... how is spending two years in a degree program and plans to spend even more getting a BS degree not supportive of education? As I have stated all along, now sit down for this one as it may be a shock to some, it is possible to be a great provider without a degree. Acknowledging this and not belittling someone without a degree is not advocating we should remain where we are and not push for increased standards... it's simply that... an acknowledgment. My program has in its basic requirements both A&P I and II... no matter if your a degree or non-degree... you still take A&P I and II. 

I can imagine how all the non-degreed Medic's on the forum must feel by now from hearing all the negativity and worthless views on non-degreed providers.

Flight-LP... ****ing off is defined as staying onscene way to long to perform skills that have not been shown to make any difference in clinical outcome of patients... particularity trauma patients and in fact the delay caused by them has been noted in studies to be a cause for not so good outcomes. So yeah, a driver and attendant with some O2 would prob be better in some cases. 

And Vent, you have had plenty of "I'm God, your not, your opinion doesn't matter and is wrong" kinda moments in A LOT of other threads with many different people.

Vent, do you even practice as a Paramedic anymore?


----------



## rescue99 (Sep 20, 2009)

MMiz said:


> I disagree.  We need education _and_ training.  Education is associated with learning done in a classroom or school, whereas training is usually associated with learning and mastering a skill.  In order to be a great EMT you need both a solid education and exceptional training.



MMiz..you are correct. The transition phase has shown us how very vital the combination of training and education are in EMS. Responders who think a patient to death just doesn't work. There has to be both.


----------



## Sasha (Sep 20, 2009)

Why do all threads that have the potential to be a great debate deteriorate into a peeing match? And it's the same one every single time.

I think training has it's place. You can throw all the education and compassion you want at someone, but if you can't start an IV or draw up a med it's useless. However, I don't think anyones arguing against that, they are arguing against Paramedic courses being soley training on how to do skills and how to read a protocol book and doesn't focus on teaching, or setting up a paramedic to make educated patient care decisions on their own two feet. It also doesn't allow them to think past patient drop off, which I think ultimately will harm a patient. 

I once had an instructor tell me to load a patient up with fluid, they'll "pay for it later" but that it wasn't your concern and let the doctors handle it. We need to get away from that kind of thinking, because I think it ultimately it hurts the very patients we care for in the long run, however paramedic "training" and education doesn't allow for that with it's two week a&p course.


----------



## rescue99 (Sep 20, 2009)

Sasha said:


> Why do all threads that have the potential to be a great debate deteriorate into a peeing match? And it's the same one every single time.
> 
> I think training has it's place. You can throw all the education and compassion you want at someone, but if you can't start an IV or draw up a med it's useless. However, I don't think anyones arguing against that, they are arguing against Paramedic courses being soley training on how to do skills and how to read a protocol book and doesn't focus on teaching, or setting up a paramedic to make educated patient care decisions on their own two feet. It also doesn't allow them to think past patient drop off, which I think ultimately will harm a patient.
> 
> I once had an instructor tell me to load a patient up with fluid, they'll "pay for it later" but that it wasn't your concern and let the doctors handle it. We need to get away from that kind of thinking, because I think it ultimately it hurts the very patients we care for in the long run, however paramedic "training" and education doesn't allow for that with it's two week a&p course.



"Education and training" includes AP. Med Term and Pharm. I assume it to mean a well rounded classroom / practical experience. Silly me


----------



## VentMedic (Sep 20, 2009)

MMiz said:


> I disagree. We need education _and_ training. Education is associated with learning done in a classroom or school, whereas training is usually associated with learning and mastering a skill. In order to be a great EMT you need both a solid education and exceptional training.


 
Somehow the other health care professions manage to get a lot of education and a lot of training done.  RNs and RRTs can log easily over 1000 hours in just clinicals in their 2 year programs.  The same for radiology.  I've lost track of how many hours PT gets since their entry level program is now a Masters and they now have the Doctorate. 

It really shouldn't be that hard for a Paramedic to accomplish education and training in a mere two year degree.


----------



## VentMedic (Sep 20, 2009)

ResTech said:


> I swear I feel like I am typing to a wall sometimes... how is spending two years in a degree program and plans to spend even more getting a BS degree not supportive of education?


 
Because all of your education plans do little to support you being Paramedic and does little to raise the professional standard.   If you fail to see the need for a decent A&P and Pharmacology class to enhance your knowledge as a Paramedic, I seriously doubt if you will ever see your way to getting a BS degree.  

BTW, how long have you been an EMT?   Didn't it take you many years before deciding to become a Paramedic?  Did you not realize it was okay to take college classes as an EMT-B even if the timing wasn't right for the Paramedic program.

If one really feels they must stay working as an EMT-B, they should still feel free to continue their education with classes that should be prerequisites for the Paramedic.  One should NEVER be told they "can't do nothing" but work as an EMT until they apply for the Paramedic program.


----------



## thegreypilgrim (Sep 23, 2009)

I think there has been more than a small measure of misunderstanding in this post. The OP was not intended to declare war on medics who don't have degrees or fall to one's knees in adoration of those who do. 

