# EMS/Nursing vs. Firefighting



## BHammond1 (Nov 23, 2010)

Greetings all, I've posted a few times here but not for a while. I have a BA and am currently working at a residential treatment facility for teens, but I'm interested in the emergency services field. In the downtime before my EMT-B program begins in March I'm trying to figure out which specific field I'm the most interested in.

I am interested in firefighting, getting my paramedic, and/or working as a RN. I have a learning disability in math so that does concern me somewhat, but by no means am I going to let that stand in my way. My plan right now is to volunteer at a fire department, get my EMT-B under my belt, and see which field I like more. I think that that will mostly determine which path I take, because if I like the medical field more I will obviously lean towards a RN degree. I know the RN offers me more flexibility and better pay, but I feel pulled towards the on-the-street, response-oriented nature of firefighting and EMS too.

I know you guys can't tell me what to do or put yourself in my shoes even, but I am wondering if any of you have advice that you'd want to give out to a newbie in the field. Basically, what would you have wanted to know when you were starting to enter the field? Is there any advice that you could give me in regards to the pros and cons of each field?


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## fast65 (Nov 23, 2010)

BHammond1 said:


> Greetings all, I've posted a few times here but not for a while. I have a BA and am currently working at a residential treatment facility for teens, but I'm interested in the emergency services field. In the downtime before my EMT-B program begins in March I'm trying to figure out which specific field I'm the most interested in.
> 
> I am interested in firefighting, getting my paramedic, and/or working as a RN. I have a learning disability in math so that does concern me somewhat, but by no means am I going to let that stand in my way. My plan right now is to volunteer at a fire department, get my EMT-B under my belt, and see which field I like more. I think that that will mostly determine which path I take, because if I like the medical field more I will obviously lean towards a RN degree. I know the RN offers me more flexibility and better pay, but I feel pulled towards the on-the-street, response-oriented nature of firefighting and EMS too.
> 
> I know you guys can't tell me what to do or put yourself in my shoes even, but I am wondering if any of you have advice that you'd want to give out to a newbie in the field. Basically, what would you have wanted to know when you were starting to enter the field? Is there any advice that you could give me in regards to the pros and cons of each field?



I don't know if I can really give you the pros and cons of each subject, however I just wanted to reinforce your idea of volunteering for the fire dept. and getting your EMT-B; that way you'll at least get some sort of idea of what you want to do. Keep in mind, you can still do all of the above if you really can't decide; you can work as an RN and volunteer as a fire-medic once you finish school. 

As far as having a learning disability in math, I wouldn't worry about it too much, the calculations that paramedics have to do aren't overly complicated.


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## MrBrown (Nov 23, 2010)

Do you want to be a firefighter or do you want to be a healthcare professional?


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## uhbt420 (Nov 23, 2010)

volunteer in a fire dept AND in a hospital, preferrably in a nurse's station.  that way you can see how both work.

nursing offers higher scope of practice, more education, etc but it is usually in a controlled, clinical environment.  if you prefer uncontrolled street medicine then firemedic is probably more your fit

nursing and firefighter subcultures are two different animals.  you just have to get a glimpse of both and make your decision

(and politely ignore any comments about firefighters not being healthcare professionals, there are many fire depts where ems is very important)


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## Shishkabob (Nov 23, 2010)

uhbt420 said:


> nursing offers higher scope of practice, more education



No, it does't.  I truly wish people would quit perpetuating this fallacy.

You cannot compare the scopes and education of nursing to paramedicine, as they are truly apples and oranges.  




The only thing you can say that will hold true a majority of the time is RNs tend to make more than Paramedics.   If you want money, RN will probably be a better bet.


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## 46Young (Nov 23, 2010)

MrBrown said:


> Do you want to be a firefighter or do you want to be a healthcare professional?



