# What would happen if the NREMT required a degree?



## ExpatMedic0 (Nov 14, 2013)

I figure instead of hijacking another thread or going off topic, I'll just start my own. 

So I ask you, what do you think would happen if the NREMT required a college degree for Paramedic or even EMT certification? What do you think this would do for us (EMS) as a profession/career and why?

Thoughts, ideas, comments, opinions?


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## CFal (Nov 14, 2013)

A degree for Paramedic I can see arguments for, but for EMT it would be the death of EMS


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## TransportJockey (Nov 14, 2013)

CFal said:


> A degree for Paramedic I can see arguments for, but for EMT it would be the death of EMS



Maybe ems as we know it in the us needs to die. And then get a proper ems system like some other countries have. 
I would be all for requiring at least an associates to work on a bus, with a high level medic being a bachelors degree minimum.


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## Carlos Danger (Nov 14, 2013)

ExpatMedic0 said:


> So I ask you, what do you think would happen if the NREMT required a college degree for Paramedic or even EMT certification? What do you think this would do for us (EMS) as a profession/career and why?



I think requiring a 2-year degree would have little impact. Those entering EMS would have to spend a little more time in school, and community colleges would offer bridge program for those already practicing. I think it's be a positive but would have little real impact on anything. 

If they required a 4-year degree, I think you'd see the NREMT die because no states would require it anymore.

I do not see a 4-year degree being commonplace - never mind mandatory  - anytime soon.


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## Mariemt (Nov 14, 2013)

It would be the rural areas that would suffer. The towns with only a few calls a week where they can't staff full time medics and rely on volunteers.


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## EpiEMS (Nov 14, 2013)

Require 30 undergraduate credits (1 year of undergraduate study) for EMT or an Associates in any other field (a la Texas Paramedic) and an Associates in EMS for Paramedics or a Bachelors in any other field. Then ratchet it up, as needed, with the goal of making paramedics a bachelors trained profession at the minimum, and AEMT a bachelors in anything else or an Associates in EMS.



Mariemt said:


> It would be the rural areas that would suffer. The towns with only a few calls a week where they can't staff full time medics and rely on volunteers.



The volunteers probably cost as much as full time folks, when you add it all up.


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## Clipper1 (Nov 14, 2013)

Other professions (RN, RT, RRT, OT, PT, SLP) encouraged the professionals in their profession to get a degree or a degree higher long before it ever became mandatory.  This made the transition a mere formality when it came time to be the entry point into the profession.

We saw this with nursing back when the diploma to degree transition took place in the 70s and now with over 50% of the RNs holding BSNs, the transition there should be in about 10 years for many states. RTs took 20 years to transition to Associates and then 5 more to complete it.  OT, SLP and PT (an old profession) have had long range goals set over several decades which is how they achieved their professional foot hold with CMS.  They have also keep up with their research to show their worthiness in healthcare. 

Just the degree alone will be nothing unless your profession has something to show how it improves quality of care. 

The education models for transition in healthcare are there and so are the degrees. But EMS seems to want to reinvent the wheel.

But, then EMS also has already imbedded itself by "progressing" to a higher level with another quick cert level for "community Paramedics" which is at least a Bachelors or Masters in other countries. So, why spend time in college if you can do it all with very little extra school time?  I think there was also a discussion here where skills made you just as marketable as those with education in other countries.  

I also agree that some states would just drop the NREMT like Michigan threatened to do with the school accreditation requirement.


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## Rialaigh (Nov 14, 2013)

requiring an associates wouldn't do jack. I could probably find an "online associates program" and have one in less than 6 months. 

I am probably one of the few people that really doesn't see a huge benefit in requiring tons more education for EMS. That education could be very well spent on other career fields that need it more.


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## terrible one (Nov 14, 2013)

The fire unions would be pissed!


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## CFal (Nov 14, 2013)

terrible one said:


> The fire unions would be pissed!



Not in Rhode Island, fire depts don't use NREMT.  And anyways, most unions have it in contract that having a degree gives them more money.


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## ffemt8978 (Nov 14, 2013)

CFal said:


> Not in Rhode Island, fire depts don't use NREMT



And if the NREMT required a degree, a lot more agencies would stop using it.  Realistically, it would spell the end of the NREMT.


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## CriticalCareIFT (Nov 14, 2013)

1-States would drop NREMT and administer own state exams

2-Those states that don't drop it would see a abundance of bridge programs spring up all over the state (online and hybrid) or some type of "grandfathered in" clause where you do some CME or some other nonsense. 

How would you reply to old timer medics who would say "I am doing this job for 15 years, why should I all of a sudden go to college? To do the same job that I already perform with the same protocols and get paid the same?"

I truly don't understand anyone that wants to stay in EMS as a career, you get shi-ted on everyday, pay sucks, no advancement, working EMS should fuel your efforts to get a real degree and find a real career.


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## ExpatMedic0 (Nov 15, 2013)

For those that think it would be the end of the NREMT or no state would go for that, I would have to disagree, and here is why.

Example 1: If that is your case, then how do you explain for example, nursing, which did not use to be a degree. It has found a way to transition to a degree. Although there are a handful of diploma/certificate RN facilities still out there, but its pretty much extinct.  I did not see people throwing out the NCLEX exam when this happened. Why is that? Also, how about RT's? 

Example 2: Australia. Australia's Paramedics use to be a vocational trade with no degree. I spoke with a close colleague of mine who is a flight medic and ICP in Australia about the Australian EMS education issue and he said the following 

"yes I have been in the system long enough to compare & contrast the transition from unskilled drivers/stretcher bearers to vocational tradesman's assistants to university education & professional autonomy." 

It should be noted, they require a minimum bachelors degree now with post graduate opportunities available.

How do you explain the 2 examples above?

Although this discussion is strictly hypothetical , thinking like "That is the way we have always done it", "that wont work", ect ect.... is why we are in the rut we are in people...  Our paramedics make 40k a year with private ambulance and the rest of the worlds make 80-100k+ doing the same thing.


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## joshrunkle35 (Nov 15, 2013)

CriticalCareIFT said:


> 1-States would drop NREMT and administer own state exams
> 
> 2-Those states that don't drop it would see a abundance of bridge programs spring up all over the state (online and hybrid) or some type of "grandfathered in" clause where you do some CME or some other nonsense.
> 
> ...



Well, if I understand correctly, nurses were grandfathered in. Additionally, consider that a person that has worked in EMS since 1990 knows a lot more than when they went to school. If I understand correctly (because I was not a paramedic then), things like C-PAP, various splinting devices, fibrinolytics and today's pre-hospital cardiology and treatment is different. Advances in medicine mean a lot more information. The person without a degree has most likely continued learning over time and has amassed much more information than a bachelor's-level degree. 

I don't think that people who already work in the field should have to go back to school, but I definitely think that there is so much information that could be learned that I would fully support future students having at least an associates degree. I am currently completing an Associates degree in EMS/Fire and one of the major benefits is the access to ALS training: post-paramedic school, and then also a lot of rescue tech courses. In addition, all of the simple basic courses like math, English, etc make a person well rounded and figure into things like report writing or drip calculations/drug dosages. Also, with federal and state standards on how many have to graduate, schools are incentivized to plan in things like "pre-paramedic" courses that focus on things like biology and chemistry, which I also believe makes for a more "well-rounded" person. I don't know that an Associates degree can actually be completed in 60 credits, many pre-requisites like EMT basic and pre-paramedic coursework didn't count towards my degree. I am at over 100 semester credits and still haven't graduated. I haven't taken any "remedial" coursework either. Because this is the case, I would advocate for a Bachelor's level degree, simply because despite what you read on paper, the difference may actually be 3 years vs 4 years, rather than the traditional 2 yrs vs 4 yrs. 

I think this would help bring Paramedicine into the "Allied Health" fold.


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## triemal04 (Nov 15, 2013)

ffemt8978 said:


> And if the NREMT required a degree, a lot more agencies would stop using it.  Realistically, it would spell the end of the NREMT.


Bingo.  Everyone needs to remember that NREMT is a testing agency.  They don't set or enforce standards for the nation, just for those who want to use their test.  And there is no requirement that any state use it.

If anyone was to ever get serious about requiring a degree it would be tied to medicare reimbursements, and to a lesser extent private insurance; require the provider holds a specific degree before medicare will pay a dime for the treatement they gave.


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## triemal04 (Nov 15, 2013)

ExpatMedic0 said:


> For those that think it would be the end of the NREMT or no state would go for that, I would have to disagree, and here is why.
> 
> Example 1: If that is your case, then how do you explain for example, nursing, which did not use to be a degree. It has found a way to transition to a degree. Although there are a handful of diploma/certificate RN facilities still out there, but its pretty much extinct.  I did not see people throwing out the NCLEX exam when this happened. Why is that? Also, how about RT's?
> 
> ...


You're talking about 2 vastly different things than American EMS.

RN's have to take the NCLEX; there is no other alternative.  For EMS there is; any state can create their own test without any issue, complication, or change in reimbursements.  I suppose you could argue that the same could have happened for RN's back in the day, but I don't believe there was ever the mishmash of different tests for RN's that there are for paramedics (could be wrong on that, admittedly).  That's part of why it would be so easy to drop the NREMT; there are allready lots of states that have their own test, and, let's face it, it would be very simple to come up with a paramedic test anyway.

The nursing profession also seemed to have figured out that holding a degree would eventually lead to higher reimbursement rates, higher pay, and the ability to do more for patients (let's save the arguement about whether or not that is needed for another day).  EMS hasn't got that yet.

Australian EMS is nowhere as large as EMS in the states, nowhere near as fractured, and when it started it went down a very different road than it did here.  Many of the problems we face they don't and because of how their entire medical system runs never did, and even the way that EMS providers are used is very, very different.


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## Carlos Danger (Nov 15, 2013)

triemal04 said:


> ExpatMedic0 said:
> 
> 
> > For those that think it would be the end of the NREMT or no state would go for that, I would have to disagree, and here is why.
> ...



You both have good points.

Keep in mind that a BSN is still not required of nurses, and while the percentage of RN's holding a BSN is increasing steadily, ADN programs are not going anywhere anytime soon. There is actually a fair amount of debate still over whether it is necessary or cost-effective to require a BSN, and whether it is wise for the industry to keep pushing for higher education as hard as it is.

I don't know how nursing came to be so well organized and cohesive, to be honest. How did it come to be that every state requires the NCLEX? How did the CCNE (the agency that accredits nursing programs) come to have such influence over the industry? Why is the ANA so much more powerful than the NAEMT? Learning a little about these things would be a worthwhile project for anyone really intent on helping push EMS in the same direction.

But while I think nursing probably holds some good lessons for EMS, I think the two are different enough that they maybe shouldn't be compared as often as they are. Maybe an allied health profession makes a better model for EMS to follow? Respiratory therapy.....


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## triemal04 (Nov 15, 2013)

Halothane said:


> You both have good points.
> 
> Keep in mind that a BSN is still not required of nurses, and while the percentage of RN's holding a BSN is increasing steadily, ADN programs are not going anywhere anytime soon. There is actually a fair amount of debate still over whether it is necessary or cost-effective to require a BSN, and whether it is wise for the industry to keep pushing for higher education as hard as it is.
> While a BSN isn't required, an associate's still is.  We can argue all day long about how "neccasary" a BSN is, and how much more is actually learned (or not learned potentially) about patient care with a BSN.  What matter's though is that the minimum required education really is required and enforced for EVERYONE, AND it meets an easily seen, easily understood, and quantifiable level; an associates degree.
> ...


Honestly, I think it probably happened with nursing and not with EMS at this point for a couple reasons.

EMS has been very fractured ever since it started.  From the beginning there have been multiple competing groups attempting to provide it, and often times butting heads over how it should be done, and what is needed to do so.  Makes it very different to come up with anything close to a consensus, or to make any strict requirements and innovations.  Not so much with nursing.

Nursing has always been a profession.  I'm sure plenty of people will freak out, but the simple fact is that there are a large amount of volunteer EMS providers out there who lobby to keep the standards low.  The reasons why matter very little for the most part, and it doesn't change the fact that requiring extra education when so many people do this as a hobby and not as a career will be very hard.  Even getting the two different groups to see eye to eye and speak in a cohesive fashion can be next to impossible.

We don't need to compare what we do medically to nurses, but I do think we should be looking at what they've done to get where they are a lot more.


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## lightsandsirens5 (Nov 15, 2013)

ffemt8978 said:


> And if the NREMT required a degree, a lot more agencies would stop using it.  Realistically, it would spell the end of the NREMT.



Which would be wonderful...


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## Christopher (Nov 15, 2013)

terrible one said:


> The fire unions would be pissed!



We've added an associates onto everybody's development plans who do not have a degree already at our fire department. Not every fire department drags their knuckles.


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## Wayfaring Man (Nov 15, 2013)

This would be a great idea if there were ways to get degrees in the US without going through the for-profit education industry.  It is a terrible condition our country is in where education requires thousands of dollars at least, often tens of thousands, for even 2 or 4 year degrees.  Requiring someone to get a degree is a fruitless act that does little but benefit the for-profit education system.

What would be the benefit?  It would prove that someone has a creditable, good education that meets relevant standards?  That's the entire point of the NREMT in the first place, and requiring a degree won't help anything there.

Edit: I see on page 2 you're comparing to other countries.  Other countries have significantly different education systems.  Australia literally has the best (tied with Denmark and Finland) education system per Education Index in the entire world.  Tertiary education (college and technical trade) is funded by tax dollars.  The average total cost of a degree in Australia is less than $8000.

They also use a UK-derived model.  There are physicians in Australia with bachelor's degrees.

Simply adopting a degree requirement because another country has done is utterly unreasonable when our education system is so utterly broken by comparison.  There is no way to implement a "have a degree or else" requirement, at least not at the BLS level.  At the ALS level, many medic programs already are part of an associates program or higher, and there is enough content in a medic class to call it a degree in itself, but putting that in the hands of for-profit universities only is a sure way to guarantee the costs go up, making the degree ultimately less viable as the earning potential relative to the cost to get the degree goes down.

One thing the US definitely does not need more of is young working people saddled with virtually unlimited debt that will follow them to their graves.


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## CriticalCareIFT (Nov 15, 2013)

joshrunkle35 said:


> Well, if I understand correctly, nurses were grandfathered in. Additionally, consider that a person that has worked in EMS since 1990 knows a lot more than when they went to school. If I understand correctly (because I was not a paramedic then), things like C-PAP, various splinting devices, fibrinolytics and today's pre-hospital cardiology and treatment is different. Advances in medicine mean a lot more information. The person without a degree has most likely continued learning over time and has amassed much more information than a bachelor's-level degree.



On the job experience and CME are not the same as formal college education. I believe one needs both to be a well rounded provider. Formal college education does not just offer insight into new topics, or material but to obtain a degree to a bachelors level in senior college shows that you learned certain life skills like time management, proper discourse, certain level of maturity, time management, reading and writing ability above GED/High school level and you have read literature that is written for adults. 

Spend sometime with college grads and then spend some time with non college grads (AKA EMS) and observe how the conversations/aspirations differ. Working EMS and meeting people who hold degrees is not the norm, although outliers do exist. 

My point being still in 2013 a guy with no college degree and a medic card with 7 years on the job will be much more sough after than a guy with a bachelors degree and 3 years on the job. This is why the top tier people who are smart and ambitious leave EMS because of frustration, and in 10 years from that day the medic without a degree will still be a medic, and medic with a degree will be PA, MD, DO etc.


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## triemal04 (Nov 16, 2013)

Wayfaring Man said:


> This would be a great idea if there were ways to get degrees in the US without going through the for-profit education industry.  It is a terrible condition our country is in where education requires thousands of dollars at least, often tens of thousands, for even 2 or 4 year degrees.  Requiring someone to get a degree is a fruitless act that does little but benefit the for-profit education system.
> Your personal view of the educational system has no bearing on whether or not more education is needed, nor if a degree should be used to highlight that level of learning.
> 
> What would be the benefit?  It would prove that someone has a creditable, good education that meets relevant standards?  That's the entire point of the NREMT in the first place, and requiring a degree won't help anything there.
> ...