I don't have a degree as of yet, but I'm in the process of completing one. I think I'm a decent medic, however, and certainly would not assent to the proposition that unless one has a degree then one cannot be a good medic. 

My whole point was, this notion of building a program for professional licensure around training for skills is unheard of for other medical professions. It is also, I believe, the primary cause of most of the industry-related problems that we who work in EMS have to deal with. There is another side of this story, however, and I actually think a large portion of the blame lies with the physicians and nurses who _design_ and _carry out_ the education and training of future paramedics. They're the ones who created these programs and felt that 700 total hours with dumbed down A&P and little clinical reasoning is sufficient to fill the streets with paramedics.

Some have raised the question of whether or not holding a piece of paper from some pretentious university to be framed on your wall really makes a difference in the nitty gritty reality of the pre-hospital world. I would respond by saying that in some instances it might not, but it certainly _*can*_ and is therefore worth the effort (I suspect this "well it doesn't make much difference so we shouldn't do XYZ" is guilty of deriving what _ought_ to be from what _is_ - see the Is-Ought Problem). We really ought to be giving our patients the best chance possible, and I think having advanced pre-hospital EMS providers with a university education would be doing just that for our patients. It's also the only real way to fully professionalize the field, solve our deplorable financial reimbursement problems, and gain recognition from other medical professionals as a whole rather than on an individual basis (i.e. the physicians and nurses at the various local hospitals you run into begin to respect you & don't interrogate you with a million questions when you ask for orders because after working with you for so long, they've finally realized you do actually know what you're doing but still view other paramedics with suspicion...).

I would also argue that when education is lacking, patients ultimately _*do*_ suffer. I'll use the county I work in as an example (I'd rather not name it, hopefully this is understood). The situation we have here is the epitome of what the droves of anonymous posters that haunt EMS forums such as this one rail against. It's a fire-based system with the primary paramedic training center here being widely considered to be a Medic Mill in its purest form. The curriculum there does not extend into National Standards - the students learn the County protocols, the County policies, the County drugs, and that's it. Many of them have a difficult time with the NREMT exam afterward because they simply don't learn about anything that isn't done here. The result is an army of medics with a cook-book mentality and a cowboy bravado. Then everyone wonders why our local scope of practice becomes more and more limited (no RSI, no pediatric intubation, no needle cric, no IO's except on dead people, a drug box that consists of just 16 meds, few procedures allowed prior to base contact, making base contact entails a tediously detailed and point-by-point report as opposed to a chief complaint a destination facility and an ETA, the list goes on). The excuse of "short transport" times is often given as justification for slashing pre-hospital procedures, but everyone knows what the real reason is. Hospitals are tired of having esophageally intubated patients with no capnography used (despite its being both available and mandated) brought into their ED's.

Sure, a non-degreed paramedic can run a megacode or a chest pain or a trauma just as well and competently as a paramedic who does have a degree. This is probably true. It all really comes down to the individual medic's desire to be a medical professional. This is, however, is myopic. Few people realize the impact pre-hospital providers can have on healthcare as a whole. Imagine being able to close simple lacerations in the field with sutures and a tetanus booster, replacing g-tubes in the field, referring/transporting to urgent care facilities, transporting drunks (when this is their only problem) to sobering centers, or any of hundreds of other "treat and release" type procedures which could desaturate ED's and reduce costs of needless ambulance rides and hospital bills. Can you imagine that happening with the current system we have in place? Can you really imagine paramedics functioning as truly independent practitioners with this expanded scope without more education? That was what I was getting at.


----------



## 46Young (Sep 23, 2009)

thegreypilgrim said:


> I think there has been more than a small measure of misunderstanding in this post. The OP was not intended to declare war on medics who don't have degrees or fall to one's knees in adoration of those who do.
> 
> I don't have a degree as of yet, but I'm in the process of completing one. I think I'm a decent medic, however, and certainly would not assent to the proposition that unless one has a degree then one cannot be a good medic.
> 
> ...



I understand that a formal degree should produce the best product, and that even a medic mill graduate can bring themselves up to speed if they put in the work. What I can't grasp is medics doing treat and release, due to the high liability potential. It would require the medic to make a definitive Dx in some cases. Perhaps some provisions with tort reform could protect us if this additional scope is realized.


----------



## VentMedic (Sep 23, 2009)

46Young said:


> Perhaps some provisions with tort reform could protect us if this additional scope is realized.


 
Why? Shouldn't the Paramedic be held to the same professional standards as others who treat and release? One can be sued for just about anything but taking away the fear of being sued can make some in this profession even more complacent. As it is now those that do work for a government agency know they have limited liability through the immunity statutes.


----------



## medichopeful (Sep 23, 2009)

ResTech said:


> it is possible to be a great provider without a degree.



So is it possible to be a great doctor without pre-med?


----------



## 46Young (Sep 23, 2009)

VentMedic said:


> Why? Shouldn't the Paramedic be held to the same professional standards as others who treat and release? One can be sued for just about anything but taking away the fear of being sued can make some in this profession even more complacent. As it is now those that do work for a government agency know they have limited liability through the immunity statutes.



