# Design a new Paramedic Baccalaureate-Level Curriculum



## thegreypilgrim (Jan 3, 2011)

OK guys, I'm sure this has been done before (in fact I remember doing something similar a while ago) but put those concerns aside and indulge me.

Say you've been charged with developing a curriculum for a Bachelor of Science degree in Paramedicine in a university context. What should the prerequisites be? What are the core upper division courses? Have at thee!


----------



## gicts (Jan 3, 2011)

Nothing personal, but I have to question why. Not why you are posting this (too lazy to do a little creative HW?), but why would one enter a Bachelor's program in Para-medicine? There would be no pay benefit from those without even an Associates degree, and no guarantee of quicker promotions. Heck, even if a promotion was guaranteed, wouldn't another, more broad and diverse degree be more optimal for their future seeing as the average EMS career is 7 years?

I can't imagine 2 more years over the Associates degree being necessary or beneficial to the average paramedic. I'll cheat and say look at Canada's 4 year programs for my input in prerequisite's and curriculum. I truly couldn't imagine any sane person entering into such a program.  h34r:


----------



## thegreypilgrim (Jan 3, 2011)

Wow, ok let's recap what we've got here:

(1) Irrelevant comments that miss the point.

(2) Avoiding the idea of a higher education standard.

(3) An assumption about motives.


Definitely an EMS forum.


----------



## gicts (Jan 3, 2011)

thegreypilgrim said:


> Wow, ok let's recap what we've got here:
> 
> (1) Irrelevant comments that miss the point.
> 
> ...



Wow, ok let's recap what we've got here:

(1) Not answering my question as to why. 

How would these students benefit from a higher education degree?


----------



## thegreypilgrim (Jan 3, 2011)

Not the purpose of the thread man...the idea is to engage in hypothetical reasoning because sometimes (astonishingly) such an endeavor might be fun/beneficial/interesting. Sometimes. Like this time.


----------



## Veneficus (Jan 3, 2011)

I think before you can define a curriculum, you must first define the role. 

If you are talking about a "community health paramedic" role your curriculum is going to be different than a strictly emergency role. 

Some universal provider who would be able to handle everything from routine IFT to emergency, to critical care, disaster response or anything else you want to toss in would be different still. 

It might even call for a basic level of education with later subspecialty. 

It is not that I don't want to answer, but all education has to be tailored to the position. Otherwise you spend a lot of time, money, and effort and wind up with a lot of nothing.


----------



## thegreypilgrim (Jan 3, 2011)

Good point. For the purposes of this thread then, presume a "Community/Public Health Paramedic" who's supposed to function in a comprehensive out-of-hospital medical care capacity.


----------



## gicts (Jan 3, 2011)

thegreypilgrim said:


> Not the purpose of the thread man...the idea is to engage in hypothetical reasoning because sometimes (astonishingly) such an endeavor might be fun/beneficial/interesting. Sometimes. Like this time.




Ahh. I gotcha. I'll play.

Freshman and Sophomore year I would keep as-is for Associate's degree programs. Basic English, math, anatomy, and EMT/Paramedic programs. If Biology and Chem aren't included, I would add those if possible.

First semester of Junior year, students would be recommended to take:
Personal Health 101
Basic Finance 101
Physical Education 101
The Law And You! 101

That would probably end up being 12 hours and the minimum for full time- there for the maximum as well.

Second Semester of Junior year would include
Common Sense 101
How to play nice with others-and nurses too! 101
How not to cheat on your spouse 201
Anatomy 102

Again-12 hours and obviously plenty of work for the students


Summer internship includes extensive time spent at the career center.

If any students enlist for the senior semester they are recommended to the local mental health center.

h34r:





thegreypilgrim said:


> Good point. For the purposes of this thread then, presume a "Community/Public Health Paramedic" who's supposed to function in a comprehensive out-of-hospital medical care capacity.



Awwww take the fun and feisty sarcasm out of things. 
I would highly recommend having an internship at a progressive EMS service (like Wake County EMS) be a full semester. That would be beneficial for not only the student's practical skills, but for preparing the student to teach and expand tomorrow's EMS vision (God willing). A condensed version of a Physician's Assistant's program may not be a bad decision for one or two semesters and perhaps segue into an option to continue their education into a Physician's Assistant Graduate Program. That would give the graduate a foundation for continuing their education as well as beneficial (including hands-on and practical) education in EMS.


----------



## usafmedic45 (Jan 3, 2011)

> How would these students benefit from a higher education degree?



Ever heard of a self-induced false shortage?  Ever wonder why physical therapists went to requiring a doctorate and why they are paid so dang much?


----------



## gicts (Jan 3, 2011)

usafmedic45 said:


> Ever heard of a self-induced false shortage?  Ever wonder why physical therapists went to requiring a doctorate and why they are paid so dang much?



We are having difficulties getting patients to pay our $1000 transport bills and therefore slashing expenses left and right. The only way I see raising salaries is by raising transport costs- which I can't fathom. :glare:

Ideally, yes. Previously, more education would equate to higher paying salaries. However, IMO, budgets and revenue in the EMS systems are attacked by many different angles, and the bottom of which are the salaries for employees. It doesn't matter if you slap doctors and nurses on ambulances, the pay of those who drive ambulances aren't going to go up.  YMMV depending on if you are private, volunteer, or a city service, but the same principle remains.

It would be nice if the education standards were raised, but in my region we are having difficulties filling the seats of ambulances as it is. Until the pay becomes desirable, which I can't see happening anytime soon (don't get me started on the new health care 'reform'), don't expect an interest in increasing the educational standards.

If for some reason there was a new standard requiring a masters degree to be a paramedic or whatchamacall'um, what would happen? Instead of 2 years of schooling, students are forced through 6. The chain of events would play out so there would be less people who could make it through the programs, and they would be expected to be compensated financially for it. Cool. Let's look at the average pay of a master's degree
(quick google search) http://www.happyschoolsblog.com/average-masters-degree-salary/

Let's say conservatively a Master's degree is worth $65,000. I make $36,000. Could your service employee twice as many Paramedics who sit on their a** and don't even check out a truck? 

Hang tight, I can read your mind. These new magic medics would be Community Paramedics and be able to choose where to send people and cure stuff magically. You still receive the same amount of calls, forcing your transport fees to literally double. Who pays $2000 for glorified taxi drive? Let's not kid ourselves, more often than not that is what were are called for. How many people would pay? 

