# Proposed EMS Scope of Practice Model



## disassociative (Dec 22, 2007)

Some of you may be familiar with "Dr. Brian Bledsoe's Scope of Practice Model for EMS", others may not. However, I encourage you to review this article from the <i>Journal of EMS</i> by clicking the following link:

http://www.jems.com/news_and_articles/columns/Bledsoe/Bledsoes_EMS_Scope_of_Practice_Model.html

What do you think about this scope of practice model? Why?


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## Flight-LP (Dec 22, 2007)

It has already occured in some areas, but until we make some radical, unpopular changes such as eliminating volunteers and stop allowing BLS units to operate as primary 911, it will never materialize. Until we can COMPLETELY regulate and eliminate the backwoods good 'ol boy persona that plagues many agencies, we will be stagnant in our efforts. Until we realize that a 120 hour first aid course does not properly prepare an 18 year old kid to operate on an ambulance, EMS will be just as it is today............A vocational trade.


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## Ridryder911 (Dec 22, 2007)

Although, it would be nice to have a somewhat formal scope of practice, I do not like Bledsoe's "dream. Again, too many levels. Why is we think we have to have so many 8%##! levels? 

Why not, educate Paramedics properly, then they can specialize into an area, like physicians, nurse, and the rest of the medical community. 

The problem is again the old adage of volunteers and lower levels, as well getting Medicare and other insurance payors to properly reimburse EMS. 

R/r 911


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## seanm028 (Dec 22, 2007)

Flight-LP said:


> Until we realize that a 120 hour first aid course does not properly prepare an *18 year old kid* to operate on an ambulance, EMS will be just as it is today............A vocational trade.



Are you suggesting that the minimum age needs to be raised?


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## Flight-LP (Dec 22, 2007)

Indirectly, I suppose yes. Since Paramedic education should be at a minimum an associate level degree, it would be difficult to obtain at the age of 18. Age isn't so much of a factor, but an 18 year old with only an EMT-B course is substantially less prepared to actually intervene for a patient than a 20 year old with 2 solid years of true education including specific knowledge in pharmacology, anatomy, and pathophysiology of disease. I also would like to see more focus on teaching student on how to correlate knowledge in addition to application of knowledge. The EMT-B level offers only rote memorization with an emphasis on simplistic skills. There is a huge difference between the two.

But as usual, Rid has a very valid point. Even Dr. B himself proposes too many levels. But at least his levels focus on a Paramedic education as the core instead of 30 million different lower level titles. Yeah, in a perfect world there would be a Paramedic and an advanced Paramedic running primary 911 EMS. Nothing less. But we all know how perfect our world truly is. Maybe in my lifetime we'll see it, who knows......................................


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## seanm028 (Dec 23, 2007)

Well, I can see what you're saying.  I'm 18 and I just obtained my EMT-B four months ago, but on the other hand, I guess I'm going at my EMS career a little differently than most.

A lot of my family has been in medicine, so I've had exposure to it all my life.  I also have no intention of stopping at the basic level; it's sort of a stepping stone.  My university doesn't have any EMS classes, but I am taking some nursing courses (human development, A&P, microbiology, healthcare organizations and ethics, etc).  Unfortunately, the community college where I got my EMT-B education only accepts students into their paramedic program if the student it currently employed by a private ambulance service or fire department.  I'm trying to get hired with an ambulance service, but there's a lot of competition.

Basically, I think the difference for me is that I intend to continue educating myself in EMS and I'm consistently supplementing my training with whatever material I can get my hands on (a friend just loaned me his EMT-P textbook and some material on arrhythmias... not quite within my scope of practice, but I think good general knowledge and hopefully it will help when I eventually find my way into a paramedicine program).


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## daedalus (Dec 23, 2007)

I, too, am 18 years old. Finished EMT not to long ago. And I have been exposed to medicine my entire life as well. I grew up in my grandfathers practice. He is a (recently retired) family doc, my mother, grandmother, and great grandmother are/were RNs. I have volunteered for three years at a local free medical clinic and shadowed many doctors there. I have taken advanced Biology and Honors A and P. What sets me apart from some 18 year old with a cert, is that, i can approach a patient. I have done it for three years. The doc and me would go in, i would assist with his history and while he assesed the pt, i was right there listening to lung/heart sounds, looking in ears... After that when we left he would discuss the disease process or injury with me. I realise not every person my age has done these things, however, age should not be used to judge an EMT or paramedic. Their knowledge and ability is far more importance.