I don't know of any agencies give their medics autonomy regarding treating and releasing pts. All pt care situations that result in the pt bring released post treatment require refusals. Some areas have protocols to forego spinal motion restriction if the pt falls under certain parameters. Some agencies allow medics to declare a "no need for EMS" if it's warranted after evaluating the situation. I can understand releasing a pt after suturing a lac and giving a tetanus (under protocol) as well as G-tube replacements. 

As far as referring pts to urgent care facilities, txp drunks to detox and such would require a true Dx. My understanding is that this right is reserved for doctors only. My understanding is that medics can only offer a "suspected diagnosis", nothing more. When you're on the stand, saying "I diagnosed the pt with APE" will get you jammed up in a hurry. The correct thing to say would be "I treated the pt for rales per protocol". It's not cookbook medicine if you're treating the pt according to guidelines, as you can jump protocols if needed, or deviate within reason based on current validated medical knowledge/practices. You're using the guidelines, essentially the OMD's "rules" to treat the pt based on your findings. You're not actually diagnosing anything.

Now, if we increase the scope (with the requisite education) to allow the medic to diagnose certain conditions, is it worth it in regards to potential liabitily? It only takes one poor pt outcome for you to lose your house and/or license. Do I want to go to school for 4-6 years, MAYBE make 100k or so (not likely by a long shot) and have that much more of a chance to lose my house and my shirt? even PA's operate under an MD's license. 

If you're doing treat and release under the OMD's guidelines that's one thing, it's another thing entirely to have the autonomy to make your own Dx and definitively decide on pt tx for certain pt populations.

So, who besides doctors have the autonomy to treat and release pts without protocols or oversight from a higher medical authority?


----------



## medic417 (Sep 23, 2009)

medichopeful said:


> So is it possible to be a great doctor without pre-med?



Actually yes.  There have been people that have acted as doctors and only had read books.  Yet they were considered by their patients to be very good.  

But that would be the rare case.


----------



## VentMedic (Sep 23, 2009)

We seem to have a serious communication problem here. I did NOT type anything about treating and releasing being okay as education stands now nor did I in anyway promote it. 

I was reflecting off your statement that if additional scope was allowed, you wanted tort reform.



46Young said:


> I understand that a formal degree should produce the best product, and that even a medic mill graduate can bring themselves up to speed if they put in the work. What I can't grasp is medics doing treat and release, due to the high liability potential. It would require the medic to make a definitive Dx in some cases. Perhaps some provisions with tort reform could protect us if this additional scope is realized.


 
My statement was that if a Paramedic wants additional scope of practice they should be held accountable and not given a free ride. 



> Why? Shouldn't the Paramedic be held to the same professional standards as others who treat and release? One can be sued for just about anything but taking away the fear of being sued can make some in this profession even more complacent. As it is now those that do work for a government agency know they have limited liability through the immunity statutes.


----------



## Shishkabob (Sep 23, 2009)

medichopeful said:


> So is it possible to be a great doctor without pre-med?



A smart person does not a degree make.


----------



## JPINFV (Sep 23, 2009)

To be fair, in a lot of countries the basic medical degree is an undergraduate degree (e.g. MBBS (Bachelor of Medicine, Bachelor of Surgery). That said, it is still a degree and not a simple certification.


----------



## EMSLaw (Sep 23, 2009)

medichopeful said:


> So is it possible to be a great doctor without pre-med?



I believe I read somewhere that while a strong sciences backround helps on the MCAT and USMLE Step I, performance in practice (presumably, though I don't recall, meaning your patients think you're a 'good doctor', among other things) is more based on prior education in the humanities.  

But I would venture to say there are loads of great doctors who weren't pre-med as undergrads.  Of course, if you mean "a great doctor without going to medical school"...  well, that's a horse of a different color, but it apparently worked just fine until the early 1900s. 

More on topic - medical professionals who engage in even mid-level (pseudo-)independent practice tend to have master's degrees.  PAs, NPs, etc.  If paramedics were looking for an increased scope of practice, it stands to reason they would need additional education to handle the vastly increased responsiblity.  Even assuming you're willing to accept a purely didactic and clinical program on a technician, rather than technologist, level (without any of that fancy book learnin', especially in 'useless' subjects like the liberal arts), maybe, possibly, an associates degree would be sufficient, especially that were the minimum before beginning clinical work.

Anyway, this has been clobbered to death multiple times in this forum, so I'll shush.


----------



## VentMedic (Sep 23, 2009)

EMSLaw said:


> (without any of that fancy book learnin', especially in *'useless' subjects like the liberal arts*),


 
Yeah, nobody needs to waste time with readin', writin' and arithmetic.

These forums are proof of that.   

At least lately we have had less "r u an EMT" posts.


----------



## medichopeful (Sep 23, 2009)

medic417 said:


> Actually yes.  There have been people that have acted as doctors and only had read books.  Yet they were considered by their patients to be very good.
> 
> But that would be the rare case.