If you live in the right area, you can do both and be very well off financially. Over here, the FFM starts at 53k and quickly goes to the low 70's after the academy and ALS internship. The OT opportunities are copious until you get to the Lt. level. They make anywhere from 90k to 120k USD, depending on pay step if they're also ALS certified and regularly ride EMS txp units. When you replace that reduced OT opportunity with 50 dollars an hour as a nurse, you'll live like a king. That's what I'm aiming for. FT Fire/EMS officer, and per diem RN.


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## 46Young (Nov 23, 2010)

@ the OP,

See my above post. If compensation, benefits, retirement, schedule, etc. are the most important to you, then I would suggest going FT as a career FF/medic. Do nursing part time. You may not be able to explore all the different areas nursing has to offer, but you'll be well taken care off on all accounts. Try finding a place that offers both a pension and a DROP. A DROP is where you effectively retire, and then work several more years and both continue to earn your check, and also receive your pension checks for that time period, typically 3-5 years, in deferred comp. It's a huge boost to retirement at the end of your career. Most can't save the requisite 10% of their pay each year to have even a chance at a decent retirement. You'll have a pension and the DROP to cover you well.

I'd recommend getting your RN first, and then find a way to either challence the medic exam, or do an accelerated EMT-P program. Going back to get your RN while doing rotating shift work can be difficult. Also, more and more FD's give heavy weight for promotions to those that carry degrees.

Having said that, being a nurse and having the opportunity to advance to all the different areas involved may be more important to you. I would then suggest that you do nursing FT, and then find a dept that hires FF/medics part time or per diem to get your kicks. Virginia has a bunch of them, typically volunteer FD's that have started to hire limited career staff, those that already possess their FF1 and FF2 along with EMT-I or P.

Really, if firefighting and 911 EMS ground txp appeal to you the most, then go in that dierction. If medicine in the broad sense appeals to you more, then go in that direction. You have to be happy in your chosen career.


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## Aerin-Sol (Nov 23, 2010)

Check into the requirements for paramedic and accelerated BSN degrees in your area. Most will require a year of Anatomy & Physiology, so if you didn't take those during your first degree, you have at least a year before you have to make that decision. Use that time for working as an EMT, volunteering as a firefighter, and volunteering at a hospital or working as an ER Tech. Then you can make a better decision than strangers on the internet. =)


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## BHammond1 (Nov 24, 2010)

Aerin-Sol said:


> Check into the requirements for paramedic and accelerated BSN degrees in your area. Most will require a year of Anatomy & Physiology, so if you didn't take those during your first degree, you have at least a year before you have to make that decision. Use that time for working as an EMT, volunteering as a firefighter, and volunteering at a hospital or working as an ER Tech. Then you can make a better decision than strangers on the internet. =)



Thanks for your reply, Aerin and everybody else. I know you all are "strangers on the Internet," but at the same time most of you are professionals in the field I'm looking into and thus your opinions do hold some credence.

I am initially more attracted to street medicine as a firemedic, but I know that the competition can be brutal to get hired on to a paid fire department. Working off of pure economics is against my nature, but before I landed my current job I was in the wind for six months looking for one. Having gotten a taste of that uncertainty and having a pointless Bachelors degree (English), working as a RN does appeal to me due to the security and the pay. Plus, my mom has worked as a nurse my entire life so I'm familiar with the schedule, lifestyle, etc.

Nevertheless, I don't get the same sort of excitement looking at a hospital that I do looking at a fire engine or an ambulance. I know both are jobs and that work is work, but I guess I'm sort of stuck in a passion vs. job security argument.


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## Aerin-Sol (Nov 24, 2010)

BHammond1 said:


> Nevertheless, I don't get the same sort of excitement looking at a hospital that I do looking at a fire engine or an ambulance. I know both are jobs and that work is work, but I guess I'm sort of stuck in a passion vs. job security argument.



I feel you there, but after six months of working on an ambulance, I don't find it quite as exciting as I used to.


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## Indy (Nov 25, 2010)

To fill in on the Paramedic vs. Nursing topic, Paramedics have a lot harder of a job than nurses. My sister is a nurse in an ICU, so she would argue this but a paramedic has a harder job than nurses do.