Cheers


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## disassociative (Dec 23, 2007)

I would like to see the various non-paramedic level EMT designations be consolidated into: EMT and EMT Advanced, instead of one state having EMT-IV, while another has EMT-Shock Trauma's, etc. I think that the outlined scope of practice for these provider levels is more than suitable; given that the education time reflects that of the skills being taught. We have had EMT-IV's here for as long as I can remember; NREMT-B with extra training in a TN approved EMT-IV program lasting 1 yr. These providers cannot drop ET's however they can use combitubes, PtL, LMA, start IV's, run d50w/d25w, and administer the standard EMT-B line of meds(SL Ntg, Activated Charcoal, Epi 1:1000 SubQ and Epi-Pen). I like Rid's idea with regard to Paramedic specialties such as in nursing in which an RN can pursue further specialization in a specific area: Ob/Gyn, Critical Care, Med/Surg, Geriatrics, etc. I see nothing wrong with consolidating the various entry-level EMT-B rankings into one system allowing for this larger scope of practice; however, if we are going to give these EMT-B's these skills; we must give them the appropriate training; no more of this 120 hr $#%#. As for Paramedics; formal education & licensure(A.A.S., B.S., M.S.).

I encourage you to research: Paramedic Intensivists; and Paramedic Practitioners.


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## medicdan (Dec 23, 2007)

I am 18 years old and have been certified for six months.  From my perspective, the issue is not one’s age, but the nature of EMT-B training.  I had a very good University-based course, but I agree with those who have noted that 120 hours (my course was actually 150 hours) is not sufficient to allow one to understand the range of problems and treatment protocols one needed in the field.  I’m doing a “gap year” before going to college and have been volunteering ever since I was certified.  I’ve had experience now with almost 150 patients.  I’ve learned more in the field than I did in my course (partly because I have worked with great paramedics and (because 3 months of my experience was in Israel) with MDs.  

At this point, I have no problem acting as a second pair of hands stabilizing and transporting patients with a more expierence partner.  I feel competent supervising (monitoring) and stabilizing patients while rapidly transporting (evacuating) to the hospital. I feel comfortable doing the equivalent of non-emergency transports. I also feel very comfortable calling for ALS backup if help is needed.  The reason I now feel comfortable is that I have had good clinical experience.  If anything is changed, it should be to require internships and more clinical experience.  There is a big gap between classroom discussions/simulations and actual practice.  

Although I don’t think age should be a barrier to practice, clearly maturity is needed.  Perhaps many 18 year olds are not ready for the responsibility of being in the field.  But I suspect there are more than a few 21+ year olds who are not ready (judging from some of the stupid things I have seen patients and even EMTs do).  More stringent clinical requirements would level the field and ensure that only qualified people are allowed to provide unsupervised patient care.


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## Flight-LP (Dec 23, 2007)

daedalus said:


> I, too, am 18 years old. Finished EMT not to long ago. And I have been exposed to medicine my entire life as well. I grew up in my grandfathers practice. He is a (recently retired) family doc, my mother, grandmother, and great grandmother are/were RNs. I have volunteered for three years at a local free medical clinic and shadowed many doctors there. I have taken advanced Biology and Honors A and P. What sets me apart from some 18 year old with a cert, is that, i can approach a patient. I have done it for three years. The doc and me would go in, i would assist with his history and while he assesed the pt, i was right there listening to lung/heart sounds, looking in ears... After that when we left he would discuss the disease process or injury with me. I realise not every person my age has done these things, however, age should not be used to judge an EMT or paramedic. Their knowledge and ability is far more importance.
> 
> Cheers



This is true to a certain level, however you have to realize that EMT's are also exposed to at least 10 year of education, yet most do not take an ounce of it with them into a career in EMS. Your "applicable" experience is indirect and while helpful in getting you acclimated with an introduction into healthcare, it does not greatly assist you in becoming an EMT.

Too much emphasis on the age statement I made. That was not my point. The point was that education standards are currently sub par for lower level providers, hence the fact that they should not be responsible for primary 911 response. Sorry for the perceived confusion.................................