Thanks for the help medic417 <_<


----------



## atropine (Sep 23, 2009)

r99, don't worry about it, the day the us require all paramedic providers to have an AA degree, is the day that system status will be no more. Look ems is not going to change, because politicians want the cheapist labor as possible.^_^


----------



## medic417 (Sep 23, 2009)

medichopeful said:


> Thanks for the help medic417 <_<



Your welcome.


----------



## medichopeful (Sep 23, 2009)

Linuss said:


> A smart person does not a degree make.



No, but it does make an educated one.


----------



## medichopeful (Sep 23, 2009)

EMSLaw said:


> I believe I read somewhere that while a strong sciences backround helps on the MCAT and USMLE Step I, performance in practice (presumably, though I don't recall, meaning your patients think you're a 'good doctor', among other things) is more based on prior education in the humanities.
> 
> But I would venture to say there are loads of great doctors who weren't pre-med as undergrads.  Of course, if you mean "a great doctor without going to medical school"...  well, that's a horse of a different color, but it apparently worked just fine until the early 1900s.
> 
> ...



You're right, I should have been more clear.  Let's clarify.  The question should have read like this:

"So is it possible to have a good doctor who didn't have any training before medical school?"

:wacko:B)


----------



## medic417 (Sep 23, 2009)

medichopeful said:


> No, but it does make an educated one.



Sadly in many peoples cases it just means a piece of paper.  Many people get degrees and never put any effort.  So hard to say they are educated.  

Sorry it seem I keep helping the anti education crowd today.


----------



## medichopeful (Sep 23, 2009)

medic417 said:


> Sadly in many peoples cases it just means a piece of paper.  Many people get degrees and never put any effort.  So hard to say they are educated.
> 
> Sorry it seem I keep helping the anti education crowd today.



Stop doing that!


----------



## VentMedic (Sep 23, 2009)

medic417 said:


> Sadly in many peoples cases it just means a piece of paper. Many people get degrees and never put any effort. So hard to say they are educated.


 
It doesn't mean they don't have the potential to reconnect with their education. Many young and immature people are sent to 4 years of college by their parents. Many may not realize the value of that education until a few years after they graduate. Was that education wasted? Absolutely not.

There are also doctors who have been sent to school because their parents expected it of them. Some are well educated but unhappy. However, since they do have an education, they now have choices. 

Now take EMS. So many complain about the Liberal Arts classes if they go for a degree. Few realize the benefit of being able to read, write and do math. 

The one thing about an education is that it gives you more choices and opens up many more doors somewhere down the road. Some may think getting a two year degree is a waste but may regret not getting one when another opportunity comes along with higher education standards. Regardless of what one thinks of that piece of paper or why they got it, you still have it. For that reason your education is usually the first letters placed after your name when listing your alphabet soup in the signature. The reasoning behind that is your education can not be taken away from you. Certs and licenses can lapse or be revoked.


----------



## ResTech (Sep 23, 2009)

> your education can not be taken away from you. Certs and licenses can lapse or be revoked.



That's a very good point....


----------



## medic417 (Sep 23, 2009)

VentMedic said:


> It doesn't mean they don't have the potential to reconnect with their education. Many young and immature people are sent to 4 years of college by their parents. Many may not realize the value of that education until a few years after they graduate. Was that education wasted? Absolutely not.
> 
> There are also doctors who have been sent to school because their parents expected it of them. Some are well educated but unhappy. However, since they do have an education, they now have choices.
> 
> ...



But with no effort comes no education thus it is just a piece of paper.  Later in life they can return to school for an advanced degree and then get educated but that paper is just paper, an education it does not make.


----------



## VentMedic (Sep 23, 2009)

medic417 said:


> But with no effort comes no education thus it is just a piece of paper. Later in life they can return to school for an advanced degree and then get educated but that paper is just paper, an education it does not make.


 
So you really do believe education is a waste.

No. Even if you only learned to type a full sentence that is readable it is not a waste. You would be surprised what the brain retains even if very little effort is put into it. 

Education is a choice. The fact that one does stick it out through a college degree shows they know a little about the benefits of an education even if they don't admit it or appear disinterested. They could easily leave the college. 

Do you know how many Art History or some other Liberal Arts majors get well paying jobs with major companies or government agencies just because of that piece of paper? It didn't matter what they had the degree in. It just mattered that regardless of their opinion about education they still FINISHED what they started. I am of course talking about a 4 year degree but even a 2 year degree is an accomplishment or at least an initial step.


----------



## medic417 (Sep 23, 2009)

VentMedic said:


> So you really do believe education is a waste.
> 
> No. Even if you only learned to type a full sentence that is readable it is not a waste. You would be surprised what the brain retains even if very little effort is put into it.
> 
> ...



But Vent again the piece of paper got them the job, not the education.  You have met as many and probably more people than me  w/ piece of paper but no education.  If you use learning a proper sentence as education then you would also have to argue that the 10 week Paramedic wonder also got educated as he can draw up a syringe of meds.  Both are education by your argument.  

Sorry I can't stop myself as much as I want to as I believe we need higher education in EMS.  Maybe an anti education person has taken over my brain.  Help.