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## TransportJockey (Nov 25, 2010)

Just after working as a floor tech I have to disagree with this. Med/surg and ed nurses work their asses off every day, while a medic might have several hours of downtime. ICU nurses tend to have more free time than RNs on other units due to low patient load (and generally a decent amount of those patients are tubed  ) 


Indy said:


> To fill in on the Paramedic vs. Nursing topic, Paramedics have a lot harder of a job than nurses. My sister is a nurse in an ICU, so she would argue this but a paramedic has a harder job than nurses do.


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## Shishkabob (Nov 25, 2010)

Hardness of a job, just like who's better at ivs, cannot be argued.

Are there medics with off time?  Yupp.  Are there nurses with plenty of off time too, even at a county hospital such as Parkland?  You bet.


But go to station 33 in Dallas.  Or station 19 in Miami.  Or any MedStar truck.  Or any Detroit truck.   And tell me they don't run their butts off on a regular basis.



Both professions have their sides that run all day, or hardly run at all, therefor you cannot say one is harder than another in the aspect of patient / call volume.




Now, what CAN be argued is the complexity of field medicine compared to hospital medicine.  Two totally different beasts, with field medicine having issue that those iin a hospital couldn't dream of.


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## phildo (Nov 25, 2010)

Get your RN BEFORE you get locked into a full time schedule in Fire or EMS.  Hire on as a firefighter, let them pay for your emt-b cert, then challenge the paramedic exam.  Then do fire full time, nursing on your off days.  You'll have much better benefits and retirement in fire service than in EMS or nursing.  Live on your FD pay, bank as much of your prn nursing pay as you can.


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## ertech (Nov 26, 2010)

I work as an Emt and as an Er tech,for now.I will be going back to school and will further my education in both fields.being on the street is far more exciting,than being in a building all day.


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## JPINFV (Nov 26, 2010)

Linuss said:


> Now, what CAN be argued is the complexity of field medicine compared to hospital medicine.  Two totally different beasts, with field medicine having issue that those iin a hospital couldn't dream of.



...and medical care in the hospital deals with issues that EMS either willfully ignores or can't comprehend.


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## Shishkabob (Nov 26, 2010)

JPINFV said:


> ...and medical care in the hospital deals with issues that EMS either willfully ignores or can't comprehend.



Like I said... two totally different beasts.


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## gicts (Nov 26, 2010)

The busy-ness is a wash like Linus said. I've had nurses say they never got into EMS because they didn't like the one-on-one responsibilities and liability.
Personally, I could never deal with doctors all day . I think that is the reason they are paid so well h34r:.

If the medical field is for you, get into a second degree BSN program and don't look back. I know of some programs that offer a master's program in a year for full time students.

A nursing profession offers different career paths if you wish (NP, CRNA etc.), promotions, raises, and different enviroments (surgery, ER, doc's office etc.)- all of the things you wish to see in a career. I'll be so bold as to say EMS doesn't deliver in any of those aspects.


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## JPINFV (Nov 26, 2010)

gicts said:


> Personally, I could never deal with doctors all day . I think that is the reason they are paid so well h34r:.



:sad:


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## 46Young (Nov 26, 2010)

Indy said:


> To fill in on the Paramedic vs. Nursing topic, Paramedics have a lot harder of a job than nurses. My sister is a nurse in an ICU, so she would argue this but a paramedic has a harder job than nurses do.



How so? Medics only have to deal with one pt at a time. Nurses can be covering two, three, up to nine or more in some cases. Even if we're running non-stop, we can at least hold a signal for a few minutes to open the cooler and have a meal.


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## Shishkabob (Nov 26, 2010)

46Young said:


> How so? Medics only have to deal with one pt at a time. Nurses can be covering two, three, up to nine or more in some cases. Even if we're running non-stop, we can at least hold a signal for a few minutes to open the cooler and have a meal.



On the other hand, they also have virtually unlimited resources and help.