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## Ridryder911 (Dec 23, 2007)

Heck.. I will jump with both feet first into the matter..! (as I always do) Yes, there should be age restrictions. Simply put, most of those under the age of 21 (in which we have to use) are not able to make critical decision making  problems. This has been proven scientifically per research and even per thermal image CT scans. The brain does not mature until about the age of 21, in the reasoning and logistics area. This is nothing new. Insurance corporations, even the military has known this for years. The same reason most Law Enforcement agencies do not allow anyone < 21 years of age. 

As well, medicine is an art as much as it is science. Sure, anyone can spit out treatment protocols, facts and figures, if they are intelligent. The difference is to understand the appropriate time and the human aspect. Having life experience is a critical point of making rational non rash decisions. Exposure to traumatic events such as what the EMT sees everyday can be detrimental to those that are still developing mentally. It is even dangerous to those that already have, why cause more problems. 

Personally, I do not worry about the age problem. Insurance corporations are already dealing with that. Denying coverage for drivers <21 to 23 and now some are denying malpractice coverage for those < 21. 

Yes, there are exceptions. I am quite aware of them, and have seen many prime examples of immature 40 year olds, and mature 17 year olds. I even received my Paramedic when I was 17, so yes I can understand. It is that in the general population, we have to categorize them. 

R/r 911


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## disassociative (Dec 23, 2007)

Ever wondered why the legal drinking age was 21?

I think Rid just answered that one.


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## skyemt (Dec 23, 2007)

Flight-LP said:


> It has already occured in some areas, but until we make some radical, unpopular changes such as eliminating volunteers and stop allowing BLS units to operate as primary 911, it will never materialize...



Flight-LP, I work for a volly agency, where BLS operates as primary 911.  We have ALS, paramedics when needed... it works very, very well.  i would like to know why it didn't work for you when you worked volly 911...  would like to compare notes.

of course, if you haven't worked in such a system....


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## Flight-LP (Dec 23, 2007)

Its really quite simple, every patient deserves a thorough assessment and intervention from the highest available level of care possible. That is NOT an EMT-B. It is currently accepted to be a Paramedic. I have heard almost every excuse as to why this "is not possible". The bottom line is that communities that do not provide this service do so due to fiscal reasons. If it is acceptable in your community, then great. But my community demands a high quality Paramedic level service and they gladly pay for it. We are successful in what we do and it maintains a level of pride and professionalism. 

When you look nationwide at volunteer systems, you will notice two things. 1) the numbers are on the decline, and 2) they are mostly BLS services. Why is that? Because not too many people who advance to a career level Paramedic training are willing to do the job for free. I know I certainly won't. I will not devalue myself to do a job that others are getting compensated for, just for the sole "opportunity" to do it. On the flip side, everytime a Paramedic volunteers, it gives an employer one more reason to not pay ME or pay me less. That is just purely unacceptable.

Communities will have to realize that you do not get quality for free. You get what you pay for. Want a high quality service, well guess what, you're going to get taxed for it. Don't want to pay for it, well enjoy your BLS service and hope that they do not financially go under. Then you have NO EMS.............

Don't believe me or agree?????????  Tell me when you last saw a trash man that volunteered to do his job or a community that didn't pay for his service.


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## skyemt (Dec 23, 2007)

Flight-LP,

as i stated before, we are volly, but not limited to emt-b... we have quite enough paramedic ALS for those that need it.  a twisted ankle does not require a medic. a laceration to the arm does not require a medic... stable "sick" pt's do not require medics.  when a pt does need one, ALS is provided. Does this not meet your criteria?  Our ALS is volly, and they care solely about the pt, and don't really care about your job security.  It is purely about pt care.  in some ways, preferable to the system you work in, from the sounds of it.

Also, since you have not worked in a system such as ours, you are entitled to your opinion, but you really have no idea what you are talking about.

the issue here isn't emt-b vs paramedic, as you keep wanting it to be.

the issue is that in different parts of the country, different types of systems DO work.  Perhaps you could think about considering what works in different situations, instead of blindly disparaging those that are different.


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## bstone (Dec 23, 2007)

disassociative said:


> Ever wondered why the legal drinking age was 21?
> 
> I think Rid just answered that one.



Only in this country. Everywhere else it's 18. I once worked at a cafe in Israel and we didn't even card. Alcohol there is just totally different. The only people falling over drunk were the American tourists.