----------



## VentMedic (Sep 23, 2009)

medic417 said:


> But Vent again the piece of paper got them the job, not the education. You have met as many and probably more people than me w/ piece of paper but no education. If you use learning a proper sentence as education then you would also have to argue that the 10 week Paramedic wonder also got educated as he can draw up a syringe of meds. Both are education by your argument.
> 
> Sorry I can't stop myself as much as I want to as I believe we need higher education in EMS. Maybe an anti education person has taken over my brain. Help.


 
So you believe a person can learn ABSOLUTELY NOTHING by getting higher education?  

You believe there is NO social interaction or discussion even between students that can pass on something new to that person? 

Do you not think showing up for class does not teach some type of responsibility and establish some maturity?

I believe even the most disinterested person or dead beat can accomplish something from 4 years of college.  While it is not difficult it does take some effort.  If one puts forth that effort, there will be something in their college years that they will learn.  

Do you realize that many of the "blue collar" jobs now have 2 and 4 year degrees?  Coal Miners, Welders and Construction workers have all seen the need for higher education to do what had been thought of as strictly labor type jobs.

I can not believe we are about to enter the year 2010 and these anti education attitudes still exist.    Some parents consider themselves a failure if they can not find a way to get their kids through a 4 year college.  Kids are also striving for good grades or even a sports scholarship to get into a decent college.   Grants and scholarships have made it much easier but still some can struggle.  But yet, if you have even spent any time on a university campus you will find students holding down fulltime plus course loads as well as full time jobs.  Yet, so many in EMS feel 600 hours of training way too much.    

The college students that make the effort to finish will be successful even if they just work as a barista.  They know what they have accomplished regardless of how they express it.    Even if they don't wave that piece of paper in everyone's face, they may engage in a slightly more intelliegent conversation that they may not have been capable of doing prior to college.   That may make the difference in their customer service.

It is a shame that so many in this profession have your attitude towards education.    I just don't understand why some shun even a 2 year college degree.   There are so many opportunities out there and EMS has yet to explore most of them.   As long as the education level remains at a few hundred hours of training, EMS may never know what what it can accomplish. 

BTW, what is your highest level of education?


----------



## medic417 (Sep 23, 2009)

VentMedic said:


> So you believe a person can learn ABSOLUTELY NOTHING by getting higher education?
> 
> You believe there is NO social interaction or discussion even between students that can pass on something new to that person?
> 
> ...



My point is many get the degree while only doing the minimum, just like in many EMS programs.  

I'm working on pre-school right now, maybe I'll continue to kindergarten. h34r:


----------



## VentMedic (Sep 23, 2009)

medic417 said:


> My point is many get the degree while only doing the minimum, just like in many EMS programs.


 
But the minimum still consists of somewhere around 64 semester credit hours for a 2 year degree and 128 for a 4 year degree. Few are going to call that a "minimum". Some may choose an easier major but still 4 years is a decent commitment. 

That is the same at almost any college/university you attend in the U.S. 

One doesn't have the opportunity to move from Oregon to Texas if they want a "lesser" 4 year degree. You still have to finish the college credits. However, for Paramedic with the same move, you go from a 2 year degree requirement to 600 hours of training.




medic417 said:


> I'm working on pre-school right now, maybe I'll continue to kindergarten. h34r:


 
Those that haven't taken the first steps toward higher education usually present the more emotional and irrational arguments against education.


----------



## medic417 (Sep 23, 2009)

VentMedic said:


> But the minimum still consists of somewhere around 64 semester credit hours for a 2 year degree and 128 for a 4 year degree. Few are going to call that a "minimum". Some may choose an easier major but still 4 years is a decent commitment.
> 
> That is the same at almost any college/university you attend in the U.S.
> 
> ...



But you do not even have attend, just show up and pass exams, at many colleges.  I have seen many college students send a recorder with another student and end up passing and getting credit. How is that education?  Heck even the online education that you seem to love so much requires much more effort than that.  

So point is on paper they have lots of college hours yet really never set in and got any education.  Heck you can even challenge many college courses for full credit.


----------



## VentMedic (Sep 23, 2009)

medic417 said:


> But you do not even have attend, just show up and pass exams, at many colleges. I have seen many college students send a recorder with another student and end up passing and getting credit. How is that education? *Heck even the online education that you seem to love so much requires much more effort than that. *
> 
> So point is on paper they have lots of college hours yet really never set in and got any education. Heck you can even challenge many college courses for full credit.


 
You are speaking without the experience of obtaining a college degree. 

Why haven't you gotten a degree?

Online education that I seem to love so much? The only comments I have made about this is that it is very appropriate for some lecture classes. I am not an advocate of it for the sciences such as chemistry and A&P which still need the benefit of a lab. 

Yes you can challenge a course but that doesn't mean you'll pass to get the credit. Also, not all classes are eligible for challenge. 

As far as the recorder in class, that is a smart idea if the eduator doesn't keep a copy of his/her lecture for viewing/listening through the internet or library. The student is still taking the time to listen to the lecture and felt motivated enough to have it recorded. That does not show a disinterest but rather caring enough not to miss something if there is a reason not to attend the lecture that day. I have even recorded many of my classes when I worked the night before and new I was not at my best for listening or I borrowed someone's recording. I do not consider myself a minimalist when it comes to education because of it. 