You need to drop you bias and start to understand the profession you've gotten yourself into.


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## NBFFD2433 (Nov 16, 2013)

CFal said:


> A degree for Paramedic I can see arguments for, but for EMT it would be the death of EMS



LOL! I agree. I am not old enough for college.


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## TransportJockey (Nov 16, 2013)

NBFFD2433 said:


> LOL! I agree. I am not old enough for college.



No offense, but the fact we let, in some areas, people that are under 18 do EMS does not do us any favors. Same with others treating this job as a hobby. It's no wonder EMS is not a career


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## EpiEMS (Nov 16, 2013)

TransportJockey said:


> No offense, but the fact we let, in some areas, people that are under 18 do EMS does not do us any favors. Same with others treating this job as a hobby. It's no wonder EMS is not a career



Counterargument: fire departments have explorers, as do police departments. The problem, you could say, is when under-18s are substituting for paid workers.


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## TransportJockey (Nov 16, 2013)

EpiEMS said:


> Counterargument: fire departments have explorers, as do police departments. The problem, you could say, is when under-18s are substituting for paid workers.



You do bring up a point... But that's if you want EMS to stay under a public safety umbrella where we are the :censored::censored::censored::censored::censored::censored::censored: stepchildren. With the recent pushes towards community health and advanced practice paramedics (with laughably inadequate education), we should be pushing to fall more into the healthcare arena... And where in healthcare do you see under age RNs or PAs or MDs? Or even CNAs for that matter?


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## CFal (Nov 16, 2013)

When I was in highschool I knew kids that volunteered in hospitals, but besides that point I think EMS should fall under public safety.


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## TransportJockey (Nov 16, 2013)

CFal said:


> When I was in highschool I knew kids that volunteered in hospitals, but besides that point I think EMS should fall under public safety.



Really? Out here they have to be 18 at least to volunteer in a hospital. Which I suppose would let some seniors in HS do it... but not a 16 year old Sophomore. And why do you believe we should fall under public safety? I'm just curious.. .but then again I hate EMS falling under the FD umbrella anyways.


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## Rialaigh (Nov 16, 2013)

TransportJockey said:


> Really? Out here they have to be 18 at least to volunteer in a hospital. Which I suppose would let some seniors in HS do it... but not a 16 year old Sophomore.* And why do you believe we should fall under public safety?* I'm just curious.. .but then again I hate EMS falling under the FD umbrella anyways.



Im going to jump in here.

Because the purpose of EMS is to provide _*emergency, life saving, immediately benefiting care to those that NEED it.*_ EMS was not created or intended to ever do any type of community medicine. It was not intended for non emergencies. If EMS is to adapt the the levels that some of you want it to then it will no longer be EMS in any manner of the form. It will simply be "MHS" or mobile healthcare service.

And mobile healthcare services are very different animals from EMS and cannot be treated as EMS at all.


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## CFal (Nov 17, 2013)

Rialaigh said:


> Im going to jump in here.
> 
> Because the purpose of EMS is to provide _*emergency, life saving, immediately benefiting care to those that NEED it.*_ EMS was not created or intended to ever do any type of community medicine. It was not intended for non emergencies. If EMS is to adapt the the levels that some of you want it to then it will no longer be EMS in any manner of the form. It will simply be "MHS" or mobile healthcare service.
> 
> And mobile healthcare services are very different animals from EMS and cannot be treated as EMS at all.


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## CFal (Nov 17, 2013)

TransportJockey said:


> Really? Out here they have to be 18 at least to volunteer in a hospital. Which I suppose would let some seniors in HS do it... but not a 16 year old Sophomore. And why do you believe we should fall under public safety? I'm just curious.. .but then again I hate EMS falling under the FD umbrella anyways.



Ideally it should be 3rd service, but in some places it makes more sense to have it fire based.


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## MrJones (Nov 17, 2013)

CFal said:


> Ideally it should be 3rd service, but in some places it makes more sense to have it fire based.



In what places and in what ways?


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## Rialaigh (Nov 17, 2013)

MrJones said:


> In what places and in what ways?



Again if I may jump in here. It makes way more sense to have EMS be fire based in most areas, or at least working in conjunction with the fire department or contracted by the fire department. Instead of having guys sitting in rigs on street corners you could have EMS crews enjoying the comforts of fire stations and the company of other people during shift. It makes way more sense to build one station to house both instead of two stations to house them seperately, or having the crew sit on street corners. It makes more sense to already have a secured area where you can restock. It makes sense to already have training rooms and areas available to you. 

From an efficiency standpoint ($$$) it would make sense for all EMS To be fire based, or at least contracted by the fire department. 

If current fire based EMS services would do a study that would show how much time an average EMS crew spent away from the station in a 24 hour period (averaged over months and dozens of stations..etc..) compared with how much time the average fire crew spent away from the station in those same periods, and then hired "fire medics" that were solely for the EMS side of things (maybe cross trained in some extrication) and paid them accordingly for their time, then maybe this fire medic thing would work a lot better. You would have designated medical personal that were not there just for the fire side, and you would have them paid accordingly, then shared facilities would become a standard.


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## Summit (Nov 17, 2013)

Rialaigh said:


> Im going to jump in here.
> 
> Because the purpose of EMS is to provide _*emergency, life saving, immediately benefiting care to those that NEED it.*_ EMS was not created or intended to ever do any type of community medicine. It was not intended for non emergencies. If EMS is to adapt the the levels that some of you want it to then it will no longer be EMS in any manner of the form. It will simply be "MHS" or mobile healthcare service.
> 
> And mobile healthcare services are very different animals from EMS and cannot be treated as EMS at all.



At that point, you may as well make it a nursing specialty.


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## Carlos Danger (Nov 17, 2013)

Summit said:


> At that point, you may as well make it a nursing specialty.



You better run for cover.....h34r:

I'm not touching this one after the RN-to-Paramedic thread, lol.


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## ExpatMedic0 (Nov 17, 2013)

Might as well eliminate every kind of healthcare occupation and make it some kind of nursing specialty or have it fall under nursing in some kind of way. Or at least that is what some nurses seem to think that post on this forum. Apparently this trusty holistic sidekick of the doctor complements all realms of healthcare.


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## ExpatMedic0 (Nov 17, 2013)

I feel a storm front with a high probability of **** storm.... in the upcoming forecast


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## TransportJockey (Nov 17, 2013)

Rialaigh said:


> Im going to jump in here.
> 
> Because the purpose of EMS is to provide _*emergency, life saving, immediately benefiting care to those that NEED it.*_ EMS was not created or intended to ever do any type of community medicine. It was not intended for non emergencies. If EMS is to adapt the the levels that some of you want it to then it will no longer be EMS in any manner of the form. It will simply be "MHS" or mobile healthcare service.
> 
> And mobile healthcare services are very different animals from EMS and cannot be treated as EMS at all.



Umm... How much of your call volume matches up with they bolded statement? We do more social working and non emergency stuff than emergent critical treatments.


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## Summit (Nov 17, 2013)

I knew my buddy would come and play. :rofl:

I'm just saying, if you want EMS providers to suddenly be a super combination of a Flight RN and a CH RN, don't you want an RN? That is what some countries do!

Rialaigh has a point: EMS can focus on being emergency care professionals.


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## ExpatMedic0 (Nov 17, 2013)

I don't feel nursing is the best answer to EMS, or to every other healthcare occupation. I am not saying it can't be done (because some countries do follow this). 

 I think the idea and concept of Paramedicine is great, it just needs to progress like we have seen it do in every other English speaking 1st world country in the world. It can be frustrating at times to always be the underdog and redheaded stepchild of both healthcare, and public safety in the USA, but I think one day in the not so distant future, America will catch up with the rest of the world.

I know I would not have dedicated 4 years of university and soon to start post graduate work while remaining in EMS if I did not have some passion for it and hopefully can help advocate for furthering it one day. Having been in it for 10 years now, I know the giant **** sandwich I have signed up for, but I don't think nursing is know all cure all answer to all things health related.


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## Summit (Nov 17, 2013)

I don't think nursing is THE answer. It could be AN answer. It depends on what EMS is going to be. I really like what I hear and see in the NZ, Canadian, and Australian systems. I doubt the answer will be that... or nursing. I don't think answer will be a good answer. The green tinted glasses folks love disposable technicians.


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## EpiEMS (Nov 17, 2013)

Summit said:


> The green tinted glasses folks love disposable technicians.



From a cost perspective I don't see the "disposable technician" side having a large advantage, at least, it's revenue model dependent. If the revenue model is going to be transport based, yes, it may make sense. However, if the "revenue" model is based on municipal tax receipts, just as it is for FD and PD, then "disposable" isn't good -- if you have the broad tax base supporting it, you can afford to have professionals, people with advanced training, degrees, you name it.


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## SandpitMedic (Nov 17, 2013)

EpiEMS said:


> -- if you have the broad tax base supporting it, you can afford to have professionals, people with advanced training, degrees, you name it.



Indeed!


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## SandpitMedic (Nov 17, 2013)

ExpatMedic0 said:


> I know I would not have dedicated 4 years of university and soon to start post graduate work while remaining in EMS if I did not have some passion for it and hopefully can help advocate for furthering it one day. Having been in it for 10 years now, I know the giant **** sandwich I have signed up for, but I don't think nursing is know all cure all answer to all things health related.



This made my day!!!! Someone thinking outside the box! Going the extra mile to further the cause! This is what I'm talking about.. we need more "yous!"


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## Summit (Nov 17, 2013)

EpiEMS said:


> From a cost perspective I don't see the "disposable technician" side having a large advantage, at least, it's revenue model dependent. If the revenue model is going to be transport based, yes, it may make sense. However, if the "revenue" model is based on municipal tax receipts, just as it is for FD and PD, then "disposable" isn't good -- if you have the broad tax base supporting it, you can afford to have professionals, people with advanced training, degrees, you name it.



Municipal tax base green tinted glasses folks love disposable technicians if the EMS disposable technicians are simple add-ons to FFs and the goal is to support engines, ladders, pumpers, first.


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## CFal (Nov 17, 2013)

Summit said:


> Municipal tax base green tinted glasses folks love disposable technicians if the EMS disposable technicians are simple add-ons to FFs and the goal is to support engines, ladders, pumpers, first.



Municipalities put a lot of money into training their people, especially dual role training.  They sure don't treat employees as disposable like privates do.


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## Carlos Danger (Nov 17, 2013)

ExpatMedic0 said:


> Might as well eliminate every kind of healthcare occupation and make it some kind of nursing specialty or have it fall under nursing in some kind of way. Or at least that is what some nurses seem to think that post on this forum. Apparently this trusty holistic sidekick of the doctor complements all realms of healthcare.



Well, the reality is that nurses DO already exist in all realms of healthcare....CCT, acute inpatient care, long-term care, home care, and everything in between.....but I don't think anyone here (or anywhere else) is advocating eliminating other healthcare professions.

The thing about community health is not that nurses should "take it over", it's that nurses _already do it._ Many of the early influential nurses (Nightingale, Lillian Wald, etc) were focused on public health, and today there are probably 10's of thousands of full-time home healthcare nurses. 

I do think that community health can/should/will be a big part of improving access to primary care and reigning in healthcare costs in the future, which means there is a lot of room for expansion. And I do think that there is plenty of room for paramedicine to be involved in that. 

What I don't see is any demand or justification for going to all the trouble and expense of inventing a completely new profession at the mid-level provider for paramedics who want to do primary care in the community. I just do not see that ever happening, and I think it is too bad that so many see a complete re-invention of their profession as the only salvation for paramedicine. 

Here is something I wrote in another thread on this topic: 



Halothane said:


> If the government decides to increase funding for community health initiatives, it makes more sense to simply expand the existing infrastructure than it does to invent a whole new provider. We already have NP's, PA's, and CHRN's. The existing entities all have more political pull than EMS, and will quickly snatch up any funding made available. And as a taxpayer who would rather see his tax dollars go towards the actual delivery of care rather than towards funding redundant educational programs, I wouldn't necessarily disagree with that.
> 
> Now, that said.....
> 
> ...



And my vision of what paramedicine should and realistically can and should be:



Halothane said:


> This is exactly why "normal" paramedics need the ability to do non-emergency care, and part of the reason why having dedicated "community health paramedics" is unworkable, IMO:
> 
> A patient calls 911 for shortness of breath, just like they do now. A paramedic unit responds emergently, just like they do now.
> 
> ...


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## MrJones (Nov 17, 2013)

Halothane said:


> ...And my vision of what paramedicine should and realistically can and should be:
> 
> 
> 
> ...



You left out one key bit of information: How is the ambulance service reimbursed for this call? A sustainable funding model is absolutely imperative for your vision to succeed in the long run.


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## CriticalCareIFT (Nov 17, 2013)

Halothane said:


> Well, the reality is that nurses DO already exist in all realms of healthcare....CCT, acute inpatient care, long-term care, home care, and everything in between.....but I don't think anyone here (or anywhere else) is advocating eliminating other healthcare professions


I agree that nurses do exists in all realms of health care and function in their respected roles and practice nursing. Yet have a  belief that after years of nursing that they can take a 2 week course here, a residency training there, or masters degree and transform to another health care profession with equal competencies and be a paramedic, primary care physician as NP, anesthesiologist as CRNA etc. etc.  




Halothane said:


> What I don't see is any demand or justification for going to all the trouble and expense of inventing a completely new profession at the mid-level provider for paramedics who want to do primary care in the community. I just do not see that ever happening, and I think it is too bad that so many see a complete re-invention of their profession as the only salvation for paramedicine.



You mean line nurses did with NP? And wanted to practice medicine in rural areas where there is need, but really stay in major cities and university hospitals?


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## EpiEMS (Nov 17, 2013)

Summit said:


> Municipal tax base green tinted glasses folks love disposable technicians if the EMS disposable technicians are simple add-ons to FFs and the goal is to support engines, ladders, pumpers, first.



Yes, there are some synergies with having FF-based EMS. The personnel are already cross-trained (I say trained for a reason) and much of what they do is related (MVAs require FD for rescue, in most communities where EMS doesn't have "organic" rescue expertise, for example), and the stations are already there. However, remember that most of what the FDs do today is superfluous -- the reason why we don't have lots of fires (or lots of folks dying due to fires) has nothing to do with fire departments, but everything to do with engineering and fire protection technologies. Better construction has reduced the need for fire suppression and financial innovation covers the risk from the cost side. Fire departments are -- on the mean -- overstaffed and overfunded.

Some of the cost disadvantages of FD-based EMS:

-- You're pulling out engines and ladder trucks -- it costs more to have the 3 FFs and 1 officer on an engine respond than it does an EMT/Medic ambulance, and the value-added by the FF/EMTs is pretty minimal, other than for lifting. And we can easily substitute capital for labor (think power stretchers), which are much cheaper than (unionized) FFs. If you really feel that we need more personnel at any given call, I'd wager that the costs (fixed and variable) for having a 3 or 4 person-staffed ambulance (or 2 person ambulance with a 1 person fly-car) are dwarfed by a fire engine.

-- FFs don't want to be doing EMS, on the mean. Less motivation can quickly turn to lower quality of care (or, at the very least, not up-to-date care because of a lack of engagement with the literature, etc.)

-- It provides a reason to add staffing to fire departments where the marginal benefits are exceeded by the marginal costs (i.e. the value added of another FF is smaller than the added benefits provided).

I like to think of FF-based EMS as well-intentioned (even though it perpetuates an extent and outdated system) but ill-informed. Firefighters don't fight fires. We are better off having single-role EMS personnel do EMS, not firefighters.