Sure, there are many variables in the United States. Urban and Rural cities. Private and Public services. Three tier and Fire based. LMAO at the thought of some firefighter medics sticking around for a Master's degree.



Maybe I am too burned out already, or just a realist. Without an increase in pay, our educational standards are going nowhere- and I don't see our pay going up anytime soon. I am just happy to have a somewhat secure job where I don't hide behind a corner every day trying to avoid a pink slip from my manager.


----------



## usafmedic45 (Jan 3, 2011)

> It doesn't matter if you slap doctors and nurses on ambulances, the pay of those who drive ambulances aren't going to go up. YMMV depending on if you are private, volunteer, or a city service, but the same principle remains.



But if the only option was to pay a wage deemed acceptable by the majority of us or not have ambulances at all, then you have a whole other ballgame.   The problem is that enough of our ranks are made up of people who are young, immature, stupid, adrenaline-seeking, or socially inept (or a combination of some or all of the above) that they will work for anything and they are the reason our salaries are so low.  If you cut the supply of them off (get rid of the diploma mills, shutter the "online programs" and establish a higher standard for entry to practice), then the same thing that happened with nursing, RT, etc will happen with EMS.



> don't expect an interest in increasing the educational standards.



You think the rank and file nurses are thrilled every time the standards are jacked up a little more?  I know a lot of us in the RT field are annoyed by the political grandstanding because we're at a point where increasing the educational standards is not going to garner us any more pay increases.  It's just a way of maintaining an artificial scarcity to keep the pay scale at a decent level.  

My advice: Ignore the "interest" of the rank and file EMS providers and make a unilateral move to either play ball or get out.  Those with the determination to better themselves will be thankful in the end.  An added benefit for forum members like us will be a decrease in the number of threads about which holsters is better for your trauma shears, which lights to put on your car and whether you're allowed to carry a gun at work as we push the Ricky Rescues out of our midst.


----------



## gicts (Jan 3, 2011)

usafmedic45 said:


> But if the only option was to pay a wage deemed acceptable by the majority of us or not have ambulances at all, then you have a whole other ballgame.   The problem is that enough of our ranks are made up of people who are young, immature, stupid, adrenaline-seeking, or socially inept (or a combination of some or all of the above) that they will work for anything and they are the reason our salaries are so low.  If you cut the supply of them off (get rid of the diploma mills, shutter the "online programs" and establish a higher standard for entry to practice), then the same thing that happened with nursing, RT, etc will happen with EMS.



I am in a urban setting in Kentucky, not far from you. Many of our transports are under 5 miles. Right now I feel guilty sticking patients with the bills that they receive. 

I understand what you are saying, however I can't imagine being able to come up with any more revenue to support EMS (likely double what we spend now) if we demand higher education.

In some situations a community paramedic would be nice- but that niche has been filled already in some places with at home nursing care. h34r:

The more I am in the field the more I wish we were better than what we are, but the more I doubt that day will ever come. :shrug:


----------



## usafmedic45 (Jan 3, 2011)

gicts said:


> I am in a urban setting in Kentucky, not far from you. Many of our transports are under 5 miles. Right now I feel guilty sticking patients with the bills that they receive.
> 
> I understand what you are saying, however I can't imagine being able to come up with any more revenue to support EMS (likely double what we spend now) if we demand higher education.
> 
> ...


I'm enough of a moral relativist that I don't have a problem justifying it.  Of course, the crappy pay is one reason I got out of EMS.  I make $23 an hour now sitting on my butt posting this.  That's what I made as an EMS supervisor doing 10x as much work.  I don't feel guilty at all...in fact, there's a strange sense of entitlement at play here in my case....


----------



## gicts (Jan 3, 2011)

usafmedic45 said:


> I'm enough of a moral relativist that I don't have a problem justifying it.  Of course, the crappy pay is one reason I got out of EMS.  I make $23 an hour now sitting on my butt posting this.  That's what I made as an EMS supervisor doing 10x as much work.  I don't feel guilty at all...in fact, there's a strange sense of entitlement at play here in my case....



That crappy pay is the reason I spend days looking for a career outside of EMS, not using it as a motivator to further my education in the system. The same principle is why I criticize the thought of additional education in EMS, especially when people speak of tacking 2+ years on to what we do. 

I can hardly support myself right now with my college debt, even with the 10+ hours of OT I pick up a week. I couldn't imagine paying for more years of that quality learning.


----------



## firecoins (Jan 3, 2011)

I read the first post only.

*First Year*
English I & II 6 credits
College Algebra 3 credits
Statisitics 4 credits
A&P I&II 8 credits
Psychology 3 credits
Abnormal Psych 3 credits
EMT class  6 credits

*Second Year*
human development 3 credits
Neuro science 4 credits
pharmacology 4 credits
pathology 4 credits
legal writing 3
Criminal Justice 3
Public Health 3
Plebotomy 3 
EKG/Heart anatomy 3 
Hospital volunteering 2 

*Third Year*
Paramedic Program 32 credits

*Forth Year*
Accounting 4
Managment 4
Emergency Management 3
Terrorism 3
Crimonolgy 3
Sociology 3
World History 3
American History 3


----------



## Melclin (Jan 3, 2011)

*Year 1*
BEH1021 Professional Communication in CBEH 
BMA1901 Human Structure and Function 1
BEH1102 Clinical concepts of paramedic practice 1
IPE1011 Foundations of Health in Primary Clinical Care 

BEH1022 Pharmacotherapy in CBEH (6)
BMA1902 Human Structure and Function 2 (6)
BEH1011 Clinical Concepts of Paramedic Practice 2
NUR1202 Legal Issues and Concepts

*Year 2*
BEH2011 Professionalism and Community Based Emergency Health Systems 
BEH2041 Human Development and Health Across the Lifespan
BEH2021 Population Aspects of CBEH Services 
BEH2501 Community Health, Culture and Society 

BEH2012 Paramedic Management of Cardio-Respiratory Conditions 
BEH2022 Paramedic Management of Trauma and Environmental Conditions 
(BEH2032 Paramedic Clinical Practice 1)


*Year 3*
BEH3011 Paramedic Management of Medical Conditions 
BEH3051 Paramedic Management of Mental Health 
BEH3021 Paramedic Management of Health Conditions at Life Stages 
(BEH3031 Paramedic Clinical Practice 2) 

BEH3032 Paramedic Management of Critical Care Specialty Situations BEH3012 Clinical Leadership and Emergency Preparedness 
BEH3022 Research and Contemporary Challenges in CBEH
(BEH3042 Advanced Paramedic Clinical Practice 3) 

This is our degree as it stands for new students starting last year. 