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## Jolt (Dec 23, 2007)

Flight-LP said:


> Its really quite simple, every patient deserves a thorough assessment and intervention from the highest available level of care possible.



Then why don't MDs respond to every call?  Rid has said a few times that he assisted in a field amputation which must have been performed by a physician.  The physician wasn't immediately dispatched to the call, he/she was called once the next lower qualification (in this case a paramedic) decided that he/she was needed.

It's a moot point, but maybe one to think about.  Why can't EMTs go on calls and bring in paramedics when they realize that the higher level of care is needed?  It works for many systems.  At the very least, BLS crews can do CPR until an EMT-P arrives to take over.  That way, the paramedic is freed up to do only the important calls and not the frivolous twisted ankles and stubbed toes.

With that said, I would be more than happy to do at least another 200 hours of training if it made everyone happy.  It's pretty discouraging to me as a rookie to hear that no one wants me within 100 feet of their patients.


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## Flight-LP (Dec 23, 2007)

skyemt said:


> Flight-LP,
> 
> as i stated before, we are volly, but not limited to emt-b... we have quite enough paramedic ALS for those that need it.  a twisted ankle does not require a medic. a laceration to the arm does not require a medic... stable "sick" pt's do not require medics.  when a pt does need one, ALS is provided. Does this not meet your criteria?  Our ALS is volly, and they care solely about the pt, and don't really care about your job security.  It is purely about pt care.  in some ways, preferable to the system you work in, from the sounds of it.
> 
> ...



Simmer down and read it again......................

If it works for your community and they accept it then great, but not all do...

What defines stability in the sick person?

Does the twisted ankle not deserve pain control?

What about IV access for the pt. with the contaminated laceration to his arm. Will he/she not be needing IV antibiotics?

Its not about just getting them to an ER, it is about being a part of the collaborative health care team. Personally, that is what I provide for my patients, therefore your personal belief concerning my level is care is irrelevant.

I am not "blindly disparaging" anyone. I have a fair amount of insight into this industry and many geographic and demographic specific systems. My belief is based on collection of information from all of these systems I have dealt with, whether it be as an employee, a contractor, or a consultant. These are my beliefs and those shared by many others. It is not designed to be taken as gospel, so don't over analyze it.............................


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## Flight-LP (Dec 23, 2007)

Jolt said:


> Then why don't MDs respond to every call?  Rid has said a few times that he assisted in a field amputation which must have been performed by a physician.  The physician wasn't immediately dispatched to the call, he/she was called once the next lower qualification (in this case a paramedic) decided that he/she was needed.
> 
> It's a moot point, but maybe one to think about.  Why can't EMTs go on calls and bring in paramedics when they realize that the higher level of care is needed?  It works for many systems.  At the very least, BLS crews can do CPR until an EMT-P arrives to take over.  That way, the paramedic is freed up to do only the important calls and not the frivolous twisted ankles and stubbed toes.
> 
> With that said, I would be more than happy to do at least another 200 hours of training if it made everyone happy.  It's pretty discouraging to me as a rookie to hear that no one wants me within 100 feet of their patients.



Key word is available. Here in the US as we do not value our EMS systems enough, we do not provide sufficient compensation to staff a physician run ambulance. Even if we did, it still wouldn't work until this country stops allowing frivilous ambulance chasing lawsuits. Very few MD's would want the liability of being directly involved in pre-hospital care.................

As stated in my last post, I still see that each of these pts. deserve a medic from the initial contact. Especially the CPR patient. How will you as an EMT-B provide access for anti-dysrhythmic medications? What about securing an airway? What about post resuscitative care should you immediately convert the patient?

The thought of keeping a Paramedic available is a nice one, I will admit. But when it comes down to dollars and cents, if the money is there to provide for a medic and obtain reimbursement for a medic, then how could you not think about providing one? If the money isn't there, and that is the reason, then you should be asking yourself why? Are you not billing? Do you not tax? These are strong forms of revenue and, again, since this country does not provide adequate healthcare subsidies, then that money needs to be generated somewhere. It still falls down to "you get what you pay for".......

I'd pay for quality any day of the week and twice on Sunday!


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## Jolt (Dec 23, 2007)

Flight-LP said:


> How will you as an EMT-B provide access for anti-dysrhythmic medications? What about securing an airway?