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## ExpatMedic0 (Nov 17, 2013)

Definitely a lot of interesting discussion stemming from this thread, even if I don't agree with it all. The fact of the matter is our healthcare system is changing folks, if you like it or not. Some may think I am full of hot air and over-ally optimistic, which may be partly true ;-) but we are getting ready for some big changes in healthcare, especially from a financial standpoint. I don't want to dive to deeply into the vastly expanding realm of Mobile Inter-graded Healthcare, and the amazing emerging trend of community paramedicine, nore the political agenda with the fire department or nursing, as that is best suited for another thread. However, for better or for worse... there are some big changes coming down the EMS pipeline in our career lifetimes. Personally I think it would be in our best interest to shift towards a degree requirement from a national standpoint, even if only an AAS.


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## Wayfaring Man (Nov 17, 2013)

triemal04 said:


> You need to drop you bias and start to understand the profession you've gotten yourself into.



You've missed my point here.  My point is not that level of training is unimportant, or that a degree is a problem.  I have a degree, incidentally.

I strongly agree that we need to maintain high standards of training.  We need to enforce high levels of competency because lives are at stake.  _A college degree does not do that._  It does not accomplish the things you mentioned (a high national standard or requirement, and so on) to require a college degree.  There are other accrediting standards that can be used to do that without specifically requiring _a college degree_, which is absolutely an institution that at this point is extremely exploitative.  It's not about my politics, it's about the reality of the situation.

There absolutely should be a national standard.  NREMT is not that yet, it is not mandatory, but that's what NREMT does.  It does advocacy to that end the same way CACREP advocates for counseling standards, or PTCB advocates for pharmacy technician standards, or Pro-Board accredits NFPA standard courses, and so on.

This doesn't require college.  It is a medical field, it certainly requires advanced education.  I am a huge fan of the new EMT courses that emphasize psychophysiology, and increasing the competency and knowledge of all EMS professionals from Basics to Medics.  

But mandating a college degree is not the way to do that.


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## ExpatMedic0 (Nov 17, 2013)

Wayfaring Man said:


> ....
> But mandating a college degree is not the way to do that.


Everyone is entitled to there opinion, but I think your wrong. Maybe not from a practical standpoint, completely, but lets face it; In today's world, educated professionals need to posses a degree to be taken seriously, to do research in their field, to advocate and change polices, to lead and manage, and even as a whole, to be given higher salaries, rights, and privileges. Vocational training is not cutting it if you ever want to be taken seriously and as a professional. The general public and our predecessors expect professionals to hold degree's in today's society, otherwise we are just stretcher-baring tradesmen or ambulance drivers to them, and that is how we will be treated and paid.


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## Wayfaring Man (Nov 17, 2013)

Edit: What you're saying makes good sense.  I don't agree, for the reasons I had written already which follow, but I definitely see your point.  Having a "BS in Emergency Medicine" or something like that would definitely improve the image of an EMT to the public.  I think EMS degrees should exist and should become a thing.  I think they should compete on the marketplace.  If the public demands EMTs with college degrees, then the market will bear that out when such degrees are available, without a government mandate for them.  Companies will simply prefer to hire people with a degree over people without one.  Companies will prefer to hire people with an EMS degree over those without one.  That would happen regardless of a strict mandate "have a degree or you can't get an EMS certificate."



I totally agree that we need to be standardizing from a national standpoint, that we need to be moving towards a rigorous, continuously improving program that provides best patient care based on evidence based medicine.  I just disagree that a university degree, even an AAS, is the way to do that.  It is entirely possible to train people to do emergency medicine, especially at the basic level, to practice without a degree program.  FF/EMTs that attend academies or even volunteers that attend basic training programs like those offered from University of Maryland Fire and Rescue Institute (which is done by colleges, but doesn't require a full degree) is certainly sufficient to produce quality EMTs.

An associates degree is usually comprised of 60 credit hours of education.  A credit hour is usually 15 contact hours.  That's 900 contact hours.  Most schools now require a "liberal arts" basis that emphasizes diverse studies.  _I think it's great_ and more people who are able should get such an education, because rounded education allows for better problem solving and better education.  This produces better practitioners.  _I like better practitioners._  I think I am a better EMT because I have a solid education.  But I don't think mandating a degree is the solution to the problem when it's entirely possible to create quality EMTs without the degree.  After all, a degree is just a piece of paper.  It's the education and training that matters.


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## ExpatMedic0 (Nov 17, 2013)

As I said, from a practical standpoint, I do not think your entirely wrong, I just disagree with your degree opinion. Its not what you or I think, its the reality of the world we live in. As I said before, the general public, our other healthcare colleagues, and our predecessors, expect professionals. They expect educated professionals to hold degree's in today's society. Otherwise,  we truly are just stretcher-baring tradesmen or ambulance drivers to them, and that is how we will remain and you and I will be treated and compensated for our services. Not because I think so, but because of the reality. Completing 2 semesters of general education (half of which is natural sciences and related to healthcare) ontop of a Paramedic program is not to much to ask.... I don't think.... I think we could grandfather people in who are already paramedics and start making progress like the rest of the world.

On a side note: I got a friend who works critical care transport. He is studying to become a doctor. When he shows up to take a patient on multiple drips and hooked up to invasive lines that need to be monitored and adjusted en route, nurses still refer to him as "the driver." The driver is here to take the patient...


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## Carlos Danger (Nov 17, 2013)

CriticalCareIFT said:


> I agree that nurses do exists in all realms of health care and function in their respected roles and practice nursing. Yet have a  belief that after years of nursing that they can take a 2 week course here, a residency training there, or masters degree and transform to another health care profession with equal competencies and be a paramedic, primary care physician as NP, anesthesiologist as CRNA etc. etc.
> 
> 
> 
> ...



Yep. 

Nurses rule the healthcare world. 

They are executing a vast conspiracy to control all other healthcare related professions.

They can do whatever they want. 

You exist as a paramedic only because nurses allow you to.

Deal with it.


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## ExpatMedic0 (Nov 17, 2013)

When your called to a scene, you make a differential diagnosis, and the decision to take that patients ability to breathe away, paralyze them and manually introduce an ET tube into their trachea, without ever looking at protocols or calling a doctor, I think you need to have a degree. Period.

 Not only to prove your smart enough to do the math on drug calculations, understand the anatomy and pathophysiology, and academic skills needed to write a proper report, but also because you deserve some kind of professional recognition, and your not going to get that as a vocational technician.


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## Wayfaring Man (Nov 17, 2013)

Fair enough.  I don't think those things are too much to ask except that education in general is still difficult for a lot of people.  It's still unnecessarily burdensome in my opinion, but yeah, I agree with your assessment regarding the respect it would afford the field.  Having a degree would definitely help boost the profession.

And I agree with the need we have to be asserted as a "real medical profession."  A lot of people don't see us that way, and the fire side doesn't help it.  I like the "community paramedic" model as it was pointed out to me, and I think that probably is best done as a "real education."  I am just heavily skeptical of "pricing people out of the field" so to speak.  But it's true, the culture we live in values that piece of paper a lot more than it does the actual details of an education or training, I suppose mainly because most people don't know the details of degrees outside their field.


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## Wayfaring Man (Nov 17, 2013)

ExpatMedic0 said:


> Not only to prove your smart enough to do the math on drug calculations, understand the anatomy and pathophysiology, and academic skills needed to write a proper report, but also because you deserve some kind of professional recognition, and your not going to get that as a vocational technician.



This right here is the part I absolutely agree with.  The part about not needing to prove you're smart enough to slip an ET or an RSI, because _the training and ability to perform those skills is enough to justify performing those skills_ (as avered by a standardized curriculum and accrediting agency), but because a person who has those skills deserves more respect than that of a basic vocational technician.


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## CFal (Nov 17, 2013)

EpiEMS said:


> Yes, there are some synergies with having FF-based EMS. The personnel are already cross-trained (I say trained for a reason) and much of what they do is related (MVAs require FD for rescue, in most communities where EMS doesn't have "organic" rescue expertise, for example), and the stations are already there. However, remember that most of what the FDs do today is superfluous -- the reason why we don't have lots of fires (or lots of folks dying due to fires) has nothing to do with fire departments, but everything to do with engineering and fire protection technologies. Better construction has reduced the need for fire suppression and financial innovation covers the risk from the cost side. Fire departments are -- on the mean -- overstaffed and overfunded.
> 
> Some of the cost disadvantages of FD-based EMS:
> 
> ...



When there is a fire it is very labor intensive, yes today there are more EMS calls than fire, but a fire takes longer than an EMS run and requires a lot more people to put it out.


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## NObama (Nov 17, 2013)

We have countless medics and emts with associates, bachelors, and masters degrees...this makes them neither better or worse providers.

I think an associates program would be a good minimum, simply because most of the classes required for a bachelors, are completely unrelated to EMS...

At most community colleges, all you need is general ed type stuff to get an associates in EMS, after taking all of the required courses for medic school, so an AS wouldnt really be a stretch, just a handful of other classes you would need.

Requiring a degree for an entry level position like EMT is a pipe dream.

The biggest benefit i would see from requiring a degree, is potentially higher pay and hopefully elevation of the profession as a whole.


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## Rialaigh (Nov 18, 2013)

TransportJockey said:


> Umm... How much of your call volume matches up with they bolded statement? *We do more social working and non emergency stuff than emergent critical treatments*.



I completely agree and this is my point. One of two things needs to happen for EMS to be a viable progressive field. 

We can either
1. Go back to really only treating emergencies and get progressive about dropping people off at urgent cares or outright refusing to transport non emergencies.

Or 

2. We can progress to "MHS" or mobile health services and be dispatched as "mobile health units" to take care of all variety of medical complaints that are emergent or non emergent in a much more economical and sensible fashion. 



The way we are right now is a really poor combination of the two. We see WAY more social work and non emergent stuff than emergent stuff as you have rightly pointed out. However we try and treat it all as emergent. We do EKG's in a 5 minute ride to the hospital and establish an IV and give asprin for patients who have been having chest pain for 2 weeks. If this same patient showed up at their family doctor they would be managed quite differently. We use expensive resources on routine transports because we have "emergency" on the side of our vehicle. 

We either need to get back to only really treating and transporting "emergencies" 

Or 

we need to get away from the emergency title and adapt the whole field to "mobile healthcare services" and then train accordingly. If the majority of our time will be spent with non emergent patients who could benefit vastly from proper referals correct facility placement then our training must reflect that.


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## Rialaigh (Nov 18, 2013)

ExpatMedic0 said:


> Everyone is entitled to there opinion, but I think your wrong. Maybe not from a practical standpoint, completely, but lets face it; In today's world, educated professionals need to posses a degree to be taken seriously, to do research in their field, to advocate and change polices, to lead and manage, and even as a whole, to be given higher salaries, rights, and privileges. Vocational training is not cutting it if you ever want to be taken seriously and as a professional. The general public and our predecessors expect professionals to hold degree's in today's society, otherwise we are just stretcher-baring tradesmen or ambulance drivers to them, and that is how we will be treated and paid.



I agree with what your saying here but the problem is the whole though process is wrong. You may need a degree to be viewed as a professional by the rest of the world but it doesn't (or wouldn't) make EMS any more professional or provide higher quality providers. It might provide higher salaries and more rights and privileges and let us be taken more seriously but in the end the actual training from achieving a degree does nothing to make you a better medical provider from a basic treatment standpoint (based on current American ems systems). 

Requiring everyone to have a degree will just cause the "price" of EMS To go through the roof to pay for the training and the higher salaries. The government will have to fund it by paying better rates for medicare and medicaid. private insurance will get slightly more expensive to cover the higher EMS bills, and all of that for care that likely will not improve outcomes at all for the vast majority of patients.


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## triemal04 (Nov 18, 2013)

Rialaigh said:


> I agree with what your saying here but the problem is the whole though process is wrong. You may need a degree to be viewed as a professional by the rest of the world but it doesn't (or wouldn't) make EMS any more professional or provide higher quality providers. It might provide higher salaries and more rights and privileges and let us be taken more seriously but in the end the actual training from achieving a degree does nothing to make you a better medical provider from a basic treatment standpoint (based on current American ems systems).
> 
> Requiring everyone to have a degree will just cause the "price" of EMS To go through the roof to pay for the training and the higher salaries. The government will have to fund it by paying better rates for medicare and medicaid. private insurance will get slightly more expensive to cover the higher EMS bills, and all of that for care that likely will not improve outcomes at all for the vast majority of patients.


As far as more professional and higher quality providers...I think you're off base.  Even if all that was required is an Associate's Degree, the cost of getting it will cause some people to not go for that particular cert.  This obviously isn't a complete fix, but it will require more time, effort and money than the current setup, which I think would weed out the people who don't really want to be a paramedic.

Oregon has required a degree for quite awhile (in terms of EMS anyway), and while there are still plenty of less than desirable paramedics, and people who only do it to help with getting a job as a firefighter, it seems that the average quality of paramedics here is higher than elsewhere.  

It would depend on how the degree was structured, but the extra time and credits required very well could make for a better provider; to be eligible to even get into a paramedic class you have to take a full year of Anatomy and Physiology.  Believe it or not, that pays all sorts of dividends.  There are some non-degree programs that require this, but that's just one example of something that could easily be added and would be a benefit.

I do agree that simply requiring a degree is not the perfect panacea though; it won't magically fix all problems.  But it will help, be a great start, and make many of those problems easier to fix.

Wayfaring Man...seriously, you need to learn not only about EMS, but about the entire medical profession.


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## Clipper1 (Nov 18, 2013)

Some keep mentioning "cost". I don't see how a community college degree is any more expensive than the $3000 some pay for a simple EMT course and up to $20,000 some pay a medic mill for a 600 - 1200 hour certification with no college level courses.  Then, you have people who pay well over $1000 plus hotel for a simplified overview of critical care; CCEMTP course. There are also medic mills cashing in on the CP course which is another 2 - 4 week cert which they can charge a few thousand dollars for and no college courses or prerequisites are needed.  I fail to see this cost logic when people are in debt for $20,000 for a quick cert and no credits to transfer to a college. 

An Associates degree with college level courses for A&P and pharmacology would be a benefit rather than the overview courses which some certificate programs are offering even in the colleges. And, the degree should be in EMS/Paramedic. Just having a random degree might make you more literate but the focus should be on the medical part. Very few Associates degrees for allied health have time for all those courses some believe to be a waste of time like the humanities and math. What few there are should improve your communication skills and help with drug calculations or reasoning skills.

Right now it appears there are only about 20% of those holding an active certification in EMS who have a degree. Chances are there are many of this percentage who hold a degree in something else like nursing or some totally unrelated field. This also includes the volunteers who might have another very  different profession which requires a degree such as school teachers and accountants.  

Even the percentage for the instructors holding degrees is very, very low since the Paramedic courses are considered tech school and no degree is required to teach in that classification.  This means there are very few mentors to push for education.  The change must start here first. Instructors must raise their standards first.   They also must raise their education levels so they can take charge of the EMS programs in the colleges. Right now nursing administration still plays a large role in the education portion since few are willing to move up the ladder and accept the overall responsibility. 

Until more do take advantage of the many community college EMS degrees, nothing will change. The degrees are there but it seems too many offer arguments against them. 

It also takes decades to get a degree established for licensing. It took over 15 years for the current "certification" changes to come into effect. Basically all that did was change the titles and not much else. Essentially EMS has the same education requirements it had in 1980 without much more for forward planning for degrees. There will just be more certs with each state again doing its own thing as we now see with the CP program and the CCT courses. More fragmentation and no direction can only be the endgame again. 

The state of Oregon also makes several exceptions to obtaining the degree so it is really hard to use it as an example.


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## Rialaigh (Nov 18, 2013)

Just to pose a bit of a devils advocate question

What is the purpose in your mind (those who have responded in favor of degrees for EMS) of an EMS provider having more education than currently required. Please be specific


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## Clipper1 (Nov 18, 2013)

Rialaigh said:


> Just to pose a bit of a devils advocate question
> 
> What is the purpose in your mind (those who have responded in favor of degrees for EMS) of an EMS provider having more education than currently required. Please be specific



I don't see what you mean by devil's advocate. Anyone who works in a profession which is based on billing and reimbursement should be aware of CMS and its definitions in health care. 