Go to college and then you can speak educatedly about education.

This is just ridiculous and irresponsible to try to convince some of the very young members here that they will get no benefit of higher education. Obtaining their education now will benefit them throughout their careers and they won't reach the age of 50 kicking themselves for not having that education when standards are raised or their backs are wore out and they need to find another profession.


----------



## medic417 (Sep 23, 2009)

VentMedic said:


> You are speaking without the experience of obtaining a college degree.
> 
> Why haven't you gotten a degree?
> 
> ...



You presume what you do not know concerning my education.  Attacking my education no matter how great or how smart does not support your side.

I have no problem with my students recording lectures for review but I disagree with them not attending except on exam days.  

And I have not said a college education is worthless I have said those that only got the piece of paper have no education.  And you keep saying they got the hours.  That is no different than your argument against the current EMS education, just focused on the hours.  

I am really hating pretending to be on the anti-education side but you keep leaving big openings that demand attack.  

*For all our young readers you will benefit yourself by getting an education.  I mean go to the classes, listen, take notes, do research, get educated and you will be better for it.  If you want to be in EMS get a Paramedic degree so the time spent on that education will transfer towards another degree should you decide a change is in order.  *


----------



## VentMedic (Sep 23, 2009)

medic417 said:


> You presume what you do not know concerning my education. Attacking my education no matter how great or how smart does not support your side.


 


VentMedic said:


> BTW, what is your highest level of education?


 


medic417 said:


> I'm working on pre-school right now, maybe I'll continue to kindergarten.


 
I asked you what your education level was and you gave a smart arse answer. At that point in this discussion it only demonstrated an anti-education attitude.

I take education very seriously especially for those in this profession. I would be very upset with an EMT instructor if he/she told my 17 y/o that education was a waste of time. I personnally would not want my kid to be even an ambulance driver without an education. At least then I would know there are choices available for their future. 

Unfortunately we do know discouraging higher education happens when the instructor and role model is Bubba the Great who can do all this and didn't need no book learnin'.


----------



## Foxbat (Sep 23, 2009)

medichopeful said:


> So is it possible to be a great doctor without pre-med?


This is how it works in many, if not most, countries, including Western Europe and ex-USSR. Students go from high schools straight to medical institutes and colleges to become doctors, nurses, PAs, etc. and there are plenty of great healthcare providers there.


----------



## 46Young (Sep 23, 2009)

Requiring a two year degree just for entry into the EMS field as well as four year degrees (or more) would probably weed out many individuals who enter the field just for kicks, an easy way to make money, adrenaline junkies, Rescue Randys, basically most of the wierdos and those who use it solely as a stepping stone. 

The field can't move forward until we remove the LCD's.


----------



## 46Young (Sep 24, 2009)

VentMedic said:


> We seem to have a serious communication problem here. I did NOT type anything about treating and releasing being okay as education stands now nor did I in anyway promote it.
> 
> I was reflecting off your statement that if additional scope was allowed, you wanted tort reform.
> 
> ...



I'm not asking for immunity from liability due to malpractice, but instead a reasonable amount of protection from frivolous lawsuits, provided we are making competent pt care decisions. Our society is a litigous one. I'm concerned about individuals who would be looking to make a fast buck off of us, including those who may use a suit to avoid paying a bill. I don't want to lose my license or put my family in the poor house due to someone's greed.

The thing that I like about operating under an OMD's protocols is that, based on our findings and reassessments, we can validate our (correct) pt care decisions and be able to defend them well in a court of law if needed. the attorney says "what was your Dx?" I say, I made no Dx, that right is reserved for an MD. We have S.O.P's, standing orders and protocols under our OMD. I found A,B,C. I therefore treated for X,Y,Z per protocol/OLMC.


----------



## MrBrown (Sep 24, 2009)

This is what really kills me, even here.  We need a basis of education and training; for example 

- You need to be educated about fluid compartments, osmolarity, tonicity, diffusion, mediated diffusion, cellular respiration and ventilation, shock, heamostatis (clotting) and then trained how to insert an IV cannula and run a bag of fluid.

- You need to be educated about cardiac anatomy and physiology, the cardiac action potential, intra/extracellular catons/ions, the sodium/potassium pump, Einthoven's triangle, acute coronary syndromes and how to interpret an ECG then trained how to acquire one

Education and training are *not* the same, just like oxygenation and ventliation are *not* the same.


----------



## medic417 (Sep 24, 2009)

VentMedic said:


> I asked you what your education level was and you gave a smart arse answer. At that point in this discussion it only demonstrated an anti-education attitude.
> 
> I take education very seriously especially for those in this profession. I would be very upset with an EMT instructor if he/she told my 17 y/o that education was a waste of time. I personnally would not want my kid to be even an ambulance driver without an education. At least then I would know there are choices available for their future.
> 
> Unfortunately we do know discouraging higher education happens when the instructor and role model is Bubba the Great who can do all this and didn't need no book learnin'.