Thing is though, you can only get so much out of subject titles. They bear almost no actual similarities to their actual content most of the time. "Community, health, culture and society" for example was the most bull:censored::censored::censored::censored: subject I've ever had the misfortune of having to do. Professional communication on the other hand sound like that kind of subject but its actually pretty brilliant. Amongst other things, students are taped talking and negotiating with patients to improve their communication skills body language and work with standard pt actors to get feed back on the rapport the build with people. 

The old Advanced Diploma (essentially what you would call an associates degree I suppose) that existed before the degree had an interesting system where students would alternate between periods on the road and periods at school after an initial period basic learning, which worked well and appear to be a similar structure to the medical curriculum around these parts. As it stands now, we have far too little time on road to consolidate the theoretical information we learn. That needs fixing, but in a few years I think the degree will be something pretty special.

EDIT: CBEH stands for Community Based Emergency Health. Its our official/academic version of EMS; a term that has never really been used in Australia.


----------



## socalmedic (Jan 3, 2011)

http://www.llu.edu/allied-health/sahp/emc/programinfo.page?

how about this... the work is already done.


on a side note to reply to the earlier posts about why to raise education standards. I believe that an increase in education would decrease in the overall amount of paramedics resulting in higher pay, more motivated medics, and more respect from higher level providers. i know this would not be an overnight transformation however if it went up in steps (starting at the AAS level) and got progressively higher it would work out to our benefit. i know that here in CA we have no education requirements, I also know that other states do have requirements for degrees (not necessarily in EMS but in health related fields). God forbid that Los Angeles Fire Department runs out of paramedics what on earth would we do... maby Los Angeles DHS would actually provide the EMS to the county, since they already are a county EMS agency with ambulance already on the road. http://ems.dhs.lacounty.gov/AmbulanceServices/AmbServ.htm who might i add get paid very well for only being EMTs.

anyway i guess part of my rant was to say that as a new medic i am still looking for more education beyond paramedic school, and think that we should have at least a minimum AAS to start preferably a BS.


----------



## MrBrown (Jan 4, 2011)

why not require a degree? most other nations eg Australia, New Zealand, the UK and Souh Africa require a Bachleors degree for Paramedics.  In AU and NZ the ALS level Officer known as an Intensive Care Paramedic requires a Graduate degree


----------



## jjesusfreak01 (Jan 4, 2011)

MrBrown said:


> why not require a degree?



Nobody would become paramedics if it required a bachelors degree because the pay is too low because we don't charge enough because the insurance won't pay more. 

That said, the biggest problem lies with the government. Half of our patients have Medicare as their primary insurance, and the government keeps slashing reimbursement rates. We could justify charging more for patients who have actual emergencies, but it still holds that the insurance companies aren't going to want to pay more for a paramedic with a bachelors degree than a paramedic with a cert, because they aren't going to see the difference in 99% of cases. 

I know the popular notion is that providers are going to have to take the initiative to change education standards, but I believe in the US the change is going to have to be initiated at the federal level. That doesn't mean we can't push for the change in federal guidelines, but it does limit our options.

/rant


----------



## Veneficus (Jan 4, 2011)

jjesusfreak01 said:


> That said, the biggest problem lies with the government. Half of our patients have Medicare as their primary insurance, and the government keeps slashing reimbursement rates. We could justify charging more for patients who have actual emergencies, but it still holds that the insurance companies aren't going to want to pay more for a paramedic with a bachelors degree than a paramedic with a cert, because they aren't going to see the difference in 99% of cases.


 
I think this is what makes the case for higher education actually.

EMS does not deserve what it gets now and more and more people are catching on to that. There will be a continuing trend of rates getting slashed. Especially since without unified professionals advocating on their own behalf. 

Nothing changes the fact that society whether it admits it or not values education. No education, no seat at the table discussing who gets how much.

Since the only option to prove value is to actually diversify and demonstrate either savings or revenue it will require more education.

$1000 for an ALS taxi ride today is not worth it and nobody deserves it. The constant struggle to add more trips, more responses, more toys that help in so few situations instead of more education and value of the provider is causing EMS to literally price itself out of the market. 

The only option is to evolve or become extinct.


----------



## thegreypilgrim (Jan 4, 2011)

jjesusfreak01 said:


> Nobody would become paramedics if it required a bachelors degree because the pay is too low because we don't charge enough because the insurance won't pay more.



Why don't we do what the citizens of King County, WA did and make EMS a 100% tax-subsidized public service that isn't dependent on fees for service? Those socialistic, un-American Pacific Northwesterners might actually be onto something. Of course, that requires radical departure from the status quo, which is scary, but such a radical departure is necessary. As Vene rather eloquently pointed out, the current system is _*unsustainable*_ for precisely the reason you state here.

Insurance won't pay more, and they will continue to refuse reimbursements while EMS cost of availability of service continues to increase. EMS quite simply must change or cease to exist. The pathway of change necessitates more educated professionals who provide true physician-extension with definitive care in the field, referral abilities, preventative wellness checks, etc.


----------



## firecoins (Jan 4, 2011)

thegreypilgrim said:


> Why don't we do what the citizens of King County, WA did and make EMS a 100% tax-subsidized public service that isn't dependent on fees for service? Those socialistic, un-American Pacific Northwesterners might actually be onto something. .


Some believe many state government and the federal government are unsustainable due to debt. 

100% tax subsidized public service is simply not in out future.   Don't expect it anytime soon.  NY state has a $9 billion deficit.  NYC has a $2 billion deficit.  What is California's deficit?  The first things cut are emergency services. NJ's state bugdet woes forced cities like Newark and Camden to cut police. Those are 2 of the most crime ridden cities in the US.


----------



## rescue99 (Jan 4, 2011)

EMS is not an occupation worthy of demanding more than an AAS not simply because the majority of calls are basic and because EMS workers refuse to organize themselves as professionals who are worth more. 

Today, an AAS is worth no more than a a HS diploma was 15 years ago. The push is not become more edudated so much as it is to spend the money on the higher educational institutions as we change from a country of manufacturers to a country whose primary product is healthcare. The shift in our primary product requires a shift in skills necessary to maintain production.