It's not uncommon for there to be only 2-4 EMS on scene for a code, whilst in a hospital, 10+ is common.   They also, generally, have all the experts and equipment they could ever need to manage their acute patients.  Us?  Not so much.



It's silly to compare the two, because each has their own kind of busy / difficulties about them.


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## 46Young (Nov 26, 2010)

Linuss said:


> On the other hand, they also have virtually unlimited resources and help.
> 
> 
> It's not uncommon for there to be only 2-4 EMS on scene for a code, whilst in a hospital, 10+ is common.
> ...



True, it is apples to oranges to an extent. Still, the nurse in a busy hospital will be doing some work related task nearly every moment they're on the clock. We get a breather when driving between calls, we can hold signals, take extra time to write a report, catch naps or surf the net if the call volume dies down, etc. The nurse may have more help for a code, but how many codes are we running? At my busiest back in NY, I might see an average of 1 working code per shift. All we're really doing is CPR, a line, airway, work the monitior, and push some drugs. We can work the code for 20-30 minutes and then call it, and not even need to move the pt. We do more physical work, but I'm willing to bet that the mental demands of the nurse far exceeds ours. Even when we're running our tails off, how tough do we really have it? We can only run one call at a time.


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## Indy (Nov 26, 2010)

46Young said:


> How so? Medics only have to deal with one pt at a time. Nurses can be covering two, three, up to nine or more in some cases. Even if we're running non-stop, we can at least hold a signal for a few minutes to open the cooler and have a meal.



Which one is more stressful? Paramedic or Nursing? I for one vote medic. In EMS, the pay is terrible. My sister makes over $70k a year, and she's only in her 4th year of nursing. Paramedic pay with that many years on around here tops $38,000 if you're lucky, and doesn't increase much as years go on. So stress wise, yes paramedics have a harder and more stressful job than nurses IMO. 

Also consider working conditions. Nurses during the winter are in a nice, warm and safe environment, and in the summer they have cooled buildings. EMS goes out on MVIs and other outdoor calls in 20 degree weather, in the rain, sleet, snow, thunderstorms, etc. 

Nurses also work knowing they have a doctor who can help them with anything at any time. If a paramedic gets stuck, he/she has to call a supervisor who is probably 5-10 minutes away, even when responding code.


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## TransportJockey (Nov 26, 2010)

I'm kinda curious why medics really should make any more money than they already do? Simple supply and demand there. The market in most places is oversaturated with all EMS personnel. That combined with the higher required education means that RNs usually command higher pay.


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## Shishkabob (Nov 26, 2010)

jtpaintball70 said:


> I'm kinda curious why medics really should make any more money than they already do? Simple supply and demand there. The market in most places is oversaturated with all EMS personnel. That combined with the higher required education means that RNs usually command higher pay.



There is no reason why a medic should make half as much as an RN with equivalent education and responsibilities.  None.


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## TransportJockey (Nov 26, 2010)

Linuss said:


> There is no reason why a medic should make half as much as an RN with equivalent education and responsibilities.  None.


No, there isn't. If education at least was equivalent I'd say you've got a point. But with most EMS services not putting any premium on education and hiring out at the lowest pay they can and still having lots of applicants, they see no need to increase it. 

Although you can find places that are different. You have, I believe, and I have to an extent down here. But then again, I make about the same pay as our ED nurses here in the county


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## Shishkabob (Nov 26, 2010)

The education (I'll I'll catch flak on this from some here) IS equivalent, in my opinion, on what our job actually is.   The difference is what we are educated in.

A Paramedic IS emergency medicine.  Do we lack in non-acute medicine, minor disease processes and things of that nature?  Sure... but an OB/GYN nurse lacks in cardiology, a med/surg nurse lacks in pediatric care, a respiratory therapist lacks in trauma care, etc etc.  


A brand new nurse will NEVER know more than a brand new Paramedic in cardiology, trauma, and emergency medicine.  The only nurses that can compare to medics in that knowledge ARE ER and ICU nurses, and it can fluctuate in who knows more in what... yet we make half as much as they do.  That's screwed up, regardless of any perceived overabundance.