To petition CMS to be classified as a health care professional by showing education and providing the data you make a difference in patient care. This does not mean how many "saves" you did last year but what you have done to make a difference to the community and health care with its effects on the economic status for CMS. 

Every health care profession which is reimbursement dependent has had to do this in order to survive as a profession.  This has to be done as a profession nationally. It also does not stop there but support must be continued in order to keep the money coming.


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## Masenko (Nov 18, 2013)

Rialaigh said:


> Im going to jump in here.
> 
> Because the purpose of EMS is to provide _*emergency, life saving, immediately benefiting care to those that NEED it.*_ EMS was not created or intended to ever do any type of community medicine. It was not intended for non emergencies. If EMS is to adapt the the levels that some of you want it to then it will no longer be EMS in any manner of the form. It will simply be "MHS" or mobile healthcare service.
> 
> And mobile healthcare services are very different animals from EMS and cannot be treated as EMS at all.



Just because EMS was created to respond to emergencies doesn't mean that's all we're going to face. Shouldn't we adapt and learn about what we deal with on a regular basis as well? We have to look at the reality of what we face, not just fixate on our original purpose. 



Rialaigh said:


> Just to pose a bit of a devils advocate question
> 
> What is the purpose in your mind (those who have responded in favor of degrees for EMS) of an EMS provider having more education than currently required. Please be specific


 
A degree requirement will weed out the people who don't place value on education; the ones that others in this thread have mentioned who stay in field for 10 years vs those who go on higher career paths. EMS needs to retain a few higher educated members to make progress in politics, conduct research, etc.   

I guess clinically and for our scope of practice it will not make a difference. It would be the same way an ASN is no different from an BSN, yet the BSN looks better on paper. Awesome thread OP!


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## Rialaigh (Nov 18, 2013)

Masenko said:


> Just because EMS was created to respond to emergencies doesn't mean that's all we're going to face. S_*houldn't we adapt and learn about what we deal with on a regular basis as well*_? We have to look at the reality of what we face, not just fixate on our original purpose.
> 
> 
> 
> ...





We absolutely should adapt. We have to lead the charge by not treating every "emergency" call as an emergency. Our protocols are laid out to treat emergencies, our systems are laid out for emergency response, everything we do screams emergency. If we want to be progressive about adapting to our actual call breakdown we need protocol to refuse to transport the "back pain X 3 months" to the ER, we let him know it's not what we consider an emergent condition and leave him or her with a reference sheet of orthopedics and chiropracters. As long as we continue to transport everything to emergency rooms, then we continue to treat every condition regardless of severity, as an emergency. This has to change if we are going to adapt. That is what I was saying with the Mobile Healthcare Services side of things





As to the education portion, I agree. It would raise intelligence minimally by weeding out those who don't like minimal education. But it really wouldn't improve clinical skills or scope of practice or anything at all. I guess my point with requiring a degree is I don't think it would make one spec of difference in patient outcomes at all.


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## EpiEMS (Nov 18, 2013)

CFal said:


> When there is a fire it is very labor intensive, yes today there are more EMS calls than fire, but a fire takes longer than an EMS run and requires a lot more people to put it out.



For the small town surrounded by other small towns, the chance of there being two major structure fires at once is minimal -- mutual aid can make up the rest.

For the big city, you don't need to rely on mutual aid, assuming you've staffed appropriately.

You can model the risk of fire and staff to the expected number of fires plus some additional margin. Heck, you could staff to the 95% CI, if you wanted to.


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## EpiEMS (Nov 18, 2013)

Rialaigh said:


> I completely agree and this is my point. One of two things needs to happen for EMS to be a viable progressive field.
> 
> We can either
> 1. Go back to really only treating emergencies and get progressive about dropping people off at urgent cares or outright refusing to transport non emergencies.
> ...



These aren't mutually exclusive. We could certainly have the "MHS" model -- fly-car advanced practice paramedics, and then regular BLS and ALS 911 units that can triage to urgent cares as needed (or call for non-emergency transportation -- a taxi, say -- once they've assessed the situation).


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## CFal (Nov 18, 2013)

EpiEMS said:


> For the small town surrounded by other small towns, the chance of there being two major structure fires at once is minimal -- mutual aid can make up the rest.
> 
> For the big city, you don't need to rely on mutual aid, assuming you've staffed appropriately.
> 
> You can model the risk of fire and staff to the expected number of fires plus some additional margin. Heck, you could staff to the 95% CI, if you wanted to.



 The problem is there is barely enough fire fighters for one fire.  When you have a 2 or 3 man engine company and 2 ff on the ambulance then you don't have to wait for the second due engine company to start a search and follow 2 in 2 out


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## EpiEMS (Nov 18, 2013)

CFal said:


> The problem is there is barely enough fire fighters for one fire.  When you have a 2 or 3 man engine company and 2 ff on the ambulance then you don't have to wait for the second due engine company to start a search and follow 2 in 2 out



On the margin, I doubt it's worth it. We have to be rational about this kind of thing: just because it's better doesn't mean it's worth the added cost. The NIST study of NFPA 1710 (the 4-man recommendation) says that a 4 man engine company makes a difference, sure, but, for example, the improvement of a 4-man company over a 3-man company in terms of the number 1 duty of firefighters (other than self-preservation), conducting a primary search, is only 6%. On the margin, I don't see that as worthwhile, considering what a firefighter costs.

This is probably tangential. I am, broadly, making the point that cost effectiveness matters, it's not just about what's best, it's about what's best at a desired cost.


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## CFal (Nov 19, 2013)

EpiEMS said:


> On the margin, I doubt it's worth it. We have to be rational about this kind of thing: just because it's better doesn't mean it's worth the added cost. The NIST study of NFPA 1710 (the 4-man recommendation) says that a 4 man engine company makes a difference, sure, but, for example, the improvement of a 4-man company over a 3-man company in terms of the number 1 duty of firefighters (other than self-preservation), conducting a primary search, is only 6%. On the margin, I don't see that as worthwhile, considering what a firefighter costs.
> 
> This is probably tangential. I am, broadly, making the point that cost effectiveness matters, it's not just about what's best, it's about what's best at a desired cost.



 Problem with that study is that it is operating under the assumption  that there are other engine or ladder companies at the scene, it is OSHA requirement that you cannot go into a building with only 3 FF on scene.  You need an IRIC to start anything interior


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## Rialaigh (Nov 19, 2013)

CFal said:


> Problem with that study is that it is operating under the assumption  that there are other engine or ladder companies at the scene, it is OSHA requirement that you cannot go into a building with only 3 FF on scene.  You need an IRIC to start anything interior



Bluntly put firefighters save thousands more lives per year by doing first response medical well with quality CPR then they do by pulling people out of structure fires. There are departments that will go 10 years at a time without having a viable entrapment.


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## usalsfyre (Nov 19, 2013)

CFal said:


> Problem with that study is that it is operating under the assumption  that there are other engine or ladder companies at the scene, it is OSHA requirement that you cannot go into a building with only 3 FF on scene.  You need an IRIC to start anything interior



False. 2 in 2 outdoes not apply in life threats. 

FURTHER..how may small or for that matter large FDs regularly make grabs? How many successful RIT operations do you hear about? The insistence on interior firefighting inside modern day (since the late 60s to early 70s) construction is why we continue to kill firefighters in the same manner at a rate of 100 a year.


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## usalsfyre (Nov 19, 2013)

Rialaigh said:


> 1. Go back to really only treating emergencies and get progressive about dropping people off at urgent cares or outright refusing to transport non emergencies.
> 
> Or
> 
> 2. We can progress to "MHS" or mobile health services and be dispatched as "mobile health units" to take care of all variety of medical complaints that are emergent or non emergent in a much more economical and sensible fashion.



The problem with number one is that its not how disease works. Advances in healthcare will quite literally put us out of a job eventually. 

Number two is the only way to be viable. That requires a significantly higher level of background education to understand the factors involved. Hence degree requirements.


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## Rialaigh (Nov 19, 2013)

usalsfyre said:


> The problem with number one is that its not how disease works. Advances in healthcare will quite literally put us out of a job eventually.
> 
> *Number two is the only way to be viable. That requires a significantly higher level of background education to understand the factors involved. Hence degree requirements.*



I'm all for this. I just see more people wanting higher education requirements so we can titrate pressors more effectively or RSI better. We really need to get away from "emergency" education. Our mindset when treating most calls ought to be the same as if the patient just walked in their family practice office.


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## ExpatMedic0 (Nov 19, 2013)

A lot of interesting points. One reason I made this thread was because in my opinion, I don't believe you should have join the fire service or change heath care provider titles, to have a fulfilling, stable, and rewarding career in EMS. This includes being treated and compensated like a professional. 
As a whole, our nation is not close to this yet.  I think we have a lot to learn from the other 1st world countries and in my opinion we cannot progress any further without mandating a degree in some way. I will say I am excited to see the national healthcare changes currently and the explosion of mobile inter-graded healthcare programs EMS is initiated around the country. These could develop into something...


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## CFal (Nov 19, 2013)

usalsfyre said:


> False. 2 in 2 outdoes not apply in life threats.
> 
> FURTHER..how may small or for that matter large FDs regularly make grabs? How many successful RIT operations do you hear about? The insistence on interior firefighting inside modern day (since the late 60s to early 70s) construction is why we continue to kill firefighters in the same manner at a rate of 100 a year.



The exemption is pretty narrow.  Most times you don't know if there is anybody inside or not, hence the need for the primary search.



> OSHA regulations recognize deviations to regulations in an emergency operation where
> immediate action is necessary to save a life. For fire department employers, initial attack
> operations must be organized to ensure that adequate personnel are at the emergency scene
> prior to any interior attack at a structural fire. If initial attack personnel find a
> ...


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## Wheel (Nov 19, 2013)

ExpatMedic0 said:


> A lot of interesting points. One reason I made this thread was because in my opinion, I don't believe you should have join the fire service or change heath care provider titles, to have a fulfilling, stable, and rewarding career in EMS. This includes being treated and compensated like a professional.
> As a whole, our nation is not close to this yet.  I think we have a lot to learn from the other 1st world countries and in my opinion we cannot progress any further without mandating a degree in some way. I will say I am excited to see the national healthcare changes currently and the explosion of mobile inter-graded healthcare programs EMS is initiated around the country. These could develop into something...



So that begs the question, what can we as individual providers do to move this process along. Lobby with the NAEMT? Obviously we can all start with becoming more educated, better providers ourselves, but what is the next step? Everyone has great questions and suggestions regarding what the end game should look like, but what we need is a plan. We need a blueprint of tangible things we can actually do in order to see the coming changes in healthcare provide a positive impact on EMS, even though we obviously missed the boat regarding the ACA, what with our almost nonexistent contribution to it.


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## unleashedfury (Nov 19, 2013)

I am all for a ALS provider to be required to have at least a Associates degree in applied sciences. EMS has evolved greatly from its roots from the days of basic EKG's and a few meds to 12/15 lead ECGs, Capnography, RSI, and Much more medications coming onboard. 

Will requiring a degree push people away from EMS, Nope, Their is still going to be people who will make it through programs and the ones that get pushed through in hopes that the NREMT test will push them out. Nursing is pushing towards 2 year programs and now they are popping up everywhere I can name 20 nursing programs within a Hour of my home, The Reimbursements are limited and unless the govt. decides that transports are worth more money if a A.A.S. Paramedic vs. a Certificate medic is on the truck a degree will be valueless unless you have intentions on further your education in another spectrum 




Wheel said:


> So that begs the question, what can we as individual providers do to move this process along. Lobby with the NAEMT? Obviously we can all start with becoming more educated, better providers ourselves, but what is the next step? Everyone has great questions and suggestions regarding what the end game should look like, but what we need is a plan. We need a blueprint of tangible things we can actually do in order to see the coming changes in healthcare provide a positive impact on EMS, even though we obviously missed the boat regarding the ACA, what with our almost nonexistent contribution to it.



Even as more educated providers we are still stuck at the bottom of the food chain.  The NAEMT is a powerless EMS advocate in comparison to other Lobbying professional associations.


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## Wheel (Nov 19, 2013)

unleashedfury said:


> Even as more educated providers we are still stuck at the bottom of the food chain.  The NAEMT is a powerless EMS advocate in comparison to other Lobbying professional associations.



I am aware of all of this. My question was "What do we do?" I meant it as a point of discussion. There will always be reasons not to try to progress, like the NAEMT being ineffective and being at the bottom of the food chain. That doesn't mean we shouldn't be thinking of ways to move forward. All of the talk of progress is wonderful, but it won't get anywhere if we don't have some kind of plan of action.


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## CriticalCareIFT (Nov 19, 2013)

If you want ligitimate change for future of ems get doctorate PhD degrees or MD/DO degrees and become involved in acvancing this profession.


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## Wheel (Nov 19, 2013)

CriticalCareIFT said:


> If you want ligitimate change for future of ems get doctorate PhD degrees or MD/DO degrees and become involved in acvancing this profession.



What kind of PhD do you think is going to equip someone to improve EMS? A PhD is a research degree. If you mean doing EMS research, then ok, but if you're talking about affecting other parts of the EMS system I'd say that's overkill.

I'd also say that becoming a physician would also be overkill. Other allied health professions advanced without leaving their profession for another. Nursing, respiratory therapy, physical therapy, radiology techs, etc.


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## CriticalCareIFT (Nov 19, 2013)

And how many of those professions allow 2 week transition course for medics? Yet we allow anyone to be a medic in 2 weeks.

If you want to be taken seriously, yes you need credibility and research to back it. If you dont have a degree how can you argue the merits of mandatory degree?


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## rescue1 (Nov 19, 2013)

usalsfyre said:


> False. 2 in 2 outdoes not apply in life threats.
> 
> FURTHER..how may small or for that matter large FDs regularly make grabs? How many successful RIT operations do you hear about? The insistence on interior firefighting inside modern day (since the late 60s to early 70s) construction is why we continue to kill firefighters in the same manner at a rate of 100 a year.



I think only about a quarter of those 100 are due to interior structural firefighting.
As of 2012, only 22 firefighter LODDs were due to "activities on a fireground", and maybe half of those were due to actual fire conditions as opposed to cardiac or other medical events.

http://www.usfa.fema.gov/downloads/pdf/publications/ff_fat12.pdf


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## Carlos Danger (Nov 19, 2013)

CriticalCareIFT said:


> And how many of those professions allow 2 week transition course for medics? *Yet we allow anyone to be a medic in 2 weeks.*



I got duped, then....it took me 9 months!


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## ffemt8978 (Nov 19, 2013)

How about we stop talking about firefighter staffing requirements and get back on topic?


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## EpiEMS (Nov 19, 2013)

CriticalCareIFT said:


> And how many of those professions allow 2 week transition course for medics? Yet we allow anyone to be a medic in 2 weeks.



This is a fair point. After all, a (US-trained) MD will not (cannot?) just take the NCLEX and become a nurse.



ffemt8978 said:


> How about we stop talking about firefighter staffing requirements and get back on topic?



Sorry! My mistake!


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## Summit (Nov 19, 2013)

EpiEMS said:


> This is a fair point. After all, a (US-trained) MD will not (cannot?) just take the NCLEX and become a nurse.



You could stop at the "will not" and leave it at that. Or you could say that a MD would need a transition to RN course too, mostly role and operational. I bet they could do it in two weeks.


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## Wheel (Nov 19, 2013)

CriticalCareIFT said:


> And how many of those professions allow 2 week transition course for medics? Yet we allow anyone to be a medic in 2 weeks.
> 
> If you want to be taken seriously, yes you need credibility and research to back it. If you dont have a degree how can you argue the merits of mandatory degree?