----------



## Veneficus (Jan 4, 2011)

rescue99 said:


> EMS is not an occupation worthy of demanding more than an AAS not simply because the majority of calls are basic and because EMS workers refuse to organize themselves as professionals who are worth more.
> 
> Today, an AAS is worth no more than a a HS diploma was 15 years ago. The push is not become more edudated so much as it is to spend the money on the higher educational institutions as we change from a country of manufacturers to a country whose primary product is healthcare. The shift in our primary product requires a shift in skills necessary to maintain production.



For certain to the first part, but I don't think the primary product of the US will ever be healthcare. In order for that to be the case it must be exportable. 

The only people who can afford from abroad are people with very deep pockets and those are too few to support a nation of 300 million.

As I pointed out before, healthcare does not create wealth, it maintains it. So something is going to have to change in what the wealth creation industries are. 

Ideally it would be scientific advancement, but sadly we are fallnig behind the rest of the world in education as well.

the 2 realistic options as I see are:

1. continue with the status quo with a reduction in government services, and ever widening gap between the haves and the have nots similar to nations like India, Russia, or China where the non aristocratic class Americans have a much reduced standard of living from the current level.

2. Drop the every man for himself attitude and expend some effort and currency now in order to either soften the blow of that gap or to create a sustainable economy with a high level of educated people whos abilities cannot be exported.


----------



## thegreypilgrim (Jan 4, 2011)

firecoins said:


> Some believe many state government and the federal government are unsustainable due to debt.
> 
> 100% tax subsidized public service is simply not in out future.   Don't expect it anytime soon.  NY state has a $9 billion deficit.  NYC has a $2 billion deficit.  What is California's deficit?  The first things cut are emergency services. NJ's state bugdet woes forced cities like Newark and Camden to cut police. Those are 2 of the most crime ridden cities in the US.



Debt =/= deficit. Stable governments can rack up debt that represents a substantial portion of its GDP without losing investment (Belgium, for example, once had a national debt equal to about 110% of its GDP yet it's still functioning quite well). So, I'm not actually worried too much about debt, nor am I worried that publicly funding EMS will dramatically increase the debt of a state (much less federal) government.

Deficits are a different matter, and relate to a number of distinct variables but in the US it's mostly because of a lack of revenue due an archaic tax structure designed to benefit the most wealthy at the expense of advanced/modern social services. The details of each state's deficit problems are unique and while I can't speak to New York's problems, I can say that California's are mainly due to problems related to its ballot proposition system in which voters have enacted measures allowing budget allocations to be dictated by popular vote as well as tax rates (genius right?). This has resulted in laws which mandate certain amounts be spent in certain areas while tax rates are kept low at the whim of the fickle public. The state legislature is also horribly incompetent.

Having EMS continue to exist as a fee for service program adds costs to overall health related expenditures (since the largest payer is, low-and-behold, Medicare [i.e. the government]) thus defeating the whole purpose of delegating EMS planning to the states so it could be a self-contained system. Consolidating EMS into a publicly financed system would be a better option if we could overhaul the US tax code into a progressive system.


----------



## rescue99 (Jan 4, 2011)

Veneficus said:


> For certain to the first part, but I don't think the primary product of the US will ever be healthcare. In order for that to be the case it must be exportable.



Hmmmm....now this one is a loaded statment. Have we ever measured the number of foreign students this country gives free/discounted educations to in total? The trades is why we give outsiders what we cannot (or refuse) to give our own. Not only is education up on the free trade market but the educations in healthcare are. People come here, get their freebie educations then go back home, very often. Colleges make a buck and we get the bill. So yes, healthcare AND education are quite exportable..and exploitable.


----------



## thegreypilgrim (Jan 4, 2011)

rescue99 said:


> Hmmmm....now this one is a loaded statment. Have we ever measured the number of foreign students this country gives free/discounted educations to in total? The trades is why we give outsiders what we cannot (or refuse) to give our own. Not only is education up on the free trade market but the educations in healthcare are. People come here, get their freebie educations then go back home, very often. Colleges make a buck and we get the bill. So yes, healthcare AND education are quite exportable..and exploitable.


Ah yeah it's those free-loading immigrants that are the cause of all our problems! Certainly not the fact that the income tax brackets top out at something like $375K/year (so, Bill Gates and your neurologist pay the same in taxes), no national sales tax, tax breaks to the wealthiest 1% at a time while involved in 2 protracted wars, and defense expenditures that exceed that of the _*rest of the developed world combined*_. That has nothing to do with it.


----------



## rescue99 (Jan 4, 2011)

thegreypilgrim said:


> Ah yeah it's those free-loading immigrants that are the cause of all our problems! Certainly not the fact that the income tax brackets top out at something like $375K/year (so, Bill Gates and your neurologist pay the same in taxes), no national sales tax, tax breaks to the wealthiest 1% at a time while involved in 2 protracted wars, and defense expenditures that exceed that of the _*rest of the developed world combined*_. That has nothing to do with it.



I did not say it was any nations' fault....I simply said, education and healthcare are both exportable and exploitable.


----------



## Veneficus (Jan 4, 2011)

rescue99 said:


> Hmmmm....now this one is a loaded statment. Have we ever measured the number of foreign students this country gives free/discounted educations to in total?



Since most universities in the US expect to make money, I would think like all other businesses, they make investments in people they feel will bring money to the university.

The fact they have to look overseas for talent demonstrates either the lack of talent in the US or more probably, the lack of developed talent from the extremely underfunded and ineffective celebration of mediocrity that is primary and secondary education, because US residents seem to think investing in education is not a priority and everyone is equal when it comes to ability.



rescue99 said:


> The trades is why we give outsiders what we cannot (or refuse) to give our own.



I don't understand this statement?



rescue99 said:


> Not only is education up on the free trade market but the educations in healthcare are.



This may come as a surprise, but the healthcare education overseas is equal or better than the US.(but the propaganda says the US is always the best, just like Iran says the same about themselves) However, the institutions abroad cannot afford to "invest" in talent like the US can, because they is less free money. So the spots are much more limited.

There are whole countries without medical schools, who pay for their students to go to schools in other nations. How many attend US schools? Only a handful at best. The limited opportunity and price are removing themselves from the global market. 



rescue99 said:


> People come here, get their freebie educations then go back home, very often.



Lol, that made my night. I don't think you understand how education makes a person marketable and portable. 

Colleges that offer free education to people hope those people will stay at the college and make money for them. However, once you have a recognized education that is in demand, people compete for your talents. Like sports figures, most want to play for winning teams or those that offer the most. 