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## JPINFV (Nov 26, 2010)

Linuss said:


> A brand new nurse will NEVER know more than a brand new Paramedic in cardiology, trauma, and emergency medicine.  The only nurses that can compare to medics in that knowledge ARE ER and ICU nurses, and it can fluctuate in who knows more in what... yet we make half as much as they do.  That's screwed up, regardless of any perceived overabundance.



So, what you're saying is that a paramedic is useless outside of emergency medicine whereas a nurse has a skill set that's useful in multiple departments? Would you feel comfortable with the brand new medic following a similar orientation/new nurse program (to make it fair) taking the place of an RN in the emergency department?  Are cardiology, trauma, and emergency medicine the only three fields that matter? In terms of trauma, and surgery in general, how much training do paramedics receive for post surgical wound care and the like, or is it really an apples to oranges comparison?


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## Shishkabob (Nov 26, 2010)

And I point you back to this



> Do we lack in non-acute medicine, minor disease processes and things of that nature? Sure





As is oft stated, nursing education is generalistic, but lacks in depth in many things just as much as Paramedicine lacks in breadth.   How much training does the average non-ER nurse receive in acute care?  How about the average OB/GYN nurse in trauma surgery?  Adult ICU nurse in pediatric cancer treatment?  Public health nurse in respiratory care?



Why is it so bad that Paramedics specialize in a subset, but not nurses?



If our job was to provide post-surgical wound care, I'd be inclinced to agree that we were lacking, but it's not our job, and whilst it'd be beneficial to be more generalistic in that fashion as many of our calls are NOT true emergency medicine, I can also see why it typically (I said typically, not always) not included.


The education of Paramedics should, and often does, mirror that of an ER RN in emergency medicine.  They just learn a lot more in the theories of the non-emergency aspects that show up in the ER too, as we should strive for.



> Would you feel comfortable with the brand new medic following a similar orientation/new nurse program (to make it fair) taking the place of an RN in the emergency department? Are cardiology, trauma, and emergency medicine the only three fields that matter?



Actually having spent the time I did in ERs and trauma departments, and meeting the new nurses that work there, actually yes, I would feel comfortable.  Especially for the trauma specific areas.  No reason they can't.


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## TransportJockey (Nov 26, 2010)

Linuss said:


> The education (I'll I'll catch flak on this from some here) IS equivalent, in my opinion, on what our job actually is.   The difference is what we are educated in.
> 
> A Paramedic IS emergency medicine.  Do we lack in non-acute medicine, minor disease processes and things of that nature?  Sure... but an OB/GYN nurse lacks in cardiology, a med/surg nurse lacks in pediatric care, a respiratory therapist lacks in trauma care, etc etc.
> 
> ...



I agree with you for the most part, but nurses still have more knowledge base to build on. My biggest complaint with EMS education is that EMT-Bs and EMT-Is are definitely undereducated. And medics are to a degree as well. I'd love to see an AAS a requirement for medic, as I've said in the past. Oregon seems to do pretty well with that as a requirment, and NM has been talking about moving in that direction. If we had a more solid base of knowledge I would agree with you 100%.


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## Shishkabob (Nov 26, 2010)

So I have no knowledge base to build on either?  My knowledge is confined to JUST acute care, and the pathphys, anatomy, physiology, pediatrics, geriatrics and pharmacology, no matter how little or much, cannot be built on?


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## TransportJockey (Nov 26, 2010)

Never said you have no knowledge base to build on  Just not as broad as a Grad Nurse does to start with. If we made at least some hard sciences a requirement to entry into this field it would go a long way (A&P 1 and 2 w/ labs would be a nice start )

Besides, I just called myself undereducated, so I'm sure as hell not going to say that you have no knowledge base to build on.


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## Shishkabob (Nov 26, 2010)

But you're you, and I'm me, therefor I'm better.


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## SerumK (Nov 27, 2010)

I've got to agree with JTPaint and disagree with Linus.