Are you replying to me? If so, I didn't say anything about not having a degree to have credibility. I'm finishing my degree and would advocate for others to do the same in order to become leaders and teachers in EMS. I just don't think it needs to be a PhD or MD/DO. There are good reasons to do both of those degrees, but if your primary goal is to support and develop EMS you can do it in other ways that don't require an extra 4-10 years of post graduate training and education.


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## CriticalCareIFT (Nov 19, 2013)

Imagine if a medical director of tertiary care facility or big name hospital was able to change requirements for paramedic hire form this:

Requirements - 
Minimum five years experience as an Paramedic, preferably in a large metropolitan area. Current licensure and/or certification as listed below:

·         High school graduate or GED
·         Paramedic certification as appropriate to assigned location
·         Basic Life Support (BLS) certification 
·         Advanced Cardiac Life Support (ACLS) certification
·         Pediatric Advanced Life Support (PALS)
·         Pre-hospital Trauma Life Support (PHTLS)
·         Neonatal Resuscitation Program (NRP) certification
·         Drivers must have a current

To this
Requirements - 
Minimum bachelors degree as a Paramedic from accredited senior college/university, with 2 years on the job experience (preferred). 

No degree no acceptance!

·         Paramedic certification as appropriate to assigned location
·         Basic Life Support (BLS) certification 
·         Advanced Cardiac Life Support (ACLS) certification
·         Pediatric Advanced Life Support (PALS)
·         Pre-hospital Trauma Life Support (PHTLS)
·         Neonatal Resuscitation Program (NRP) certification
·         Drivers must have a current

Imagine this was the highest paid gig in town, working in a system that does both CCT and 911 with progressive protocols. Having other players: IFT companies, fire departments also in the game with requirements that they have now (no degree needed).

Do you think medics would go try and acquire a Bachelors degree to apply for this position?


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## Wheel (Nov 19, 2013)

CriticalCareIFT said:


> Imagine if a medical director of tertiary care facility or big name hospital was able to change requirements for paramedic hire form this:
> 
> Requirements -
> Minimum five years experience as an Paramedic, preferably in a large metropolitan area. Current licensure and/or certification as listed below:
> ...



It would be great, of course. This is not the reason you go to medical school though. Your primary job as a physician will be to treat your patients. If you want to be a doctor and be involved in EMS you will have a huge impact. That does not mean that you can't have an enormous impact within the our profession with a bachelors or masters degree.


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## Wheel (Nov 19, 2013)

Wheel said:


> It would be great, of course. This is not the reason you go to medical school though. Your primary job as a physician will be to treat your patients. If you want to be a doctor and be involved in EMS you will have a huge impact. That does not mean that you can't have an enormous impact within the our profession with a bachelors or masters degree.



Basically what I'm saying is that Med school is a long and difficult road to follow just because you are passionate about EMS, which will be a small part of a physician's job. Change in EMS will have to come from the inside. If the people that do the job don't want change, no physician will force it on them. For the most part I do agree. I'm just asking for disussion's sake what we as paramedics can do to move us forward outside of increased personal standards and education. Things such as lobbying, teaching, etc.


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## CriticalCareIFT (Nov 19, 2013)

Wheel said:


> It would be great, of course. This is not the reason you go to medical school though. Your primary job as a physician will be to treat your patients. If you want to be a doctor and be involved in EMS you will have a huge impact. That does not mean that you can't have an enormous impact within the our profession with a bachelors or masters degree.



Yes, I agree going to medical school mainly to advance EMS would be a bad proposition. Matter of fact, advancing EMS as a profession would not even be on my list of things to do. 

What impact can you have as a medic with bachelors or masters degree on EMS? Write a few articles in Jems prefacing the great injustices incurred by EMS as a profession?  Start a blog with a strong message? Perhaps EMS study that no other health care professional will give two :censored: about? Or post on a forum where people who do EMS think nurses should just challenge the test or at most do 2 week course.


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## Wheel (Nov 20, 2013)

CriticalCareIFT said:


> Yes, I agree going to medical school mainly to advance EMS would be a bad proposition. Matter of fact, advancing EMS as a profession would not even be on my list of things to do.
> 
> What impact can you have as a medic with bachelors or masters degree on EMS? Write a few articles in Jems prefacing the great injustices incurred by EMS as a profession?  Start a blog with a strong message? Perhaps EMS study that no other health care professional will give two shi-ts about? Or post on a forum where people who do EMS think nurses should just challenge the test or at most do 2 week course.



So first your advice is that you should get an MD or PhD if you want to advance EMS, but now you say it would be a bad proposition to do so? I feel like we're talking in circles.

I would agree that the best way to improve EMS would probably be through research, articles, blog posts and things like that. The desire to move forward must come from strong voices within our profession.


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## Clipper1 (Nov 20, 2013)

CriticalCareIFT said:


> Yes, I agree going to medical school mainly to advance EMS would be a bad proposition. Matter of fact, advancing EMS as a profession would not even be on my list of things to do.
> 
> *What impact can you have as a medic with bachelors or masters degree on EMS? *Write a few articles in Jems prefacing the great injustices incurred by EMS as a profession?  Start a blog with a strong message? Perhaps EMS study that no other health care professional will give two shi-ts about? Or post on a forum where people who do EMS think nurses should just challenge the test or at most do 2 week course.



For starters more Paramedics might actually be able to be in charge of the academic departments at the colleges with Paramedic programs. Right now the majority of programs at community college and universities with Paramedic courses are over seen by nurses with the higher education. The exception is the medic mills which have very few to no education requirements except for a cert the same level as being taught or higher which again can also be an RN teaching part of the EMT and Paramedic courses.


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## ffemt8978 (Nov 20, 2013)

Can anyone guess what time it is?


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## ExpatMedic0 (Nov 25, 2013)

Hey guys, the thread was reopned by admin. Lets try and keep it on track and civil to avoid another lock of the thread. I will post some EMS advocacy information and ideas later concerning the main topic.


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## Clipper1 (Nov 25, 2013)

Wheel said:


> So that begs the question, what can we as individual providers do to move this process along. *Lobby with the NAEMT?* Obviously we can all start with becoming more educated, better providers ourselves, but what is the next step? Everyone has great questions and suggestions regarding what the end game should look like, but what we need is a plan. We need a blueprint of tangible things we can actually do in order to see the coming changes in healthcare provide a positive impact on EMS, even though we obviously missed the boat regarding the ACA, what with our almost nonexistent contribution to it.





Wheel said:


> Basically what I'm saying is that Med school is a long and difficult road to follow just because you are* passionate about EMS, which will be a small part of a physician's job.* Change in EMS will have to come from the inside. If the people that do the job don't want change, no physician will force it on them. For the most part I do agree. I'm just asking for disussion's sake what we as paramedics can do to move us forward outside of increased personal standards and education. Things such as lobbying, teaching, etc.



You first need to learn who your advocates are. 

National Association of EMS Educators
http://www.naemse.org/

National Association of EMS State Officials
http://www.nasemso.org/

National Association of EMS Physicians
http://www.naemsp.org/Pages/default.aspx

American College of Emergency Physicians
http://www.acep.org/

American College of Surgeons
http://www.facs.org/ahp/trauma/index.html

American Trauma Society
http://www.amtrauma.org/

Emergency Services for Children
http://mchb.hrsa.gov/programs/emergencymedical/

American Academy of Pediatrics
http://www.aap.org/en-us/Pages/Default.aspx

American Ambulance Assoication
http://www.the-aaa.org/

Also, every state EMS office has a listing of bills pending and support provided.

The above are just a few.  
Some  may not believe these associations support EMS because "no more money was mentioned for EMTs".  But, in health care everything is a process and advocacy for the patient must take precedence especially since many raises or funding must be supported by the tax payers.  Other professionals also support each other on common goals which provides a bond for future endeavors. Unfortunately EMS tends to alienate itself with strong vocal disproval of nurses, ambulance services and anyone in management or who might have supported higher education. 

The Associate degrees have been around for a long time. But with less than 20% of EMS holding a degree and probably a lot less holding an EMS degree, this speaks volumes especially since EMS has been around longer than some of the professions now requiring degrees and have also been low paid or continue to be low paid at this time. But the degrees may represent a personal and professional satisfaction.

However, EMS as to start with its educators to become better educated and serve as mentors for the future of education.


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## unleashedfury (Nov 25, 2013)

Clipper1 said:


> *However, EMS as to start with its educators to become better educated and serve as mentors for the future of education.*



To start the process todays providers need to start focusing on the degree, Most of the providers that are instructors today that are Paramedics hold only a certificate completion, and certification card, with *X* number years experience in the field. 

I know of only 2 Programs in my area that require that the program be completed as a part of a A.A.S. a third program is aiming more towards eliminating their certificate program and requiring everyone to take the Associates program,

Problem #1 is competition if there is 5 paramedic programs within a hour distance of the student, 3 of the programs require the completion of an associates, 2 are certificate programs, cost of the degree vs. the certificate is significantly higher at least 6 grand difference. and the equivalence in pay and oppurtunitiy remains the same. 

If the NREMT required at minimum a Associates to be elgible to test the states that use NREMT as their procotored exam would have to be on board with the intentions. If they weren't States would offer their own exam and no longer have the NREMT requirement. 

In Pa there is no Paramedic State Certifcation exam its either NREMT or nothing, they are pushing towards the Basics to become NREMT exams also. Now everyone got on board with the Accrediation of their programs requirement which was a push in the right direction, now if they can increase the requirements slowly but truly without resistance a degree program would be in the works


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## Rockies (Nov 25, 2013)

I would probably earn more money.


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## ExpatMedic0 (Nov 25, 2013)

from my understanding the NREMT now requires your to graduate from a CAAHEP and CoAEMSP accredited program, which requires the EMS instructor (or program director, cant remember) to posses at least a bachelors degree.
If you dont go to an accredited program your not eligible for NREMT testing. Its a small step but its a step in the right direction. National EMS Educator Credentialing/certification is also becoming mainstream.


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## Clipper1 (Nov 25, 2013)

ExpatMedic0 said:


> from my understanding the NREMT now requires your to graduate from a CAAHEP and CoAEMSP accredited program, which requires the EMS instructor (or program director, cant remember) to posses at least a bachelors degree.
> If you dont go to an accredited program your not eligible for NREMT testing. Its a small step but its a step in the right direction. National EMS Educator Credentialing/certification is also becoming mainstream.



The Bachelors degree is a requirement for the Program Director. This is also what I was leading to in my earlier comment about Paramedics being in charge of their own academic departments. Many of the colleges already teaching accredited Paramedic programs have RNs with advanced degrees overseeing them because of this requirement. 

http://coaemsp.org/Documents/Standards_Interpretations_2_2013.pdf



> The program director must:
> 1) possess a minimum of an Associate’s degree for
> Emergency Medical Technician-Intermediate and a
> minimum of a Bachelor’s degree for Emergency
> ...



For instructors nothing has changed:


> Qualifications
> The faculty must be knowledgeable in course content and effective in teaching their assigned subjects, and capable through academic preparation, training and experience to teach the courses or topics to which they are assigned.
> 
> For most programs, there should be a faculty member to assist in teaching and/or clinical coordination in addition to the program director. *The faculty member should be certified by a nationally recognized certifying organization at an equal or higher level of professional training than the Emergency Medical Services Profession(s) for which training is being offered.*


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## Rialaigh (Nov 25, 2013)

Someone tell me what the end, and I mean the very end, goal is for furthering the education of paramedics. I don't mean this in a sarcastic way, I just want to know what the individual reasoning (or community reasons) is for furthering our education. What is the end goal in mind.


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## Rockies (Nov 25, 2013)

Rialaigh said:


> Someone tell me what the end, and I mean the very end, goal is for furthering the education of paramedics. I don't mean this in a sarcastic way, I just want to know what the individual reasoning (or community reasons) is for furthering our education. What is the end goal in mind.



Other than the CE credits, continuous eduction in a field where there is abundant red tape and a ever evolving treatment plan is almost necessary to keep you on your toes.


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## Wheel (Nov 25, 2013)

Clipper1 said:


> You first need to learn who your advocates are.
> 
> National Association of EMS Educators
> http://www.naemse.org/
> ...



Thanks for a well thought out answer and a little direction. I'm about to start finishing my bachelor's degree this coming semester, and my eventual goal is education or advanced practice.


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## Jon (Nov 25, 2013)

Clipper1 said:


> You first need to learn who your advocates are.
> 
> National Association of EMS Educators
> http://www.naemse.org/
> ...



Clipper,

You missed two big ones:

NAEMT
http://www.naemt.org/advocacy/advocacy_home.aspx

And

Advocates for EMS
http://www.advocatesforems.org/


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## Clipper1 (Nov 25, 2013)

Wheel had already mentioned NAEMT which I quoted earlier.

Advocates for EMS has not had much activity on their website since 2011.  They need to keep people interested and updated. They also link back to NAEMT.


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## Angel (Nov 26, 2013)

Personally I'm all for making an Associates the minimum for Paramedics, not so much EMTs.
Reason being is "we" demand to be paid more and respected as more than just ambulance drivers but many refuse to get some solid education under their belt. Taking GE classes at a CC isn't HARD, it will expand general knowledge (reading, math, basic English ect) and possibly even help. (How many people actually take an in depth anat and phys class?)

 A lot of people are just lazy and want to do the absolute minimum to get by and I think that's a terrible attribute for a paramedic to have.


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## Handsome Robb (Nov 26, 2013)

Rialaigh said:


> Someone tell me what the end, and I mean the very end, goal is for furthering the education of paramedics. I don't mean this in a sarcastic way, I just want to know what the individual reasoning (or community reasons) is for furthering our education. What is the end goal in mind.



I think that's kind of been stated already. 

Beyond the common pay and professional respect aspect there's the education related things such as paramedics being the director if a paramedic program, professional advancement and the potential for different areas if specialization (flight/critical care, education, community Paramedicine/advanced practice Paramedicine). 

EMS is changing. It already has internationally. It's not you call we haul anymore, that system doesn't work. We can't be a gateway to the healthcare system without having more education than just recognize, stabilize/treat life thread/symptoms, transport. Doing things like triage to urgent cares or treat-and-release with a referral to a PCP isn't going to work properly with the current education models.


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## ExpatMedic0 (Nov 26, 2013)

You guys beat me to the links and info! 

I would also like to point out when you go to the NAEMT website you can click on advocacy, there is a list of resources from that link such as "how to advocate" and many more, here http://www.naemt.org/advocacy/advocate/howtoadvocate.aspx The framework on the NAEMT website does provide a good blueprint for ways to advocate and advance if your unfamiliar. 

_Now, I am probably setting myself up to be flamed on this, and the following statements are my own ideas/opinions. _

However, one big problem I have with the NAEMT themselves, is that they claim to be the nations main EMS advocacy entity, yet what have they done for us? Keep in mind they have been around since the 1970's. 


Before you answer that question lets compare the allied health care profession of Paramedicine to Athletic Training, which did not use to require a degree. Both professions are certified allied health personal. Athletic training has been recognized by the American Medical Association as an allied health care profession only since 1990. Today, in order to become a Certified Athletic Trainer you must graduate from a bachelors or masters degree program accredited by the Commission on Accreditation of Athletic Training Education (CAATE). Furthermore Although CAT's fall under allied health, they can be used as physician extenders to complement the same kind of work as mid-levels, see link http://www.nata.org/sites/default/files/using-certified-athletic-trainers-as-physician-extenders.pdf
I use to work special event stand by's with a CAT and he worked as an extension of a DO in the field. He made over $20,000 a year more than I did . At our events he handled any and all care with the athletes other than "Emergency Care" which then became my area. His physical assessments for trauma where superior to anything I have seen aside from a doctor.