It is not that American's aren't offered the same opportunities, it is they fail to capitalize on them, becase they don't understand the value. For the last 70 years they haven't had to. They could extort outrageous prices for labor for a lifestyle that is unsustainable without an educated society. The time to pay the piper has come, and the US cannot afford it. So a lot of "middle class" and "well off" who exist beyond there means are being forced to live with what they can sustain. It is not the American dream by any length.

It is not the fault of foreigners that they value education more than who they are going to the prom with, what snookey is doing on TV tonight, etc.

Students in Europe compete to get into the best high schools. How many US students worry about going to the best high school? Do they define the best as who has the best football record?

I won't get started on elected school boards. The uneducated idiots deciding what needs to be taught, like intelligent design or rewriting conservative history to further a politcal agenda.

Fear, misinformation, and wonder, the best population control ever.  



rescue99 said:


> Colleges make a buck and we get the bill.



You know of course one of the reasons tuition is so high is because the government support of education is flawed?

Rather than giving money to colleges and forcing them to take students for it, they give it to them and demand almost nothing in return. Then to top it off, the give the students loans (which have to be repaid with interest. That is an investment) to cover the tuition which is more money for the institution only passed onto the student. So they often have to take the best deal after completion, which today likely may mean overseas. 

The effort of privatizing state education was successful. For the private investors, not for the public or the nation. Do you know in almost every country outside the US, state schools are considered far superior to private, which are often looked at as diploma mills, since if you pay you pass? Why are US state schools lesser than its private ones?   



rescue99 said:


> So yes, healthcare AND education are quite exportable..and exploitable.



Do you get this stuff off the TV?

Yes, healthcare is exportable, but not by the US. Only the wealthy can afford it. It is why medical tourism is becomming so popular. Take your money out of the US to buy medicine you cannot buy in it. Failure on the US part if it ever existed.

Education is exportable too. I pay 1/3 what I would in the US for a superior education.(most in the US never see what is going on elsewhere, the TV god tells them all they need) That money could be employing all kinds of professors and support services in the US. But the schools there cannot compete economically. While they claim they can academically, my experience doesn't support that. I can work in any system, not just the one I was trained in. Oh, the power went out! How am I supposed to work without an automated lab and CT scan?

I was reading a blog yesterday about US medical students who want less science that they find useless and more business education as part of the medical curriculum. 

How very short sighted, "how can we make more money" instead of "how can we provide care people will pay more for."

Should the US keep its mindless emotional politics of the masses, it will marginalize itself further in the world. 

I've studied this somewhere before... Oh Yea, Egypt, Rome, France, Britian, Spain, Greece, Persia, the list goes on. 

Best of luck with wherever you keep getting your "information" from.


----------



## thegreypilgrim (Jan 4, 2011)

All I have to say is pwned...actually I think we might be in qwn, rwn...perhaps even zwn status?


----------



## thegreypilgrim (Jan 4, 2011)

rescue99 said:


> I did not say it was any nations' fault....I simply said, education and healthcare are both exportable and exploitable.



You said we give away too many freebies and get nothing in return (a curious mixture of FOX News mythology and some degree of truth...but whatever truth there is in this is certainly due to the US's own fault).

Healthcare certainly is exploitable, it has been exploited for decades by the wealthy and the corporate world.


----------



## Medic2409 (Jan 4, 2011)

This thread has gotten totally off topic, so sorry for adding to it.

A lot of hospitals appear to be doing quite well at making money, why can't EMS?

IMHO, one option may be to make EMS part of the County Public Health Department.

One city here local requires their PD to have BS degrees, why can't EMS?


Also, here in Texas, within the next few years, in order to teach EMS, you have to have a BS degree, and I believe that degree, is in EMS.  It's a beginning.


----------



## medicRob (Jan 5, 2011)

thegreypilgrim said:


> OK guys, I'm sure this has been done before (in fact I remember doing something similar a while ago) but put those concerns aside and indulge me.
> 
> Say you've been charged with developing a curriculum for a Bachelor of Science degree in Paramedicine in a university context. What should the prerequisites be? What are the core upper division courses? Have at thee!



I actually have been charged with this task, but for an associates level. However, I will show you what I think would be a good Bachelors program, that meets gen ed requirements of course.  


Lower Division - Paramedicine
----------------------------------------------------------

*Freshman Year *

Semester I

General Biology I (4)
English Composition I (3)
College Algebra (3)
US History I (3)
General Chemistry I (4)

Semester II

General Biology II (4)
English Composition II (3)
US History II (3)
Dosage Calculation (1)
General Chemistry II (4)



*Sophomore Year*

Semester I

Anatomy & Physiology I (4)
Fundamentals of Prof Communication (3)
Medical Terminology (3)
General principles of pathophysiology and disease (3)

Semester II

Anatomy & Physiology II (4)
Drugs & Solutions (1) 
General Microbiology (4)
American, British, or World Literature (3)
*One of the three (Required for a bachelors degree regardless of field):*

   Art Appreciation (3), Music Appreciation(3), Theatre appreciation(3) 



Upper Division - Paramedicine
---------------------------------------------------------------------
*Junior Year*

Semester I

Paramedic Theories I (4)
Pathophysiology for the paramedic (2)
Physical Assessment and Evaluation (2)
Advanced Cardiac Life Support (2)
Paramedicine Clinicals (4)


Semester II

Paramedic Theories II (4)
Pediatric / OB GYN Emergencies (2)
Gerontology, Community Health, and Home care (2)
Advanced Principles of Pharmacology (2)
Paramedicine Clinicals (4)


*Senior Year*

Semester I

Paramedic Theories III (4)
Research in Paramedicine (1)
Trauma & Critical Care (2)
Critical Care Clinicals (4)
EMS Management and grant writing

Semester II

Field Internship
Medical director's summative review


----------



## Melclin (Jan 5, 2011)

*Not reading the EMS Vs Education posts*. :deadhorse:

On the OPs topic of curriculum design...(because the topic is of particular interest to me). 

At a symposium (makes it sound a bit more fancy than it actually was) on education in EMS, one of the presenters asked the question, "Who should Ambulance (EMS) most closely align itself with in terms of education?" The answers (conveyed via electronic clicky thingies) were in order of popularity, 1) No one. Do it our own way, 2) Medicine, 3) Nursing, 4) Mainstream academia.