Again I have not said education is a waste of time.  I have said some get a piece of paper but that piece of paper does not equal education.  Yes they are ahead in life later when they realize they need a real education as that piece of paper helps them get a higher degree.  But it is just a piece of paper if they failed to apply themselves.  

Yes many seem to discourage advancement of education in EMS even many with multiple degrees.


----------



## thegreypilgrim (Sep 24, 2009)

46Young said:


> I don't know of any agencies give their medics autonomy regarding treating and releasing pts. All pt care situations that result in the pt bring released post treatment require refusals. Some areas have protocols to forego spinal motion restriction if the pt falls under certain parameters. Some agencies allow medics to declare a "no need for EMS" if it's warranted after evaluating the situation. I can understand releasing a pt after suturing a lac and giving a tetanus (under protocol) as well as G-tube replacements.
> 
> As far as referring pts to urgent care facilities, txp drunks to detox and such would require a true Dx. My understanding is that this right is reserved for doctors only. My understanding is that medics can only offer a "suspected diagnosis", nothing more....So, who besides doctors have the autonomy to treat and release pts without protocols or oversight from a higher medical authority?


I think a case can be made for being able to refer pts to urgent care and/or sobering centers without making a formal "diagnosis". Obviously with the increased scope of practice for paramedics in this scenario there would have to be various legal reforms and updates in local policies/protocols to account for these new features of pre-hospital care. As I understand, most jurisdictions permit paramedics to determine in certain situations that no services are needed. You do a thorough assessment and exam of the patient and you determine that there are no apparent life-threats - this is not anything new or something paramedics do not do already. In fact this is done all the time when paramedics downgrade patients from ALS to BLS transport. If you ever find yourself in court one day and an attorney asks you, "Why did you arrange for my client to be transported by a lower medical authority? What was your diagnosis so you felt this was appropriate?" You need not answer with a diagnosis, the correct response is simply, "I completed a thorough assessment and exam of my patient in accordance with Advanced Life Support parameters and the patient was not found to have any anomalies. There was no immediate threat to life or limb, hence BLS transport is completely appropriate."

Not every patient you release at the scene is done so "Against Medical Advice." They do not all need to sign your release form, and having them sign it anyway does not provide any liability protection in such scenarios because there is no medical advice which they are going against. 

You don't need to make a formal diagnosis to determine a patient to be stable. If you can release a patient at the scene and it's not an AMA situation already, why can you not just refer them to urgent care? Especially in this hypothetical scenario with increased paramedic education and scope of practice? Same things with ETOH patients and sobering centers. I'm not talking about being able to enroll them in a rehab facility, but just taking them to a facility that can protect them from themselves until they sober up. They already have such facilities in places like Santa Barbara and Oakland here in California where police officers (people with _*no*_ medical training or at most a First Responder cert) can transport drunks to. Why is it different for EMS?

Why couldn't Medical Directors draft protocols for these sorts of things? Even if you have to call in to medical control and get the attending physician's approval to defer to urgent care or sobering center, why can't this work even under a paramedic's "suspected diagnosis"?


----------



## atropine (Sep 24, 2009)

Why couldn't Medical Directors draft protocols for these sorts of things? Even if you have to call in to medical control and get the attending physician's approval to defer to urgent care or sobering center, why can't this work even under a paramedic's "suspected diagnosis"?[/QUOTE]

Because of "liability", thats why no MD's will sign off on something like this. They have way mor to lose than a $13.00 per hour job/hobbie.^_^


----------



## medic417 (Sep 24, 2009)

atropine said:


> Why couldn't Medical Directors draft protocols for these sorts of things? Even if you have to call in to medical control and get the attending physician's approval to defer to urgent care or sobering center, why can't this work even under a paramedic's "suspected diagnosis"?



Because of "liability", thats why no MD's will sign off on something like this. They have way mor to lose than a $13.00 per hour job/hobbie.^_^[/QUOTE]

Actually there are a number of Medical directors that do allow taking patients to clinics rather than ER. And often this is done by the Paramedic w/o calling medical control.  These medical directors are more involved and know their Paramedics thus trust them.


----------



## JPINFV (Sep 24, 2009)

atropine said:


> Because of "liability", thats why no MD's will sign off on something like this. They have way mor to lose than a $13.00 per hour job/hobbie.^_^



To be fair, I wouldn't sign off on allowing what most of the fire medics in Southern California do anyways. Guess that's why they aren't allowed to interpret 12 lead ECGs, right?


----------



## rescue99 (Sep 24, 2009)

medic417 said:


> Because of "liability", thats why no MD's will sign off on something like this. They have way mor to lose than a $13.00 per hour job/hobbie.^_^



Actually there are a number of Medical directors that do allow taking patients to clinics rather than ER. And often this is done by the Paramedic w/o calling medical control.  These medical directors are more involved and know their Paramedics thus trust them.[/QUOTE]

Yep..It's in our protocols to call first but, we can take some etoh and psych patients to intake centers.


----------



## thegreypilgrim (Sep 24, 2009)

> thegreypilgrim said:
> 
> 
> > Why couldn't Medical Directors draft protocols for these sorts of things? Even if you have to call in to medical control and get the attending physician's approval to defer to urgent care or sobering center, why can't this work even under a paramedic's "suspected diagnosis"?
> ...