Athletic Trainers Salary Survey http://www.nata.org/sites/default/files/SalarySurvey11.pdf
EMS providers Salary Survey http://www.jems.com/sites/default/files/1310-jems-tables-1--5_0.pdf

I am not an expert on Athletic Training, I know very little about it, but it would appear to me that the NAEMT should take some lessons from the NATA (www.nata.org) Possibly part of the reason the NAEMT may not be making any progress is because its in kahoots with to many other special interest groups such as the fire service. Furthermore rather than promote real EMS education, they seem to sell us merit badge alphabet soup courses up the wazoo. If the NAEMT is our advocate, why are they not advocating for not even mandatory associates degrees? 

PS: It should be noted, an athletic trainer is not a physical trainer (eg at the gym), some people mix up the names, like a Physician Assistant is not a Medical Assistant.


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## Rialaigh (Nov 26, 2013)

Robb said:


> I think that's kind of been stated already.
> 
> Beyond the common pay and professional respect aspect there's the education related things such as paramedics being the director if a paramedic program, professional advancement and the potential for different areas if specialization (flight/critical care, education, community Paramedicine/advanced practice Paramedicine).
> 
> EMS is changing. It already has internationally. It's not you call we haul anymore, that system doesn't work. We can't be a gateway to the healthcare system without having more education than just recognize, stabilize/treat life thread/symptoms, transport. Doing things like triage to urgent cares or treat-and-release with a referral to a PCP isn't going to work properly with the current education models.



 I guess my point is I think some people think that better education standards will somehow make us better paramedics (in the sense that we are paramedics now). I don't for a second believe that higher education will reduce mortality or morbidity one bit for the job and purpose we currently serve. Sure we might get paid more, we might have more respect, but beyond that (in our current system) ....what's the point. Now I do understand the calls to educate better for the purpose of transitioning into a community medicine type system, and doing all those things you stated in your second paragraph.


*I just hope that people recognize that having 2 or 4 more years of school behind you for the job that we currently do....won't make a damn bit of difference to patient outcomes. *

This is primarily why I am against raising the education standards until we can unite a little better and put some common 5 and 10 year goals in perspective and see how to best achieve those through education.


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## MrJones (Nov 26, 2013)

Rialaigh said:


> *I just hope that people recognize that having 2 or 4 more years of school behind you for the job that we currently do....won't make a damn bit of difference to patient outcomes. *



I'd say you're painting with a bit too broad of a brush. Unless, of course, you have something more than your opinion upon which you're basing that statement. And I'd love to see it if you do.


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## Clipper1 (Nov 26, 2013)

Rialaigh said:


> I guess my point is I think some people think that better education standards will somehow make us better paramedics (in the sense that we are paramedics now). I don't for a second believe that higher education will reduce mortality or morbidity one bit for the job and purpose we currently serve. Sure we might get paid more, we might have more respect, but beyond that (in our current system) ....what's the point. Now I do understand the calls to educate better for the purpose of transitioning into a community medicine type system, and doing all those things you stated in your second paragraph.
> 
> *I just hope that people recognize that having 2 or 4 more years of school behind you for the job that we currently do....won't make a damn bit of difference to patient outcomes. *



Right now a Paramedic cert is not that difficult to get and is considered an add on for some or something to get so you can be a fire fighter.  I just read an article about Memphis FD having all 375 firefighters certified as Paramedics including the 25% who are black which is what the article was actually about. I doubt if all 375 fire fighters wanted to be Paramedics but the department started their own in-house training and got everyone certified.  There are many other departments which have almost all of their FFs certified as Paramedic including the large ones in Florida and California. The kicker is you don't have to function as a Paramedic, you just have to have the cert.  That is not a "career Paramedic". Others take whatever quick cert program they can to be a FF. Many will keep their regular jobs as something else until they get hired by a fire department. 

Medical directors must also write their protocols to fit the lowest denominator which would be the one who got the cert just because he had to or for the extra pay. This is the difference between writing a protocol for a mother may I system which a recipe is followed or writing a guideline to allow those who have extended themselves to understand A&P and pharmacology to make decisions based on clinical judgment per their assessment.

You might be able to argue that those who follow the just transport to the nearest hospital as quick as possible might have better outcomes but then that also includes transporting the dead in a cardiac arrest.    Another medical director might allow the Paramedics to take to the most appropriate facility including clinics and work a code at scene until ROSC or dead is dead.  You could also argue continuing to do something the same way because that is how you've always done it is good enough.  You could also argue that you can do all the skills of someone in Australia but with 1/4 the education and can put a tube through the vocal cords just as well.   I think some see success in form of a "skill" rather than the bigger picture.

Work in a busy hospital with many different EMS ambulances coming in and you will quickly see the difference between those who consider being a Paramedic a career and those who enjoy a patch with extra pay or those aspiring to get a job on the FD for the pay and not the patient care.  The latter the private ambulance Paramedics who are just serving their time and just want a FD job. 

Replacing the 3 - 6 month programs which can also be accredited with degree programs, could make the cert less of an add on and medical directors might actually write guidelines for professionals.






Rialaigh said:


> This is primarily why I am against raising the education standards until we can unite a little better and put some common 5 and 10 year goals in perspective and see how to best achieve those through education.



It took 15 years for EMS to change the titles again without changing the education very much. Nursing has had their plan for the BSN since the 1970s or right after the transition from diploma to Associates. Before they make their next move they would like to see at least 80% of RNs holding a BSN in the work force. Right now they have reached over 50%. Some states are higher and are moving forth with BSN legislation but for the next 10 years.  This is no different than all the other health care professions which promoted the degree through long term plans but could not approach it as a legislative issue until they has nearly all members in their profession with that degree.  You should also read about the challenges in Oregon on their path to a degree. They still have to make exceptions for reciprocity and grant at least 2 years for someone who passed the NREMT Paramedic exam.  They also had to make considerations as to how the very rural and volunteer agencies could meet the requirements with no schools for many miles. But, they did have the support of the fire departments and the state.


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## ExpatMedic0 (Nov 26, 2013)

Rialaigh said:


> *I just hope that people recognize that having 2 or 4 more years of school behind you for the job that we currently do....won't make a damn bit of difference to patient outcomes. *


I don't agree with this statement. Do you honestly believe that providing paramedics with 2-4 more years of education would not increase an entry level paramedics ability to provide better patient care by, recognizing/treating disease processes, illnesses, injuries, ect; any of which could improve patient outcomes?


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## Rialaigh (Nov 26, 2013)

ExpatMedic0 said:


> I don't agree with this statement. *Do you honestly believe that providing paramedics with 2-4 more years of education would not increase an entry level paramedics ability to provide better patient care by, recognizing/treating disease processes, illnesses, injuries, ect; any of which could improve patient outcomes?*



In theory this would improve outcomes. In reality it does not. (again, I am talking about transport times of an average of less then 30 minutes). BLS systems have some of the highest ROSC rates in the nation. Stemi outcomes are only improved by transport to the closest PCI center and asprin. We all know (or should) by now that we don't treat hypertensive crisis in the field. Infection is treated at the hospital by IV antibiotics. Hypotension is treated by fluids, I doubt you could find me a study showing pressors make any difference in long term outcome in transport times of less than 30 minutes. Trauma is a BLS skill. Cpap has eliminated the need to tube everyone having trouble breathing. RSI has been shown not to help outcomes. King airways are just as effective as intubation in the short term. 

Knowing A+P better, being able to recognize disease process, being able to understand what is going on with your patient, all these things can make you a "better" paramedic....they just don't improve patient outcomes in our current system.


I'm  not arguing that higher education standards won't improve paramedics. I am arguing that higher education standards won't improve patient outcomes in our current system. Depends on what your end goal is...


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## Clipper1 (Nov 26, 2013)

Rialaigh said:


> In theory this would improve outcomes. In reality it does not. (again, I am talking about transport times of an average of less then 30 minutes). BLS systems have some of the highest ROSC rates in the nation. Stemi outcomes are only improved by transport to the closest PCI center and asprin. We all know (or should) by now that we don't treat hypertensive crisis in the field. Infection is treated at the hospital by IV antibiotics. Hypotension is treated by fluids,



The AHA did not mean for "BLS" to mean an EMT when referring to survival rates.  BLS in this sense mean early and quality CPR along with access to an AED.   This is "BLS" whether it is done by an EMT, Paramedic, Doctor or a layperson.  The study in Seattle involved Paramedics coming along after bystanders initiate "BLS" care.  AEDs are also now very much for public access in many areas.

But, if ROSC is achieved by BLS, it can quickly turn to dead again if proper post ROSC care is not followed. 

http://circ.ahajournals.org/content/122/18_suppl_3/S768.full

But, this is also a weak area in some places which could be why outcomes are not great. Some just don't want to do more because they don't know there is more or can't due to protocol limitations.

Sepsis treatment can be initiated in prehospital even without antibiotics. 

Pain can be treated. 

We also know that supraglottic tubes have limitations especially when a patient with ROSC regains their gag.  

Now let us look at the 95% of the patients you come into contact with who are not dead or going to die right now? What about the patient care aspect?  Do you think some of those who have only focused on skills and a few algorithms to get by are going to read the journals or take an interest in EBM to improve the care given?  The BSN advocates used this in their favor to get past the old guard who said their "skills" were best and bull to the new ways stated in the journals. The BSNs were more willing to trial new things and accept now ideas. Learning things through education rather than just memorization makes change easier. The BSN advocates did their own studies for patient satisfaction and implementation of new protocols, guidelines and quality control.  The ADN were still focused on tasks in some situations just like it seems some Paramedics are.


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## Rialaigh (Nov 26, 2013)

Clipper1 said:


> The AHA did not mean for "BLS" to mean an EMT when referring to survival rates.  BLS in this sense mean early and quality CPR along with access to an AED.   This is "BLS" whether it is done by an EMT, Paramedic, Doctor or a layperson.  The study in Seattle involved Paramedics coming along after bystanders initiate "BLS" care.  AEDs are also now very much for public access in many areas.
> 
> But, if ROSC is achieved by BLS, it can quickly turn to dead again if proper post ROSC care is not followed.
> 
> ...



If your talking about treating pain and improving patient satisfaction scores then absolutely more education will improve this. But lets not confuse patient satisfaction scores with patients medical outcomes. It all comes down to the goal or purpose of doing this. 

Again, I am not against more education. I just want our profession as a whole to make realistic goals about what education to require and the purpose of the additional education. To say that we want to be better educated paramedics so we can "Save more lives" is just the epitome of ignorance. To say that we want to be better educated paramedics so we can provide better service to our patients is completely reasonable.


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## Clipper1 (Nov 26, 2013)

Rialaigh said:


> If your talking about treating pain and improving patient satisfaction scores then absolutely more education will improve this. But lets not confuse patient satisfaction scores with patients medical outcomes. It all comes down to the goal or purpose of doing this.
> 
> Again, I am not against more education. I just want our profession as a whole to make realistic goals about what education to require and the purpose of the additional education. To say that we want to be better educated paramedics so we can "Save more lives" is just the epitome of ignorance. To say that we want to be better educated paramedics so we can provide better service to our patients is completely reasonable.



I can not think of any profession which has used "save more lives" as a primary argument for increasing education. CMS is one group which will recognize a profession based on education and patient care. Dead people are really not their concern for the long haul unless the person is dead or injured at the hands of the healthcare provider.  However, the recognition that layperson BLS saved lives was researched by those with education.

Also don't confuse treating patients' pain with just making them "satisfied"  Controlling pain is a vital step in improving outcomes.  But, that comes with education.


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## Rialaigh (Nov 26, 2013)

Clipper1 said:


> I can not think of any profession which has used "save more lives" as a primary argument for increasing education. CMS is one group which will recognize a profession based on education and patient care. Dead people are really not their concern for the long haul unless the person is dead or injured at the hands of the healthcare provider.
> 
> Also don't confuse treating patients' pain with just making them "satisfied"  Controlling pain is a vital step in improving outcomes.  But, that comes with education.



I would be shocked if there is a study showing prehospital pain management that coordinated with improved long term outcomes for the patient. 

I think EMS needs to move in the direction of becoming more educated to become an extension of the hospital system. We shouldn't be a separate enterprise, we should be an extending arm of the hospital system that provides smooth continuity of care to patients that utilize prehospital services. I think more integration into the hospital system would be beneficial. I would not be opposed to some ideas of the director of the ER (or directors) ultimately being over the EMS system.


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## Clipper1 (Nov 26, 2013)

Rialaigh said:


> I would be shocked if there is a study showing prehospital pain management that coordinated with improved long term outcomes for the patient.
> 
> I think EMS needs to move in the direction of becoming more educated to become an extension of the hospital system. We shouldn't be a separate enterprise, we should be an extending arm of the hospital system that provides smooth continuity of care to patients that utilize prehospital services. I think more integration into the hospital system would be beneficial. I would not be opposed to some ideas of the director of the ER (or directors) ultimately being over the EMS system.




Why do you think pain management outside of the hospital would not improve outcomes?  Chest pain? 

Pain management is a big part of the hospital and long term care. If you want to be part of that you need to get used to the concept of patient care and not just the save lives stuff. ADLs in comfort  or relatively pain free are an extension of the hospital. This does improve outcomes.

How do you want to argue for integration into the hospital? Many "techs" at entry level have at least an Associates degree.

ER doctors don't treat for long term. They refer for follow up. But when used as a primary physician you get repeaters because the care is not meant for maintenance.


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## Rialaigh (Nov 26, 2013)

Clipper1 said:


> Why do you think pain management outside of the hospital would not improve outcomes?  Chest pain?
> 
> Pain management is a big part of the hospital and long term care. If you want to be part of that you need to get used to the concept of patient care and not just the save lives stuff. ADLs in comfort  or relatively pain free are an extension of the hospital. This does improve outcomes.
> 
> ...



Which getting way off topic is why Vene would advocate to get rid of them all together..but that is a whole other discussion. 


How are we measuring outcomes. Are we using patient satisfaction scores? hospital length of stay? mortality? Are we talking medical outcomes purely or measuring outcomes in another way?


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## Clipper1 (Nov 26, 2013)

Rialaigh said:


> Which getting way off topic is why Vene would advocate to get rid of them all together..but that is a whole other discussion.
> 
> 
> How are we measuring outcomes. Are we using patient satisfaction scores? hospital length of stay? mortality? Are we talking medical outcomes purely or measuring outcomes in another way?



Getting rid of doctors? Vene?

With all of the articles available in the professional journals including emergency medicine I am surprised at your questions. Pain management is not new.  This is something you really need to start learning about by reading professional journals espcially if your medical director does not want to approach the topic. That also leaves a big why facor?  Don't let a negativity against doctors hinder progress even if you want rid of them.

This whole argument for and against education is not new either. All the other professions have gone through it in their process for professional recognition. But, they were able to better see the differences since they did take note of the changes occurring around them. RNs noticed they were the one of the least educated in the multidisciplinary rounds. RNs were also being supervised by allied health professionals in some units. RNs in the US also got a wake up call for more education when nurses from other countries took them to be only PNs due to lesser education.  RTs got left out for reimbursement in alot of things because they have not advanced to the level of the other therapies and nursing is now in a better position at the magnet hospitals.

You would think EMS would have taken a few lessens from others if they wanted to be part of the bigger picture in health care. Expanding into different ares like home care poorly prepared will not go well in the long run. Eventually the grants for the trial runs will go away.


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## Rialaigh (Nov 26, 2013)

Clipper1 said:


> *Getting rid of doctors? Vene?
> *
> With all of the articles available in the professional journals including emergency medicine I am surprised at your questions. Pain management is not new.  This is something you really need to start learning about by reading professional journals espcially if your medical director does not want to approach the topic. That also leaves a big why facor?  Don't let a negativity against doctors hinder progress even if you want rid of them.
> 
> ...



Getting ride of ER physicians, yes, and replacing them with internist. 



I think you are missing my point. If we are educating further to get more professional recognition, fine. If we are educating further to improve patient satisfaction scores, fine. If we are educating further to raise our pay, fine. If we are educating further so that we can better understand patient complaints and disease process, fine. 

But if you think educating further by EMS (in the role that we play CURRENTLY) will reduce mortality or the length of hospital stays, I highly highly doubt it. 