Responding to the atmosphere of independence and hope in the room, I answered "No one". I still agree with that to an extent, but I think we need to look to the medical model of education to do away with the methods and knowledge progressively piled on top of a frame work intended for first aiders many years ago. The nursing model, at least as it is taught in this country, is useless in ambulance and most people here seem to recognize that.

One of the education gurus at uni is trying to introduce the DENT (Define, Explore, Narrow, Test) mnemonic into the clinical decision making process. I like the attempt at moving away from the pick-a-protocol-and-transport mindset, but DENT was never for me. 

Officially speaking, our vitals/hx/physical exam is still just an expanded version of the old ambulance/advanced first aid structure. Although most paramedics superimpose more complex practice on top, I think everyone would benefit from ditching a framework that has been cobbled together over the years. Start fresh with something the reflects the education we have and the environment we now work in. How you practically achieve that, though, is beyond me. 

*@ Americans*- Whats the deal with this "college level algebra" rubbish? I did a bunch of algebra in high school and I have no particular fondness for the idea of returning to it. Why on earth would any health care professional need any understanding beyond that of highschool mathematics? EDIT: I mean before they do epi and research methods etc.


----------



## Melclin (Jan 5, 2011)

medicRob said:


> English Composition I (3) *What does this actually involve?*
> 
> Dosage Calculation (1)
> *How stupid are these people that they actually need an entire subject devoted to this? We had formulas posted online and were expected to know them come class time.*
> ...



10char


----------



## Ridryder911 (Jan 5, 2011)

First, *yes* insurance companies would love to pay us more and *yes* the average salary would double to triple for Paramedics *IF* we would actually become health professionals! 

The reason the pay sucks is simple; It's just too damn easy to become a Paramedic! Seriously, I have sat in CMS meetings and listened to EMS Administrators attempting to justify raising costs. It's laughable and embarassing. 
....Hmmm .. "So Mr. EMS Provider, your major overhead is equipment and salaries?"... For a 500 clock hour trained individual, that within six months, you will have the ability to have four times the number of applicants than positions?..... "What is so special... and unique that we should increase the payment, so that you share the offset?".... Why are the costs of EMS equipment in particular, so expensive.. Is is that they can't be responsible for upkeep and not being rough on it?....

Seriously, it does not matter the exact format for a four year?... Use the general education model that everyone else has within almost every professional health care curriculum. Yeah, that's right every other true health profession requires their programs to be credentialed and have a degree before entering the workforce! It's a wonder EMS gets paid for what it does! Pretty expensive taxi ride .... Rather EMS should be getting paid for what they know, rather than what we do. Yes, this means eliminating the old .."We're only for Emergencies"... stigma crap and truly becoming a member of the health field.

Increase the entry requirements alike every other professional program, allowing about only 1/8 of those able to enter and exit. Produce true professional applicants that have the knowledge of medical science, the exposure of clnical settings and then have a year of residency with a acredited EMS service. Those exiting will be few, the demand would be high, their ability to actually save insurance companies trillions daily would be there (yes, they would love to save money!), as well as reducing needless numbers of patients being transported to ED's that should never be there. 

We should have to be able to justify everything we do...


----------



## Melclin (Jan 5, 2011)

Ridryder911 said:


> Yeah, that's right every other true health profession requires their programs to be credentialed and have a degree before entering the workforce! It's a wonder EMS gets paid for what it does! Pretty expensive taxi ride .... Rather EMS should be getting paid for what they know, rather than what we do. Yes, this means eliminating the old .."We're only for Emergencies"... stigma crap and truly becoming a member of the health field.



+1

Community Based Emergency Health. A bachelors degree with students sharing many of the foundation classes with nurses, OTs, Physios, Midwives and health science majors. A graduate school directly involved in undergraduate education as well as its primary responsibilities too professional & clinical development and research. Paramedic schools with higher entry scores than nursing schools. Base wages fifteen thousand dollars per annum above the national _average_ wage. Increasing professional and public respect as legitimate health-care professionals with a unique body of academic knowledge to be developed. This is what we enjoy here. Its not perfect but its coming along nicely and nobody disputes the value of education.


----------



## medicRob (Jan 5, 2011)

@Melclin

In the United States, individuals pursuing a bachelors of ANY subject are required to take specific general education courses, regardless of their major. 

English composition 1 is one of those requirements,  this class focuses on essay writing and communication in written form. This course allows the medics to not look dumb on reports by using, "Your" in place of "You're" or "Their" in place of "They're" or "There", and pretty much helps you get a little more respect from your peers, even if just a little bit. English Composition II focuses on argumentative essay writing as well as research writing all the while effectively using peer-reviewed sources and having to cite them in your work. 

Of course Advanced Cardiac Life Support needs its own class because it is more than just a certification. A medic needs to understand the underlying pathophysiology associated with a patient's cardiac arrest or arrythmia instead of just playing cookbook medicine. I can think of no other topic that could use its own class. 


As for dosage calculation, I feel that it needs its own class because nursing has its own class. We learn everything from simple dose / on hand * vehicle to chemo drips, not just a dopamine clock method calculation.. If paramedics are serious about wanting to be accepted in the medical community and want to truly become ready to transition to RN, they need a FULL dosage 
calculation class, among the others I included. 


The Gerontology and Home care is to address the current issue of Community health paramedics, which emphasizes skills such as the administration of vaccinations, catheter insertion, IV Pump training, IO Sheets, care of a port, as well as drawing from a port and flushing it as well as educates them about skin tears in the elderly and focuses on things such as the nutritional needs of these individuals. 

The curriculum I posted above is based on the associate curriculum I am helping design currently for a local college who wishes to move from a certificate to a degree program in Paramedicine, choosing not to go the general technology route.


----------



## Veneficus (Jan 5, 2011)

Ridryder911 said:


> First, *yes* insurance companies would love to pay us more and *yes* the average salary would double to triple for Paramedics *IF* we would actually become health professionals!
> 
> The reason the pay sucks is simple; It's just too damn easy to become a Paramedic! Seriously, I have sat in CMS meetings and listened to EMS Administrators attempting to justify raising costs. It's laughable and embarassing.
> ....Hmmm .. "So Mr. EMS Provider, your major overhead is equipment and salaries?"... For a 500 clock hour trained individual, that within six months, you will have the ability to have four times the number of applicants than positions?..... "What is so special... and unique that we should increase the payment, so that you share the offset?".... Why are the costs of EMS equipment in particular, so expensive.. Is is that they can't be responsible for upkeep and not being rough on it?....
> ...