Yeah if we're talking about the system as it _*currently*_ is. Things would probably be different if the changes I was waxing hopelessly about earlier would be put into effect. Reading things in context usually aids understanding.


----------



## medic417 (Sep 24, 2009)

What is wrong with the quotes.  Keeps crediting wrong people with the quotes.


----------



## atropine (Sep 24, 2009)

JPINFV said:


> To be fair, I wouldn't sign off on allowing what most of the fire medics in Southern California do anyways. Guess that's why they aren't allowed to interpret 12 lead ECGs, right?



What are talking about?, all of the departments in LA County/ Orange County, San Diego County and Riverside County are using 12-leads.


----------



## atropine (Sep 24, 2009)

medic417 said:


> Because of "liability", thats why no MD's will sign off on something like this. They have way mor to lose than a $13.00 per hour job/hobbie.^_^



Actually there are a number of Medical directors that do allow taking patients to clinics rather than ER. And often this is done by the Paramedic w/o calling medical control.  These medical directors are more involved and know their Paramedics thus trust them.[/QUOTE]

Well thats cool if the MD knows and trust the medics, Where Iam at not only do we have a county MD, my department has it on MD, and several other departments have there own MD, so that getting to know and trust is kind of hard I guess.


----------



## thegreypilgrim (Sep 24, 2009)

atropine said:


> What are talking about?, all of the departments in LA County/ Orange County, San Diego County and Riverside County are using 12-leads.


Yeah, they're using them but as far as LA County goes (and probably Orange too) you're not allowed to interpret them. You have to go by what the machine diagnosis printout says...which can be horribly wrong sometimes.


----------



## JPINFV (Sep 24, 2009)

atropine said:


> What are talking about?, all of the departments in LA County/ Orange County, San Diego County and Riverside County are using 12-leads.




Interpret!=use.



			
				Orange County EMS Protocol said:
			
		

> Cardiovascular Receiving Center (CVRC) triage: If field 12-lead machine interpretation identifies “Acute MI”, "Acute myocardial infarction suspected", or "infarct-acute" – report this to the base hospital for possible triage to a CVRC.


http://ochealthinfo.com/docs/medical/ems/treatment_guidelines/03 Cardiac/C-15.pdf



			
				Los Angeles County EMS Protocol said:
			
		

> Paramedics should utilize the computerized analysis of the EKG machine. If the computer analysis of the 12-lead EKG indicates an acute STEMI or the manufacturer’s equivalent of STEMI, this information shall be conveyed to the base hospital. Transmit, if capable, the 12-lead EKG demonstrating STEMI to the receiving STEMI Receiving Center (SRC) if requested.


http://ems.dhs.lacounty.gov/ManualsProtocols/MCG/MCG-12LeadEKG.pdf

That's not *interpreting *a 12 lead, which is what I specifically said.


Yea, Riverside uses it, but if I recall correctly, most of Riverside is also run by AMR and not the fire departments.


----------



## 46Young (Sep 25, 2009)

thegreypilgrim said:


> I think a case can be made for being able to refer pts to urgent care and/or sobering centers without making a formal "diagnosis". Obviously with the increased scope of practice for paramedics in this scenario there would have to be various legal reforms and updates in local policies/protocols to account for these new features of pre-hospital care. As I understand, most jurisdictions permit paramedics to determine in certain situations that no services are needed. You do a thorough assessment and exam of the patient and you determine that there are no apparent life-threats - this is not anything new or something paramedics do not do already. In fact this is done all the time when paramedics downgrade patients from ALS to BLS transport. If you ever find yourself in court one day and an attorney asks you, "Why did you arrange for my client to be transported by a lower medical authority? What was your diagnosis so you felt this was appropriate?" You need not answer with a diagnosis, the correct response is simply, "I completed a thorough assessment and exam of my patient in accordance with Advanced Life Support parameters and the patient was not found to have any anomalies. There was no immediate threat to life or limb, hence BLS transport is completely appropriate."
> 
> Not every patient you release at the scene is done so "Against Medical Advice." They do not all need to sign your release form, and having them sign it anyway does not provide any liability protection in such scenarios because there is no medical advice which they are going against.
> 
> ...



Police officers aren't trained to the EMT B or P level, and are therefore unaccountable for a trained medical evaluation prior to taking the ETOH pt to a sobering center.

Working under an OMD's license, having protocols, and also having OLMC to gain an attending physician's approval are all ways for the medic to avoid liability, rather than being required to make a definitive Dx and take full onus for your decision. That's what I was saying. Using your training to make sound pt care/referral decisions in accordance with your agency's guidelines.


----------



## 46Young (Sep 25, 2009)

Consider also that a good number of agencies will have S.O.P.'s and protocols making it difficult to release pts onscene or acquire refusals, due to the high abuse potential by lazy providers who don't want to transport.

NSLIJ required us to contact OLMC for all refusals, then also call our supervisor so that they could possibly talk the pt into going along for txp.


----------