I'm not saying we won't be better providers, I'm not saying our patient care won't be better. I am saying that mortality and hospital length of stays aren't going to decrease because we furthered our education.


Frankly if your transport time is less then 30 minutes I highly doubt putting a physician on our ambulances with the same scope that we hold currently would really make much a difference honestly.


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## Clipper1 (Nov 26, 2013)

Rialaigh said:


> Getting ride of ER physicians, yes, and replacing them with internist. .



There are reasons why we have specialists. An ER should not be used as a primary physician's office. 





Rialaigh said:


> I think you are missing my point. If we are educating further to get more professional recognition, fine. If we are educating further to improve patient satisfaction scores, fine. If we are educating further to raise our pay, fine. If we are educating further so that we can better understand patient complaints and disease process, fine.
> 
> But if you think educating further by EMS (in the role that we play CURRENTLY) will reduce mortality or the length of hospital stays, I highly highly doubt it.
> 
> I'm not saying we won't be better providers, I'm not saying our patient care won't be better. I am saying that mortality and hospital length of stays aren't going to decrease because we furthered our education..



You are fixated on the saving lives things.  But yes, there are things EMS is researching to improve outcomes.  Being more proficient at intubation and recognizing sepsis are two things. Both of which can improve outcomes. TH and recognizing stroke patients are more things. CPAP alone is not always the answer for respiratory failure. Recognition and early intervention as appropriate is key. Just playing  by numbers is not always the only way to do things. By your reasoning all EMS should be doing is driving fast to the hospital and that nothing you do matters.  

If you can not see in any way how EMS makes a difference, time to find another profession. Unfortunately too many probably think like you or this type of talk is what some want to hear to avoid education which explains probably only 10% of those in EMS holding a degree in EMS as working Paramedics. The other 10% of the 20% probably have obtained other degrees such as in nursing or PA to get away from the downers in EMS who want to justify not getting more education or fearing change.



Rialaigh said:


> Frankly if your transport time is less then 30 minutes I highly doubt putting a physician on our ambulances with the same scope that we hold currently would really make much a difference honestly.



A doctor does not have the same scope of practice or the same knowledge base as a Paramedic.  A doctor can do more with less in some situations because of their education and experience. A Paramedic has only studied a few indications for the medications and equipment on the ambulances.   If a doctor (or PA or NP) was on the ambulance, there might not be a need to transport.  That would be doing more.


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## Rialaigh (Nov 26, 2013)

Clipper1 said:


> There are reasons why we have specialists. An ER should not be used as a primary physician's office.
> 
> 
> 
> ...




Yet people keep preaching the need to formulate protocol after evidenced based research. If the evidence states that frankly, a lot of what we do doesn't make a difference in mortality or morbidity outcomes or length of hospital stays...can you accept that? 



I see plenty of ways that EMS makes a difference. We comfort patients who are having "emergencies". We bring calm and reason to scenes and situations in which there was previously panic. We bring comfortable transports to patients in pain. We enable patients to be seen in a timely manner to receive the medication they need to get better and be more comfortable. We give patients peace of mind by assuring them they we are taking them to see a doctor and that it is going to be okay. Furthering our education can help us become better in all those areas to better serve our patients. 


Let us fix our education standards based upon things we can actually change. It all goes back to the goals of prehospital EMS services. Evaluate areas in which you can make a difference, set goals based on those areas. Set your education standards based upon those goals.


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## Clipper1 (Nov 26, 2013)

Rialaigh said:


> Let us fix our education standards based upon things we can actually change. It all goes back to the goals of prehospital EMS services. Evaluate areas in which you can make a difference, set goals based on those areas. Set your education standards based upon those goals.



You need a base education to go forth with other education goals. An Associates is barely an education as others have found out but it is a start.

As far as mortality, sometimes dead is dead. There are many life threatening events you can not change even in a major hospital.  You are not God or any other object of worship. 

If you want to remain a technician with a year or less of training (national average for Paramedic certificates) be happy. Allow other professionals who have a well rounded education do the research for EMS. Be satisfied with other professionals being the program directors of your educational institutions.  

If being a tech is good enough, go with it. You are not alone since over 80% of EMS shows support by not advancing to even an Associates degree in EMS. 

But then, you need to stop complaining about wages or reimbursement by CMS at a tech status. You need to stop complaining about not getting respect from other professionals as an equal professional. You need to stop complaining about RNs who challenge your certificate because they can due to the loop holes.  If you can go on believing you save lives now without more education or improved protocols or guidelines, good for you. 




> I see plenty of ways that EMS makes a difference. We comfort patients who are having "emergencies". We bring calm and reason to scenes and situations in which there was previously panic. We bring comfortable transports to patients in pain. We enable patients to be seen in a timely manner to receive the medication they need to get better and be more comfortable. We give patients peace of mind by assuring them they *we are taking them to see a doctor and that it is going to be okay. *Furthering our education can help us become better in all those areas to better serve our patients.



I thought EMS wanted to evolve past just driving people to the hospital. I hope you are doing more than hand holding for someone having an emergency. I also do not tell people "it is going to be okay" since I can not see into their future. Medical bankruptcy can add stress and the patient could die of an MI or suicide.

Overall, I still don't see where you get the idea EMS does not make a difference except for comfort but without the pain management we discussed earlier.  Seattle has shown that a combination of educating the layperson for BLS and their ALS knowledge has made a difference. This has also been duplicated in other cities with similar results. TH has had varying outcomes also. The way head trauma and stroke is managed has made a difference.  

I can only tell you that there are many journals out there which could provide you with more information. Also, not every EMS system just drives the patients to the hospital. Some have extensive interventions they can do to make a difference. They can do both the hand holding and the interventions while still getting the patient to a doctor.


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## Carlos Danger (Nov 26, 2013)

Rialaigh said:


> I just hope that people recognize that having 2 or 4 more years of school behind you for the job that we currently do....won't make a damn bit of difference to patient outcomes.





MrJones said:


> I'd say you're painting with a bit too broad of a brush. Unless, of course, you have something more than your opinion upon which you're basing that statement. And I'd love to see it if you do.



What reason do we have to believe that requiring more education WILL improve patient outcomes?

Remember, it is the intervention (in this case, requiring more education) that must prove itself, not the absence of the intervention.


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## AzValley (Nov 26, 2013)

Having a high(er) bar for entry typically weeds out the less serious and committed in most fields.


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## unleashedfury (Nov 26, 2013)

AzValley said:


> Having a high(er) bar for entry typically weeds out the less serious and committed in most fields.



Yes and no, 

I am a strong believer we as a field should work harder to become more like a nursing program counterpart. 

Nursing programs have their clinical time built into the program where as EMS schools have the student do it on their own time, at their convenience which is nice since you can work with your schedule, but students don't get enough time to "focus" on the current didactic at hand. 

In example I just did my airway section of my program. It was 4 classroom lectures and a fred the head sign off. Where as if this were a nursing program after this section of the program if nurses where intubating patients they would have a round with Respiratory and the OR as part of the program.

The education standards of our field our broken its more like a self study if your a paramedic. If you want to become more proficient or knowledgeable within your scope of practice you might as well go out on your own and become a more proficient and knowledgeable provider. But many are just saying well I got the certificate so I can play with needles, and meds, Maintain the minimum standards of continuing education, and merit badge courses to keep their jobs. Which from what I gather not only in my state but other states is pretty minimal. 

It goes back from the initial, paramedic training in the united states the idea was to provide the standards to get the program rolling and saturate the states with paramedics basically they found a problem and put a band aid on it. Not a long term solution but we never increased the standards after meeting the initial requirements.


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## bsmsdave (Nov 27, 2013)

Show me a State that subscribes to NREMT for licensure & I will show you a State to lazy to run their 0wn program


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## EpiEMS (Nov 27, 2013)

bsmsdave said:


> Show me a State that subscribes to NREMT for licensure & I will show you a State to lazy to run their 0wn program



Imagine if you said that for the NCLEX or USMLEs (obviously, ≥1 year of extra training required for unrestricted licensure in the latter case). How much repetitive effort is required for each state to run their own licensure exams of EMTs and Medics separately? Strikes me as an efficiency gain to use Registry.


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## Medic Tim (Nov 27, 2013)

unleashedfury said:


> Yes and no,
> 
> I am a strong believer we as a field should work harder to become more like a nursing program counterpart.
> 
> ...



Not all programs are as you describe.

I went through a CC for my AAS in Paramedicine. We had the same pre-reqs and co-reqs as the nursing students. Our program also had more class time and clinical hours than the nursing program. It was common for students to have over 1000 clinical hours between the hospital and ambulance that was  all scheduled. All of our instructors had at least an AAS. Our medical director also taught a few classes, he also guest lectured in most others a few times.

I understand that this is not the norm..... but there are good programs out there.


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## Medic Tim (Nov 27, 2013)

bsmsdave said:


> Show me a State that subscribes to NREMT for licensure & I will show you a State to lazy to run their 0wn program



care to elaborate??


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## Clipper1 (Nov 27, 2013)

Medic Tim said:


> Not all programs are as you describe.
> 
> I went through a CC for my AAS in Paramedicine. We had the same pre-reqs and co-reqs as the nursing students. Our program also had more class time and clinical hours than the nursing program. It was common for students to have over 1000 clinical hours between the hospital and ambulance that was  all scheduled. All of our instructors had at least an AAS. Our medical director also taught a few classes, he also guest lectured in most others a few times.
> 
> I understand that this is not the norm..... but there are good programs out there.



There have been some good Associates programs for Paramedic in the US since the 1970s. But, almost every college also has the cert option to stay competitive with the  private votechs.  Probably half of all Paramedics in the US are taught at private votechs or by the ambulance companies/fire departments by people who have the same cert level and no college A&P experience. Their A&P courses usually transfer nowhere and are just overview.  The students who take the initiative to find a good program will probably do well but move on to higher education such as PA or move to Canada if they meet the higher education requirements and can get through the red tape to work there.  Some moved on because they did not like working with those who did the bare minimum and complained about the possibility of more education being required all shift.

The *hours* of clinicals on an ambulance are not necessarily equal to that of nursing for patient contact.  A nursing student has one or two patients for all 8 or 12 hours and will do a variety of procedures. If their patient does not have the procedures needed, there are many other patients who might. They can also observe and talk to doctors or any other health care professional.   Paramedic students might spend 12 hours at an ambulance station watching TV or playing on the computer.  Some ambulance companies and FDs are popular because they allow for 24 hour shifts with the sleeping hours count towards total hours. Some states have gone to number of ALS patient contacts because of this but then you get patients with unnecessary IVs and ECGs just to get someone their ALS patient contact.  Some states even had to define "ambulance" since students in some places were allowed to do ALS engine rides with no transport.


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## Medic Tim (Nov 27, 2013)

Clipper1 said:


> There have been some good Associates programs for Paramedic in the US since the 1970s. But, almost every college also has the cert option to stay competitive with the  private votechs.  Probably half of all Paramedics in the US are taught at private votechs or by the ambulance companies/fire departments by people who have the same cert level and no college A&P experience. Their A&P courses usually transfer nowhere and are just overview.  The students who take the initiative to find a good program will probably do well but move on to higher education such as PA or move to Canada if they meet the higher education requirements and can get through the red tape to work there.  Some moved on because they did not like working with those who did the bare minimum and complained about the possibility of more education being required all shift.
> 
> The *hours* of clinicals on an ambulance are not necessarily equal to that of nursing for patient contact.  A nursing student has one or two patients for all 8 or 12 hours and will do a variety of procedures. If their patient does not have the procedures needed, there are many other patients who might. They can also observe and talk to doctors or any other health care professional.   Paramedic students might spend 12 hours at an ambulance station watching TV or playing on the computer.  Some ambulance companies and FDs are popular because they allow for 24 hour shifts with the sleeping hours count towards total hours. Some states have gone to number of ALS patient contacts because of this but then you get patients with unnecessary IVs and ECGs just to get someone their ALS patient contact.  Some states even had to define "ambulance" since students in some places were allowed to do ALS engine rides with no transport.



I don't disagree. I am also familiar with the differences between EMS and nursing clinical activities. I was midway through Junior year in a BSN program before deciding to go the EMS route....I know that sounds crazy to many here


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## Clipper1 (Nov 27, 2013)

Medic Tim said:


> I don't disagree. I am also familiar with the differences between EMS and nursing clinical activities. I was midway through Junior year in a BSN program before deciding to go the EMS route....I know that sounds crazy to many here




But now you are in Canada.  
The nursing programs there are also way ahead of the US for requirements and US ADNs barely can be called PNs there.

http://www.senecac.on.ca/fulltime/BSCN.html

1700 hours of clinicals exceeds the US standard.


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## Medic Tim (Nov 27, 2013)

Clipper1 said:


> But now you are in Canada.
> The nursing programs there are also way ahead of the US for requirements and US ADNs barely can be called PNs there.
> 
> http://www.senecac.on.ca/fulltime/BSCN.html
> ...



The schools that have BNs usually have even more hours. Yeah a 2 year RN can register in Canada but they need to finish a BSN or BN within a few years. Another reference point... our LPN program is 2 years.

But back to the topic.

I fully support higher education for EMS, but by itself it will most likely not take hold. The states would need to get on board or allow EMS to become an actual self regulating profession. There would also need to be a transition period (which could last quite a while) for the new "standards". It will also be very difficult to convince vollies and some (most) fire services.

I work in pretty remote areas. While it is the industry standard to work a 2 week on 2 week off rotation (oil field medical clinic), there are 911 services that operate on similar schedules to provide ALS and BLS coverage. They are able to fully cover a station with 4-5 employees and if they really want to push it 2-3 employees and local drivers. They are able to offer competitive pay and benefits along with providing rural residents access to healthcare. Transports to hospital can be hours each way.


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## Clipper1 (Nov 27, 2013)

Medic Tim said:


> I fully support higher education for EMS, but by itself it will most likely not take hold. The states would need to get on board or allow EMS to become an actual self regulating profession. There would also need to be a transition period (which could last quite a while) for the new "standards". *It will also be very difficult to convince vollies and some (most) fire services*.



But there are a lot who are not vollies or with a FD who are not pro education. The numbers of those with a degree in EMS show that after 50 years education for even an associates degree is not acceptable. The states are not stupid and probably neither are those who came up with the "new" EMT labels. If those in the profession are not proactive, the states and other government agencies probably won't be either knowing the opposition and strong view points which could be turned against them. No elected official is going to want to "piss off EMS and Fire".

Other professions did have strong leaders who reached out first to educators to raise their standards and then to those in the profession or entering the profession in school systems.  The community colleges could promote their degrees more but then some would turn it around as greed. Ambulance companies and FDs could pull their contracts with these colleges if the students started to rebel against even the mention of pushing a degree.  You have already seen here the strong arguments. 

Also, employers (hospitals, clinics) of other professions started advertising "Degree preferred" in their job section even when it was not required.  RN employers have been doing this for years with the "BSN preferred" added to ads. Now with over 3 million RNs in the US, over 50% have BSNs. This is an accomplishment since they have had to slowly come from OJT and Diploma.  RT, a much smaller profession, pushed for the Associates for about 20 years before they had enough degreed professionals where legislation could introduced to make the degree mandatory. They also came from OJT and certificate as well as meeting resistance since they were allowed to do impressive skills with very little education just like Paramedics. Nursing and RT are at least  now trying to put education before skills.

But, what would happen if an EMS employer put "degree preferred" for entry level Paramedic positions?  Would there be an outrage? Would Paramedics and unions take to a legal battle since it is not required?


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## TransportJockey (Nov 27, 2013)

There's a lot if positions here in nm where it's listed as 'degreed preferred' on all the job ads. Both in and out of hospital.


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## Clipper1 (Nov 27, 2013)

TransportJockey said:


> There's *a lot *if positions here in nm where it's listed as 'degreed preferred' on all the job ads. Both in and out of hospital.