Good to see you still hanging around here.

As a point of discussion, we have both taken up this banner for a long time. I have seen no real progress in my career. 

Could it be we have to let EMS providers fail on their own before they finally get the message?


----------



## Ridryder911 (Jan 5, 2011)

Veneficus said:


> Good to see you still hanging around here.
> 
> As a point of discussion, we have both taken up this banner for a long time. I have seen no real progress in my career.
> 
> Could it be we have to let *EMS providers fail on their own *before they finally get the message?



I believe you will see that occur. There has been over nearly 25 providers fail within my state the last couple years.. the shame is there is a law that requires the nearest community (EMS) to respond.. no matter what. The good thing there will be an EMS respond (maybe 50-60 miles away) but the bad thing is; communities are thinking.. why should we have an EMS when another community will have to furnish one?....

Maybe someday we see third party EMS develop?... Then again....

R/r 911


----------



## Melclin (Jan 6, 2011)

medicRob said:


> @Melclin
> 
> In the United States, individuals pursuing a bachelors of ANY subject are required to take specific general education courses, regardless of their major.
> 
> ...



Yeah I understand that you have gen ed requirements and I like that to an extent. Hence my not questioning the genuine subjects like American history, English lit and so forth.

Seriously? They're/There/Their? They don't cover that one in highschool a dozen times? If you have to teach your students that sort of thing, perhaps you should look at your entry requirements. Citing and source quality is something all university students are expected to figure out by themselves or attend a extracurricular workshop. Are we actually talking about university? I get confused by the "community college" thing sometimes (we don't really have a common equivalent)...are we talking more of a technical college, class room based thing? Or actual university with academics, research, grad schools, streams of publications etc?

Nurses have their own class? Okay I think there must be a difference in what we mean when we say classes, because I wasn't talking about the dopamine clock method either. Its still just year 7 algebra/basic operations/common sense. What does 'a class' actually constitute? I'm talking about 2-4hours of lectures, 2-3 hours tute/lab/prac + an expected ~6 hours of study a week, at least, several thousand words of research essays, for thirteen weeks. If a student requires that to conquer drug calcs then I don't want them looking after me. Here it is an important component to many classes, but I'm fairly certain nobody has a class on drug calcs alone.

I wish we emphasized gerontological issues more. I don't feel like I know enough about that sort of thing. Its great that you're covering that specifically. I wasn't being sarcastic with the PhD in oldness thing. I was making the point that I agree its really important.


----------



## jrm818 (Jan 6, 2011)

Melclin said:


> Yeah I understand that you have gen ed requirements and I like that to an extent. Hence my not questioning the genuine subjects like American history, English lit and so forth.
> 
> Seriously? They're/There/Their? They don't cover that one in highschool a dozen times? If you have to teach your students that sort of thing, perhaps you should look at your entry requirements. Citing and source quality is something all university students are expected to figure out by themselves or attend a extracurricular workshop. Are we actually talking about university? I get confused by the "community college" thing sometimes (we don't really have a common equivalent)...are we talking more of a technical college, class room based thing? Or actual university with academics, research, grad schools, streams of publications etc?
> [...]



That sort of requirement will exist for nearly any 2 year (AS/AA) or 4 year (BS/BA) university over here: Cold creek community college to Harvard.  Many students aren't actually going to take the basic classes because they either test out before they begin college or because they took college level English classes in high school and passed a test("advanced placement" classes).  The same is true for many other general requirements.  Rules differ between universities, but in general, even if you test out of "English comp I" you still have to take a replacement English/Lit class, just at a higher level.

In theory the basics of English Language usage are covered in high school, but unfortunately the quality of our high schools is extremely variable, and many do not do a good job of preparing their students for college-level academics.

Community colleges offer English classes even more basic than Eng. Comp. I, which serve as remedial classes for students who are extremely unprepared after high school (students have to take placement tests before enrolling in classes, and if they do poorly, remedial classes may be a requirement before taking higher level classes).  I believe that in most cases those sorts of remedial classes do not count as college credit and will not transfer to 4 year universities.

Just as explanation, since _there _seems to be some confusion: our community college system is intended to provide access to college/degrees (most often 2 year associate degrees) to students who are either unprepared or unable to afford to attend 4 year universities.  Tuition at community colleges may be somewhere around $150/credit.  By contrast tuition, board, and fees at a US university can range from $30k-$50k a year (2 semesters).  In theory community colleges offer classes of comparable content and difficulty to the same classes offered at a university, although in practice I have my doubts. Credits earned at a CC will be mostly transferable to a university, functionally allowing a student to do the first year or two (mostly gen-ed classes) of university at a community college for much less money.


----------



## MrBrown (Jan 6, 2011)

In our model of education sub-Bachelors programs (called TAFE in AU and the NZQA here) are the realm of para-professional more technical type  occupations that lean more towards the realm of behaviourist education rather than the application of high level cognitive knowledge which will be further specalised at the graduate level.

For example we offer one year certificates and two year diplomas in all sorts of things like automotive technology, hairdressing, interior design, welding etc etc.  

All health disclipines require a bachelors degree for entry including Paramedic.  More specalised roles like NP or Intensive Care Paramedic (ALS) require Graudate qualifications.

Our degrees are only three years since we do 5 years of secondary education and we specalise early with no general ed requirements.  First year exchange students Brown knows who went to the US had to take second and third year subjects to equate to the same level of acaedmic knowledge.  We are expected to be independant very early in our university education and critically reflect; as such a large amount of work is spent on several thousand word essays, case studies, research presentations etc etc

At this stage Brown does not think the US is ready to move to a four year degree for Paramedics (ALS) however a two year EMS degree without half of it being filled up with general education 101 is required.


----------



## medicRob (Jan 6, 2011)

Melclin said:


> Yeah I understand that you have gen ed requirements and I like that to an extent. Hence my not questioning the genuine subjects like American history, English lit and so forth.
> 
> Seriously? They're/There/Their? They don't cover that one in highschool a dozen times? If you have to teach your students that sort of thing, perhaps you should look at your entry requirements. Citing and source quality is something all university students are expected to figure out by themselves or attend a extracurricular workshop. Are we actually talking about university? I get confused by the "community college" thing sometimes (we don't really have a common equivalent)...are we talking more of a technical college, class room based thing? Or actual university with academics, research, grad schools, streams of publications etc?