These two problems were actually addressed in the proposed scope of practice (allowing EMTs to place IVs and combitubes).  I think another 40-50 hours would be sufficient to teach those skills without increasing class times too much.


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## Flight-LP (Dec 24, 2007)

Jolt said:


> These two problems were actually addressed in the proposed scope of practice (allowing EMTs to place IVs and combitubes).  I think another 40-50 hours would be sufficient to teach those skills without increasing class times too much.



And this is precisely why it will not pass nationwide. I can teach these skills in about 2 hours, but one cannot truly apply or correlate the didactic knowledge behind WHY these interventions are performed without substantial additional education. If we just allow basics to perform these skills without providing adequate education to support these interventions, we are then being counterproductive. It is difficult to carry yourself as a healthcare professional when you are performing in a counterproductive environment.

Take a moment to search the forum, there are many threads covering this very topic..............Here a recent one for reference.................

http://www.emtlife.com/showthread.php?t=5674


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## daedalus (Dec 24, 2007)

aye!
Most patients who dial 911 do in fact deserve paramedic response. 

In my area, we have paramedic/EMT ambulances, our EMTs are trained to assist paramedics in ALS procedures (place the leads in 12L EKG, set up for intubation, spike IV bags, ect). Additionally, our EMTs are trained to monitor simple ECG and provide manuel defib, but only while with a paramedic or RN. This isnt bragging about the extra "skills" we can preform but it effectivley makes us better team players and being a shorter training program, there are EMTs available for the increased patient load in the coming years.

This system, and call me out here if you disagree, seems to work wonderfully. AMR runs these units in my county.

As for age, Rid, you are exactly right. Brain devolopment, especially in the frontal lobe, takes until at least 20 years to fully mature. This wont stop me from being an EMT however, because if I pass the class final, skills final, and the national registry, I have demonstrated that I can effectivley preform my required duties. If the National registry isnt good enough to prove critical thinking ability as it applies to EMS, maybe we should make the National Registry more difficult, theres a thought.

I strongly advocate more difficult and longer EMT programs. Mine was at least 170 hours. I think it should be pushed to 200 and encompass more of the science of medicine. I wouldnt change the scope of practice execpt to add starting IV lines and simple fluids// this includes learning fluids, elctrolytes, and Acid-base balance. There would be more than enough time in an extra 80 hours, which divided by 4 (4 hour classes) is 20 extra classes.


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## medicdan (Dec 24, 2007)

daedalus said:


> I strongly advocate more difficult and longer EMT programs. Mine was at least 170 hours. I think it should be pushed to 200 and encompass more of the science of medicine. I wouldnt change the scope of practice execpt to add starting IV lines and simple fluids// this includes learning fluids, elctrolytes, and Acid-base balance. There would be more than enough time in an extra 80 hours, which divided by 4 (4 hour classes) is 20 extra classes.



I agree, and one more time defer to the Israeli system. The Hovesh (Medic/EMT) course (200 hours + driving) covers exactly what you mentioned-- starting IVs (only NS), and learning fluids, electrolytes, and Acid/Base Balance but no meds (including no glucogel, albuterol, nitroglycerin or aspirin)  Again, the idea being (supported by research), specifically in serious trauma (terrorist attack), the best treatment, (sorry Rid) patient outcome comes with IV fluids and transportation to a trauma center. The reality is, on the scene of a serious attack, you are not going to have a paramedic treat every patient. I will note, a Hovesh cannot initiate an IV without the permission of a paramedic, although often at large attacks, there are blanket orders given for all patients of a certain condition.  
Glucometer/Glucogel/Asprin use is limited to Hovesh Bachir (the closest equivalent to EMT-I).  
In the additional time in the 200 hour course, students learn in-depth the kinematics of trauma, how to improvise when supplies are low, how to help paramedics (because often at a MCI, you jump in wherever nessecary, and uniquely-Israeli EVOC. 
I am all for extended education-- I think 200 hours is the proper amount of time for a Basic course-- but emphasis should be put on further education at some point.


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## Jolt (Dec 24, 2007)

Now I feel like I have to take an EMT-I class just to start at the basic level.