Do you have some examples of entry level Paramedic positions listing a degree?

Just a quick search came up with these which seem to be fairly notable employers. None mentioned an Associates degree. 

https://rn21.ultipro.com/AIR1006/JobBoard/JobDetails.aspx?__ID=*70D64220BE58BE7D

Flight Paramedic; *Air Methods*
Education: High School Diploma

*Gila Hospital Silver City*http://ch.tbe.taleo.net/CH07/ats/careers/requisition.jsp?org=GRMC&cws=1&rid=1476&source=Indeed.com
Qualifications required:
Must have a Current license as an New Mexico EMT-Paramedic
 Current Basic Life Support (BLS) card
Current PALS Certification
Current ACLS Certification
Valid New Mexico Drivers License at class “D”, or above

*University of New Mexico*
https://hospitals.health.unm.edu/in...fuseaction=posting_detail&posting_id=12258109

http://www.miracleworkers.com/jobs/...iteid=indeedppcmw&job_did=j3g7fx6z45x3tfry434
Education Requirements:
High School Diploma or GED equivalent

*G4i* 
http://ch.tbe.taleo.net/CH18/ats/careers/requisition.jsp?org=G4I&cws=1&rid=587&source=Indeed
Education: Graduation from an accredited EMT-paramedic (EMT-P) certification program.

*Presbyterian*
https://careers.peopleclick.com/car...ource=Indeed.com&sourceType=PREMIUM_POST_SITE

https://careers.peopleclick.com/car...ource=Indeed.com&sourceType=PREMIUM_POST_SITE

https://careers.peopleclick.com/car...ource=Indeed.com&sourceType=PREMIUM_POST_SITE

High school or equivalent plus trade or vocational school in medical / surgical patient care. NM Paramedic license is required. ***Cardiac Telemetry experience is preferred. Experience in cardiac monitoring is preferred,
*
Corrections*
http://ch.tbe.taleo.net/CH10/ats/ca...g=CORRECTIONCARE&cws=1&rid=2214&source=indeed


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## TransportJockey (Nov 27, 2013)

Clipper1 said:


> Do you have some examples of entry level Paramedic positions listing a degree?
> 
> Just a quick search came up with these which seem to be fairly notable employers. None mentioned an Associates degree.
> 
> ...



AMR lists advanced education preferred


http://phiairmedical.hirecentric.com/jobs/56360.html
PHI states BS in a healthcare field preferred

The older UNM Lifeguard and UNM ER Paramedic jobs both listed degree preferred, but I am on a work computer and don't have a cache of those pages.

AAS USED to list it. But it's been a while since I looked at those.
http://jemezpueblo.org/emt-paramedic-1.aspx
Pueblo of Jemez lists post secondary education preferred


Those are the ones I can find that are hiring


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## Clipper1 (Nov 27, 2013)

TransportJockey said:


> AMR lists advanced education preferred
> 
> 
> http://phiairmedical.hirecentric.com/jobs/56360.html
> ...



That  could lead to a whole new discussion about the requirements to be a Critical Care Paramedic or Flight Paramedic.  On the other hand some Flight Paramedics complain about not be equal to the Flight RNs so now they have to have the same education requirements for this employer.



TransportJockey said:


> The older UNM Lifeguard and UNM ER Paramedic jobs both listed degree preferred, but I am on a work computer and don't have a cache of those pages.
> 
> AAS USED to list it. But it's been a while since I looked at those.



 None of the new ads mention a degree. The GED, HS Diploma and tech school requirements are now listed in all their Paramedic positions on the websites. Maybe some raised a stink about the degree requirement. This is what my earlier questions were leading to about the reaction of the EMS community


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## TransportJockey (Nov 27, 2013)

Clipper1 said:


> None of the new ads mention a degree. The GED, HS Diploma and tech school requirements are now listed in all their Paramedic positions on the websites. Maybe some raised a stink about the degree requirement. This is what my earlier questions were leading to about the reaction of the EMS community



One thing to keep in mind with the UNM position, it's a transfer paramedic position, not ER or flight. I believe thosep ositions generally had a higher requirement. But now that you mention it, I'm gonna start asking around.


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## Clipper1 (Nov 27, 2013)

TransportJockey said:


> One thing to keep in mind with the UNM position, it's a transfer paramedic position, not ER or flight. I believe thosep ositions generally had a higher requirement. But now that you mention it, I'm gonna start asking around.



Transfer Paramedic?

Job description from that link.



> •ALS - Provide advanced life support to include oral/nasal endotracheal intubation, needle thoracostomy, needle/surgical cricothyroidotomy, introsseous catheter insertion, pericardiocentesis; perform 12-lead EKG's and chemical blood glucose tests



I was not referring to Flight Paramedics for a degree requirement. I said "entry". What if AMR, RM and some of the others "preferred" a degree?
Even the program at Harborview in Seattle is not an Associates.  EMS has to start someplace to get people's attention.


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## TransportJockey (Nov 27, 2013)

Clipper1 said:


> Transfer Paramedic?
> 
> Job description from that link.
> 
> ...


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## Clipper1 (Nov 27, 2013)

Like CCT?


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## TransportJockey (Nov 27, 2013)

Clipper1 said:


> Like CCT?



On a rare occasion it seems. Primarily just standard inpatient going from one hospital to the other due to bed shortage or a certain surgeon being at one facility or the other. I've done a few for UNM when their transport unit was out and it was stuff like someone being transferred for an appendectomy or for iv antibiotics admission for an infection. Nothing more than an antibiotic drip and some narcotics during transport. That's the typical transport for them. There's rumors of that changing soon, but nothing set in stone. Talking about combining it to an extent with UNM Lifeguard flight teams.


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## ALS5 (Feb 28, 2018)

Wayfaring Man said:


> This would be a great idea if there were ways to get degrees in the US without going through the for-profit education industry.  It is a terrible condition our country is in where education requires thousands of dollars at least, often tens of thousands, for even 2 or 4 year degrees.  Requiring someone to get a degree is a fruitless act that does little but benefit the for-profit education system.
> 
> What would be the benefit?  It would prove that someone has a creditable, good education that meets relevant standards?  That's the entire point of the NREMT in the first place, and requiring a degree won't help anything there.
> 
> ...



Wayfaring man,

    I respectfully disagree with you, I believe we need a mandated degree in pre-hospital medicine if we are going to consider this field a career, other wise we are always going to be bottom feeders always accepting whatever we can get. We practice pre-hospital emergency medicine, if we stay where we are now, then why expect people to get a doctorate in medicine in order to practice medicine, why not just let them go through a 1-2 yr MD program and then let them practice? What’s the difference?...... I think we need to keep ourselves at a higher standard, look at Nurses, they can’t practice autonomously like we can but they are now required to have a bachelor’s degree, WHY? They need an MD to tell them what to do, you can teach a monkey to do follow directions.


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## akflightmedic (Feb 28, 2018)

Yeh! Getting a degree might help with research, grammar, syntax, etc...!!

FYI...Wayfaring hasn't been seen since October 2014 and you revived a post from 2013 without adding any real new support to the overall topic.


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## DrParasite (Feb 28, 2018)

ALS5 said:


> why not just let them go through a 1-2 yr MD program and then let them practice? What’s the difference?


When I was looking at becoming a Physicians assistant, I looked at several programs.  I found there were a few AAS programs (but very few), some BS programs (which was what I was initially looking at), and a whole lot of MS programs.  At the end of each program, you were eligible to take the PA-C exam, and if you passed, you were a certified as a physicians assistant.  Regardless of the time spend in education, you were still evaluated using the same test.  

So going back to the quoted question: should we let someone go through a 1-2 year MD program and let them practice? They have the knowledge required to pass the "entry level" exam, which was the standard to judge if you have the minimum knowledge to be a doctor.  well, if they can pass the medical licensing exam, and the appropriate board specialty exam, does it really matter how long their MD program was?


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## joshrunkle35 (Feb 28, 2018)

DrParasite said:


> So going back to the quoted question: should we let someone go through a 1-2 year MD program and let them practice? They have the knowledge required to pass the "entry level" exam, which was the standard to judge if you have the minimum knowledge to be a doctor.  well, if they can pass the medical licensing exam, and the appropriate board specialty exam, does it really matter how long their MD program was?



Yes. For several reasons:
-They need to work regularly with other professionals like social workers, psychologists, public health professionals, etc., and almost all of those people hold advanced degrees. They need to have a large amount of time learning in order to be respected by colleagues in similar professions, so that patient care is not harmed by a broken professional relationship.
-They need to be respected by the general populace. Would you respect a doctor’s opinion if they had 1-2 years of schooling but you had 12?
-They can’t learn the information in 2 years. Pre-med education is only 10-12 classes, but each of those classes might have significant prerequisites unless the student goes though a college prep high school. That information would all need to be learned to form a basis for the information learned in medical school. Even if a person studied 24 hrs a day for 2 years, I don’t know that they could absorb all of the information from a post-high school education to the current standard of medical education. 
-Lastly: do you respect or trust a Paramedic any more if they currently hold advanced training/licensure/degrees? I sure do!


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## EpiEMS (Feb 28, 2018)

DrParasite said:


> Regardless of the time spend in education, you were still evaluated using the same test.



Competency-based education is the next great step in education.


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## Summit (Feb 28, 2018)

Associates Degree PAs do not have only 1-2 years of post-HS education.

They are typically 2-3 year programs with 1-2 years of prereqs at mininum.


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## DrParasite (Feb 28, 2018)

EpiEMS said:


> Competency-based education is the next great step in education.


So, you agree with what I said?  And if not, how do you propose that competency be evaluated?


joshrunkle35 said:


> They need to work regularly with other professionals like social workers, psychologists, public health professionals, etc., and almost all of those people hold advanced degrees. They need to have a large amount of time learning in order to be respected by colleagues in similar professions, so that patient care is not harmed by a broken professional relationship.


Oh, I get it..... the knowledge isn't important, it's only how long they were in school for...... and the longer someone is in school, the smarter they must be.... no one would ever respect a smart person who knew what they were talking about if they didn't hold an advance degree.


joshrunkle35 said:


> -They need to be respected by the general populace. Would you respect a doctor’s opinion if they had 1-2 years of schooling but you had 12?


I can honestly say that I have never asked my doctor how long they went to school for (or where they went to school for that matter, because some schools are better than others).  They had MD after their name, which means they deserved my respect because they were qualified as medical doctors. Whether it took them 2 years, 4 year or 6 years, they still passed the requirements to be an MD





joshrunkle35 said:


> -They can’t learn the information in 2 years. Pre-med education is only 10-12 classes, but each of those classes might have significant prerequisites unless the student goes though a college prep high school. That information would all need to be learned to form a basis for the information learned in medical school. Even if a person studied 24 hrs a day for 2 years, I don’t know that they could absorb all of the information from a post-high school education to the current standard of medical education.


what are you basing that on?  are you allowing your own biases cloud your opinion of what a person is capable of?  I mean, you know the youngest medical doctor in the US graduated medical school at 17, right?  and there are others who completed all that schooling in less time than you or I would need.QUOTE="joshrunkle35, post: 664115, member: 13783"]-Lastly: do you respect or trust a Paramedic any more if they currently hold advanced training/licensure/degrees? I sure do![/QUOTE]honestly?  no.  I have know quite a few arrogant paramedics who have bachelors in paramedicine, and they perform no better than the non-degree ones.  I know of a paramedic who has a PhD (albeit in an unrelated field), but shes the same as every paramedic at the agency.  

I know of a FF/PM who currently has her masters degree, but on the truck, she is treated the same as every other paramedic (although she is also the department chair of a university's pre hospital medicine program, but that's not her clinical job).

And just for the record, I know of many nurses who have associates degrees who don't think having a bachelors makes nurses anything special, and they are damn good nurses.  The only reason they got it was because their employer was pushing for all nurses to have them.


Summit said:


> Associates Degree PAs do not have only 1-2 years of post-HS education.
> 
> They are typically 2-3 year programs with 1-2 years of prereqs at mininum.


I didn't say otherwise, and almost all PA programs have prerequisite classes, but the program is still an associate degree in length.  Don't believe me?  check out .http://www.mdc.edu/physicianassistantas/ (although I will stipulate that it is being rolled into a bachelors degree at a future date).

and even so, it doesn't matter: at the end the program, regardless of if you took a AAS program, BS program, or MS program, you still sit for the same PA-C exam.


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## EpiEMS (Feb 28, 2018)

DrParasite said:


> So, you agree with what I said? And if not, how do you propose that competency be evaluated?



I totally agree - competency is the next frontier, meaning that fixed length programs are (hopefully) going to start being the exception, rather than the rule. Not only is it cheaper, it's more efficient. For example, if I can demonstrate my skill/knowledge (like via exam) in some subset of X as part of my degree (or license) in X, I should be able to skip that portion.

One thing that is inherently valuable about a degree, though, is that it takes time. I'd argue that part of the reason why extensive schooling for physicians is valuable is that (1) it selects for people with patients and (2) it produces its end output at age 30...that's (on average) a more mature person with (usually) more experience. That's a good thing, in general.


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## Summit (Feb 28, 2018)

DrParasite said:


> And just for the record, I know of many nurses who have associates degrees who don't think having a bachelors makes nurses anything special, and they are damn good nurses.  The only reason they got it was because their employer was pushing for all nurses to have them.
> I didn't say otherwise, and almost all PA programs have prerequisite classes, but the program is still an associate degree in length.  Don't believe me?  check out .http://www.mdc.edu/physicianassistantas/ (although I will stipulate that it is being rolled into a bachelors degree at a future date).
> 
> and even so, it doesn't matter: at the end the program, regardless of if you took a AAS program, BS program, or MS program, you still sit for the same PA-C exam.


You are saying that a MD is 12 years vs "1-2" for a PA AAS you are failing in your comparison.

12 years MD:
4 years of undergrad
4 years of medical school
4 years of residency

9 years to MD:
2 years of undergrad (some schools don't technically require a 4 year degree, just the prereqs which account for only about 2 years, and there are some accelerated direct entry 6 year BS/MD programs)
4 years of med school
3 years of residency (EM, IM, FP, Peds... or in some areas have limited or supervised GP practice without a residency (function like a PA))

3+ year PA AAS: (per MDC website you linked to)
1+ years of prereqs
2 years of PA school

So you can get an PA AAS in a minimum of 3 years (but usually it is 9+ with experience)
Or you could get an MD in a minimum of 9 years (but usually it is 12+)
You could also get a NP MSN in a minimum of 6 years (but usually it is 9+ with experience)

But all of those numbers are atypically low kind of like how you _can _get your paramedic in 3 months. The market seems to want more rigor (eg most new grad RNs have a BSN even though you don't technically need a degree to get your RN).

PA MS usually it is 9+ with experience
MD usually it is 12+
NP MSN usually it is 9+ with experience


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## Carlos Danger (Feb 28, 2018)

EpiEMS said:


> I totally agree - competency is the next frontier, *meaning that fixed length programs are (hopefully) going to start being the exception, rather than the rule.* Not only is it cheaper, it's more efficient. For example, if I can demonstrate my skill/knowledge (like via exam) in some subset of X as part of my degree (or license) in X, I should be able to skip that portion.



Reminds me of Excelsior's motto back when I did my original nursing education there: "What you know is more important than where or how you learned it".

I wish the part I bolded were true but the problem is the establishment has much incentive to keep things the way they are. To use medicine as an example, the universities and medical schools make money hand over fist and won't benefit financially by shortened educational programs. The physician's lobby itself (AMA, etc.) is made up of individual doctors who have no interest in increasing the supply of physicians with whom they'll have to compete. Actually, using the ACGME, the physician lobby regulates the supply of new doctors closely in an attempt to keep the supply of physicians low in relation to demand. (Which of course is the real reason they have such a problem with non-physicians working independently, though that's an entirely other discussion)

In the end, no entity who has the power to innovate and make this type of education more affordable and accessible has an economic incentive to do so.


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