Did you know that most paramedic textbooks are only written at a 10th grade reading level? Look at some of the patient narratives, and you will see that the majority of EMS Providers (Not all of them) have horrible grammar skills and suck at effective written communication.


----------



## Veneficus (Jan 6, 2011)

jrm818 said:


> In theory community colleges offer classes of comparable content and difficulty to the same classes offered at a university, although in practice I have my doubts. Credits earned at a CC will be mostly transferable to a university, functionally allowing a student to do the first year or two (mostly gen-ed classes) of university at a community college for much less money.



They are absolutely not equal even when taught by the exact same professor usually.

This may come as a bit of a surprise to some, but professors actually take into account how the class and information gained from it might be used at the end of the class.

At a community college, the primary goal is usually to enter the workforce. Students need to know the basic theorhetical concepts and how to apply them to various job markets. The classes and curriculums are usually based around industry (especially local industry) needs.

I try to explain it this way:

An associates is the minimum amount of education required to operate in a technical capacity in an industry that requires specialized education. If you notice, many Associate level degrees are topic intensive with just a minimum amount of general education.

A bachelor's, which doesn't automatically exclude you from an entry level or tech position, requires more general education in order to allow for more big picture thinking. In some industries this is enough to rise to the very top. In others areas which have a vast amount of specific knowledge, this is often the starting point.

The Master's assumes the bachelor's has given you enough insight to the big picture and while often requiring a bit more, becomes refocused on topic specifics in order to further condition your thought process and make second nature to the student the information learned prior.

The doctorate level (which does not always require a master's prior) serves the purpose of giving advanced, specialized knowledge in a particular topic which is very vast or extending the level of knowledge on a topic to the very reaches of what is known in order to prepare graduates to make decisions on topics that are not absolute.

The post Doc prepares students with the practical applications of being a decision maker and/or continues the exploration of unproven theorhetical concepts. (or both depending on the field)

These levels are presented here as a stepwise progression, but the curriculums are not always designed to be. So while a 4 year institution may give a student credit for previosly completed work, the more upper level coursework is still designed and assumes familiarity of the material that would be considered lower level for that degree, not lower level in terms of prior participation in the field.

Considering this perspective, arguing for a 2 year degree, as what is needed to provide a specific technical participant in a field is just as limiting to the EMS provider as demanding vocational clock hours.

By contrast, demanding a 4 year degree assumes that the ability to see big picture and demands considerable topic specific knowledge, sets the EMS provider and "profession" for further advancement with knowledge mastery, and making decisions based on unproven theory. 

Please do not fall into the trap of thinking that a 2 year degree is 1/2 of a 4 year degree. As I pointed out, the designed curriculums do not and were not meant to function that way.


----------



## usafmedic45 (Jan 6, 2011)

> Did you know that most paramedic textbooks are only written at a 10th grade reading level? Look at some of the patient narratives, and you will see that the majority of EMS Providers (Not all of them) have horrible grammar skills and suck at effective written communication.



Actually most of the books are written at a sixth or an eighth grade reading level.


----------



## jrm818 (Jan 7, 2011)

Veneficus said:


> They are absolutely not equal even when taught by the exact same professor usually.
> 
> I've become very aware of that, but I admit that I was surprised.  When I was in high school, community college was presented to us as a equivalent education for less money, and even while in school (university) I heard from the occasional transfer student who suggested the same thing.  Now, having the opportunity to experience both university and community college, I have to say there is quite a difference...much as you describe.
> 
> ...



10 characters.


----------



## Seaglass (Jan 7, 2011)

I'm not sure that letting providers fail would change anything. In fact, I suspect it would backfire and lead to lower standards. My area operates under the principle that it's better to have all kinds of intermediate providers running around than nobody at all, and that nobody would be willing to drive to college and get an associate's. I'm not sure what could change things.



Veneficus said:


> They are absolutely not equal even when taught by the exact same professor usually.



I really wish they wouldn't be billed as such. It leaves community college students unprepared for more advanced work, and they don't even know it. I tutored students at a 4-year university who had taken supposedly equivalent prep classes at a local junior college, with the same professors. Even the ones who had retained most of what they were taught usually required a lot of remediation, particularly in theoretical aspects of a subject. They were often pretty bitter about it. Given the advertising material that goes around, I can see why.


----------



## Veneficus (Jan 7, 2011)

*common sense is an uncommon virtue*

It always surprises me why people fall for the community college pitch. It is not that coommunity college is bad, they have a valuable purpose. But they are also a business which means they need to make money. In order to do that they need students. But few are ever aware that like any other major purchase in life, you need to do you own homework on what you are paying for before you sign on the line.

Truths I have discovered: 

A person usually gets what they pay for. 

If salesman A offers you an "equal" product at less than 1/2 as salesman B, somebody is not telling the truth. 

If something seems too good to true, then it is not true.


----------



## MrBrown (Jan 8, 2011)

Brown thinks Oz will agree that the Degree equips a graduate with a great deal of knowledge that can be dexteriously applied in a range of settings rather than just "which protocol does this patient fit" and "lets ring up medical control".

Brown learnt on Friday that some whom Brown works with thinks Brown has "a dangerous amount of knowledge" .... Brown is unsure how to take that 

The old vocational style Ambulance Aid courses and Diploma which was used to teach Ambulance Officers in this part of the world up until a decade ago (more recently here) focused a great deal on practical ability and was less intensive on the theory in much the same way that the American courses seem to be, and unfortunately, show no signs of giving up.  That 5,000 word third year essay we all had to write on Paramedic research or alternate pathways or community health intergration or whatever it was may not come in handy right now but its a bloody useful bit of knowledge to have floating up around in the ole brainbox.

There has been a strong shift away from "emergency" to "health care" in Australian Paramedic education with the introduction and making mandatory (in several states) of the Bachelors Degree and Graduate Program for Paramedic and Intensive Care Paramedic.  New Zealand is fast following suit and over the next few years will follow with a shift towards treatment and nontransport where ever possible or transport or disposition other than to the emergency department.  Such modalities require a strong knowledge base and "big picture" thinking beyond what has typically been the realm of the Ambulance Officer.  However such levels of cognitive knowledge are necessary even if you are transporting everybody.

No longer is it acceptable for people to go out onto the street and apply procedures they do not fully understand.  

Brown recalls from 1993 it was said that (at that time, the Australians) Mobile Intensive Care Officer training  would "leave the Yanks for dead" and nearly 20 years later it still seems to be the case.


----------