Linus, I'm not really sure where you get your idea that nurses ON AVERAGE have it easier than paramedics for twice the pay but equal education.

I will say that nurses absolutely have comfier work environments... no rain, wind, snow, etc. Nurses usually have 5 to 9 patients they are responsible for (ICU is more like 1-3, LTC one nurse may have up to 150 patients in some of the disreputable facilities).  I could go on and on about these comparisons, largely apples to oranges, but lets focus on pay and education.

The biggest difference is education. Many nursing jobs are BSN minimum or within 1-3 years of hire. There's such a glut of new nurses that even when it isn't the official requirement, a bachelors is what you need unless you have years of experience. Many new RNs are coming in with two bachelors via ABSN programs! At minimum, anywhere, you need an associates degree to be an RN. 

EMT-P does NOT require anything but high school + some watered down A&P and trade school classes. (except in OR) Employers do not reward the medics who do have the more thorough education!

RNs have a much more in-depth educational foundation which makes them much more versatile and easier to educate in the long run (interestingly, that is what they found with associate vs bachelors nurses: the associates had an edge for the first 6 months, after that the bachelor foundation proved superior). *EDUCATION IS WHY THERE IS A PAY DIFFERENTIAL BETWEEN RN AND EMT-P.* Education is also why there is nowhere to go as an EMT-P except management. It is why I chose RN over EMT-P (as the first step).

Still, I've noticed paramedics make only slightly less than nurses. In my local spot, paramedics are making 14-25/hr while nurses are making 22-32/hr (that's for FT, not including built in OT adjustments... if you look at salary its 35-55K for medics and 44-65K for nurses).

BUUUUUUUUUUUT Fire Medics always make a ton more than nonFFmedics, usually equal to what an RN can pull down. Rookie fire medics pull in 45K here MINIMUM which is what a new grad RN makes. And Fire Medics get 24s or 48s instead of what new RNs get: 12 hour rotating shifts (some nights here, some days here) or the night shift.

Lastly, there are presently jobs for paramedics, although FF/Medic jobs are insanely competitive. At least there are those private service jobs. It is not so rosy for RNs. There's a ton of new nurses that have been out of work for more than a year after graduation with no hope in sight, not even in the nursing homes. It's a common topic on nursing forums: "what rural county of what state must I move to in order to get ANY nursing job?" There's many a crying new grad who realizes after their 200th job application gets rejected that the "nursing shortage" was nothing but hype.


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## brentoli (Nov 27, 2010)

Linuss said:


> A Paramedic IS emergency medicine.  Do we lack in non-acute medicine, minor disease processes and things of that nature?  Sure... but an OB/GYN nurse lacks in cardiology, a med/surg nurse lacks in pediatric care, a respiratory therapist lacks in trauma care, etc etc.



But a nurse has the educational foundation to transition in to those areas. A nurse doesn't come out of college as a "ER Nurse" or a "L&D Nurse". Rather they come out a nurse, capable of going into any position and learning the specific demands and skill set of that job. If a nurse wants to leave L&D and go to the ER after 5 years can they? Yes. Without question. a couple of months of orientation and boom - you have an ER nurse.


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## Shishkabob (Nov 27, 2010)

So you're telling me a Paramedic can't adapt either?  You're telling me Community Paramedicine is a hoax?



What makes you think a Paramedic is completely and totally incapable of transitioning to other areas as well, with the same orientation?  What makes a new grad nurse any more capable at working in an ER than a Paramedic with the same educational requirements?




Anyway-- medicine is full of specialized professionals.  Respiratory therapist, rad techs, sonographers, etc etc.  Why is it so bad that we are specialized in emergency medicine?  No one has YET to explain that to me.


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## Symbolic (Nov 27, 2010)

Linuss said:


> So you're telling me a Paramedic can't adapt either?  You're telling me Community Paramedicine is a hoax?
> 
> 
> 
> ...



There is definitely nothing but truth in that. It's unfortunate that an 2 extra years of school and a piece of paper are enough to warrant an extra 10 thousand a year. I suppose that's like every other Job though. Its all about that diploma. 