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## Ridryder911 (Dec 24, 2007)

Jolt said:


> These two problems were actually addressed in the proposed scope of practice (allowing EMTs to place IVs and combitubes).  I think another 40-50 hours would be sufficient to teach those skills without increasing class times too much.



Hence part of the problem. Those without proper education and training attempt to decide what is needed. Sorry, the problem is simple. Basic EMT (no matter how many hours) is not qualified to assess and determine the extent of ALS versus BLS. Even for the scenarios you described for the ankle injury does not require analgesics? Even in all ER's a patient has to be triage by an RN and MSE performed by a physician or there representative (PA/NP). So yes, higher level then if needed or cleared, may then be treated by lower level of license, not reversed. The Basic curriculum is not developed and in-depth to clear and does not teach detail involved assessments to adequately make clear clinical impressions. 

Now, remember when one add hours and advanced procedures... guess what? They are no longer basics, rather they are advanced. 

Many services have utilized the "band-aid" system, where all calls are evaluated by a Paramedic, then if determined not warranted is transported by a BLS unit, thus keeping the Paramedic available. 

Financially there is very little difference in end budgets of operation between operating ALS with Paramedics and those with BLS and no ALS. Payment differential will make up the difference. Thus, if ALS is needed there is not a delay it is present, if it is not, so be it. 

Unless a town or region is very remote or *very* remote, there is no reason not to have professional EMS or at least utilize such. 

R/r 911


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## ffemt8978 (Dec 24, 2007)

Ridryder911 said:


> Unless a town or region is very remote or *very* remote, there is no reason not to have professional EMS or at least utilize such.
> 
> R/r 911



Sure there is...money.  Somebody has to pay for it, and not a lot of people will do this for free.

Yes, the public can be educated to know that professional/ALS would be better for them in an emergency, but they tend to vote their pocket books when it comes time to increase their taxes.  This is a process that takes years, and there is no guarantee that the public will continue to support such services in the future (especially with the rising costs of health care).

Given our local residents, and our local economy, there is no way the public would foot the bill for the 300-400 thousand dollars it would take to staff our ambulances with full time ALS (this includes the initial equipment purchases), and then continue to fund their salaries for any length of time.


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## Flight-LP (Dec 24, 2007)

kinda reminds me of that Cinderella song "Don't know what you got until its gone"..................................

It is unfortunate that people do not realize the true benefit of professional Paramedic level EMS. Too damn cheap to pay for it, but when its one of their loved ones that die because two EMT Basics couldn't provide the appropriate interventions, they will be the first one's to sue. Sad, truly sad. One lawsuit payout would fund a year's worth of an EMS budget.........................


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## ffemt8978 (Dec 24, 2007)

Flight-LP said:


> kinda reminds me of that Cinderella song "Don't know what you got until its gone"..................................
> 
> It is unfortunate that people do not realize the true benefit of professional Paramedic level EMS. Too damn cheap to pay for it, but when its one of their loved ones that die because two EMT Basics couldn't provide the appropriate interventions, they will be the first one's to sue. Sad, truly sad. One lawsuit payout would fund a year's worth of an EMS budget.........................



I agree with your thought but disagree with you about the lawsuit.  There would be no basis for it, provided the local providers followed the appropriate protocols and called for an ALS assist at the appropriate time.  Just because you don't have a paramedic in the back of the ambulance is not a valid basis for a lawsuit.


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## triemal04 (Dec 27, 2007)

ffemt8978 said:


> Sure there is...money.  Somebody has to pay for it, and not a lot of people will do this for free.
> 
> Yes, the public can be educated to know that professional/ALS would be better for them in an emergency, but they tend to vote their pocket books when it comes time to increase their taxes.  This is a process that takes years, and there is no guarantee that the public will continue to support such services in the future (especially with the rising costs of health care).
> 
> Given our local residents, and our local economy, there is no way the public would foot the bill for the 300-400 thousand dollars it would take to staff our ambulances with full time ALS (this includes the initial equipment purchases), and then continue to fund their salaries for any length of time.


(looking at the original topic)  This is where Bledsoe's scope could potentially help things quite a bit.  Take the Independant Practice Paramedic; in a rural area where there may only be 200 ambulance calls a year, sure, it's not going to make a lot of fiscal sense to have a fulltime ALS service, and most people probably won't want one anyway.  But, put several IPP's there to staff a medic unit AND a local clinic, and that might change things.  That way the community really does get the most for what it pays; a fulltime ambulance, and a local clinic for generic problems that don't need transport.  Kind of like what's happening in some Canadian provinces.