But honestly, going from a Medic to a Nurse realistically would take only a year extra of training, if not less.. I'm not trying to undermine the Job, but lets be honest here.


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## brentoli (Nov 27, 2010)

Nope. Just refuting your statement that a L&D nurse can't work in the ER or vice versa.

If you want to be held on the same plane as a nurse the education has to be equal, that comes out to be about 2 years of liberal education and 2 years of trade education. There's not many 4 year EMS programs in the US.


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## Journey (Nov 27, 2010)

Linuss said:


> So you're telling me a Paramedic can't adapt either?  You're telling me Community Paramedicine is a hoax?
> 
> What makes you think a Paramedic is completely and totally incapable of transitioning to other areas as well, with the same orientation?  What makes a new grad nurse any more capable at working in an ER than a Paramedic with the same educational requirements?
> 
> Anyway-- medicine is full of specialized professionals.  Respiratory therapist, rad techs, sonographers, etc etc.  Why is it so bad that we are specialized in emergency medicine?  No one has YET to explain that to me.



By your reasoning, Respiratory Therapists, Radiology Technologists and Sonographers are also the equivalent of a nurse. The difference in these professionals and the Paramedic is that their minimum entry level is a two year degree. For your state of Texas, you only need  600 hours of traiing. 

As a specialist trained specifically in Emergency Medicine, you do not have the same core education as a nurse and therefore you are not a nurse or like a nurse.

LVNs can do "community health" and they also have 2x more hours of training than what is required in TX. It does not take that much to do welfare checks and give immunizations. If you are referring to the Wake County system, many of the tasks they do should be standard for most Paramedics such as deciding which hospital to go to. That system also only requires 200 hours extra for training. Add that to your 600 hours and you still only get 800 hours which is about 600 hours less than an LVN. 

If you have additional education and still work with those who meet only the minimun 600 hours, you should see why that is very inadequate rather than arguing it is just like a nurse or a Radiology technologist. Those who actually have more education see the difference and argue for the standard to be raised rather than additional titles like "community health Paramedic" be added to a system that has not increased its minimun education requirements.  Those who do have the additional education do move on or advance to positions or professions where they are no longer working with medic mill products who continue to argue for the least minimal standards.


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## Journey (Nov 27, 2010)

Symbolic said:


> There is definitely nothing but truth in that. It's unfortunate that an 2 extra years of school and a piece of paper are enough to warrant an extra 10 thousand a year. I suppose that's like every other Job though. Its all about that diploma.



A college degree is considerably different than a certificate issued by a tech school. A tech school also has lower entrance requirements so that almost anyone can enter into a trade. 

It is attitudes like yours that keeps the Paramedic from advancing to a two year degree. You see no value in education and you believe all health care professions are as easy as the Paramedic which is an insult to the Paramedic. 



Symbolic said:


> But honestly, going from a Medic to a Nurse realistically would take only a year extra of training, if not less.. I'm not trying to undermine the Job, but lets be honest here.



That is true only if you have completed all the prerequisites for entry which includes college level A&P, microbiology, math, chemistry and pharmacology. Very few Paramedic programs require these since trade schools lead the market.  All the prerequisites will take you well over 1 year to complete and probably more like one and a half years. These prerequisites are the same for almost any allied health program.  If you wanted to be a Radiology Technologist, you would probably need another 2 years of college in addition to the prerequisites. About all the Paramedic cert will get you is the equivalent of 1 semester off a nursing program.


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## frdude1000 (Nov 27, 2010)

I do not agree with making medics take hard science courses.  To perform the current role of Paramedic, most of the information presented is not relevant.  Its not like we're going to have all sorts of specimen (urine and blood) testing equipment on a rig anytime soon.  We practice under protocols; for the most part, we treat what we see.  How does the ecology topic in a Biology class have to do with working a code in the middle of the street.  If we changed the role of a paramedic, I can maybe see a use for some of these classes.  I am all for more education for EMS personnel, but I believe it should be in something useful; we really don't use genetics and mollecular biology too much in the field.  How about more education on the illnesses, injuries, and diseases we see in the field and the skills we use to treat them.