What Bledsoe has propsed is nice, definetly needs some tweaking, but still head and shoulders above what we've got today.  And unfortunately, it'll probably never happen, and would take 20+ years to implement even if it did.

Damnit.


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## cwolfe059 (Dec 29, 2007)

*combi tubes*

Here in WI an EMT-B is allowed to place a tube, but we have to be certified as an EMT-B IV Tech, that is a whole nother class with even more hours. I do belive that we have to take a 40 hour class and have in hospital clinicals. I would not mind placing IV's, but right now I am just not in the market for more school.
Cwolfe


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## VentMedic (Dec 30, 2007)

triemal04 said:


> But, put several IPP's there to staff a medic unit AND a local clinic, and that might change things.  That way the community really does get the most for what it pays; a fulltime ambulance, and a local clinic for generic problems that don't need transport.  Kind of like what's happening in some Canadian provinces.
> 
> What Bledsoe has propsed is nice, definetly needs some tweaking, but still head and shoulders above what we've got today.  And unfortunately, it'll probably never happen, and would take 20+ years to implement even if it did.



I've got to chuckle at this (not at you triemal04) after reading thread after thread with people in EMS complaining about not wanting to do BS calls or be stationed anywhere near an ED.   And, that is with the crew sleeping nights as well as taking afternoon naps.    Now we want them to miss their naps and do clinic type patients?    

If we weed out those in EMS or applying to EMS who are not truly serious about medicine, what percentage would we lose?   

The purpose is to define first an identity as established by standardized education across the board.   The A.S. degree mimimum + and X amount of years of experience for CCT or Flight is long over due at the very least. 

I would like the paramedic first to become the very best Mobile Intensive Care Clinician possible before getting fragmented again into too many directions or certifications...again.


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## triemal04 (Dec 30, 2007)

VentMedic said:


> I've got to chuckle at this (not at you triemal04) after reading thread after thread with people in EMS complaining about not wanting to do BS calls or be stationed anywhere near an ED.   And, that is with the crew sleeping nights as well as taking afternoon naps.    Now we want them to miss their naps and do clinic type patients?
> 
> If we weed out those in EMS or applying to EMS who are not truly serious about medicine, what percentage would we lose?
> 
> ...


Well...can't say to much to the first part, other than if you increase the standards and training, make it harder to become a paramedic, and ensure that people are actually trained appropriately in the medical science, then most people who are in it just for the thrill will be gone; the ones that are left will be the ones who actually like medicine, like EMS, and like doing patient care.  So I don't think there would be much of a complaint about working partially in a clinical setting.  Plus, if you look at the proposed scope, not everyone would have to be an IPP; in fact the only ones would probably only be the ones who were willing to take a 4-year program on top of their original cert and experience, which most likely would mean they wouldn't have a problem with a clinic.

You're right though; there would initially be a lot fewer paramedics out there, especially if nobody was grandfathered in; if you didn't have at least an AAS then you had to go back to school.  And you know what?  I'm ok with that.  The people left would really be serious about EMS, as would the people coming in; nobody who did it because they wanted a job at a Fire Dept and went to a medic mill.  And with the increased education, increased standards, and hopefully increased quality of the paramedics, the respect given to the profession and professionalism could only increase.  (over time...like 20+ years).

I don't see how this is fragmenting anything.  Get rid of the vocational paramedic and the specialized and leave the licensed as the minimum, followed by critical care (or whatever it was called) and independant practise.  That way everyone starts at the same place, and getting a higher cert would be more of a way to move on to another job, or to provide better care at the current job.  And while you're at it remove either the medical responder and increase the educational hours to 450 for an EMT, or get rid of the EMT and leave the medical responder.

Honestly, I'd love to see this get implemented nationwide.  Unfortunately, it won't, for a lot of reasons.  To many states have their own little EMS fiefdoms, the lack of a national EMS authority, IAFF (much as I hate to say it), lack of schools available to teach to the new standards...and so much more.  Not to mention that it wouldn't be prudent to grandfather anyone in, which would mean that there would be very little in the way of paramedics for awhile.

I don't know.  This would only help (if done right) but will never get done, at least not anytime soon.


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