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## brentoli (Nov 27, 2010)

Do you think a paramedic should be on par with a nurse? They have a year of chem, micro biology, a year of a&p, along with other math, science, and english classes.


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## Akulahawk (Nov 27, 2010)

Journey said:


> A college degree is considerably different than a certificate issued by a tech school. A tech school also has lower entrance requirements so that almost anyone can enter into a trade.
> ...
> That is true only if you have completed all the prerequisites for entry which includes college level A&P, microbiology, math, chemistry and pharmacology. Very few Paramedic programs require these since trade schools lead the market.  All the prerequisites will take you well over 1 year to complete and probably more like one and a half years. These prerequisites are the same for almost any allied health program.  If you wanted to be a Radiology Technologist, you would probably need another 2 years of college in addition to the prerequisites. About all the Paramedic cert will get you is the equivalent of 1 semester off a nursing program.


Let's see: College level A&P, Micro, Math, Chem... got'em all. I got all but one of those classes during the first Allied Health program I went through. Pharmacology may or may NOT be required prior to entry, depending upon the program. It would certainly be part of the program though. 

Not all programs are identical, nor require the same number of hours to complete. The program I took required about 68 units in core coursework, of that, about 6 were directly listed in the core work. The rest of my prereqs for a nursing program came from prereqs for those required core classes. After reviewing the core work and prereqs for them for my local ADN and RN programs, it appears that they're done after about 40-44 units. But an ATC program is NOT an RN program and the reverse is also true. An RN does not possess the educational foundation to be able to become an ATC or to safely function in that environment without a LOT more education.


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## Symbolic (Nov 27, 2010)

brentoli said:


> Do you think a paramedic should be on par with a nurse? They have a year of chem, micro biology, a year of a&p, along with other math, science, and english classes.



It would be nice, but in the grand scheme of things it seems unrealistic. looking at it from a fire-medic perspective, It would require potential candidates to complete at least two years of college level classes while also working full time with the fire-department. I don't necessarily think this is a bad thing, but promotions would be long and dragged out. IF you plan on working as a fire-medic, most departments require that you be on as a firefighter for at least 3 years before eligibility. The 3 years of work experience in conjunction with at least 2 years of college education seems a bit excessive, at least to me.  Also, its really not necessary to take a micro biology or chemistry class, or even anatomy and physiology in order to become a competent Medic. Education can never be a bad thing and I think Para-medicine would be more respected if it was held to higher standards, I just don't know how realistic that would be. If anything, it would narrow the competition.


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## TransportJockey (Nov 27, 2010)

Symbolic said:


> It would be nice, but in the grand scheme of things it seems unrealistic. looking at it from a fire-medic perspective, It would require potential candidates to complete at least two years of college level classes while also working full time with the fire-department. I don't necessarily think this is a bad thing, but promotions would be long and dragged out. IF you plan on working as a fire-medic, most departments require that you be on as a firefighter for at least 3 years before eligibility. The 3 years of work experience in conjunction with at least 2 years of college education seems a bit excessive, at least to me.  Also, its really not necessary to take a micro biology or chemistry class, or even anatomy and physiology in order to become a competent Medic. Education can never be a bad thing and I think Para-medicine would be more respected if it was held to higher standards, I just don't know how realistic that would be. If anything, it would narrow the competition.



I'm trying to understand why this would be a bad thing?


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## Akulahawk (Nov 27, 2010)

frdude1000 said:


> I do not agree with making medics take hard science courses.  To perform the current role of Paramedic, most of the information presented is not relevant.  Its not like we're going to have all sorts of specimen (urine and blood) testing equipment on a rig anytime soon.  We practice under protocols; for the most part, we treat what we see.  How does the ecology topic in a Biology class have to do with working a code in the middle of the street.  If we changed the role of a paramedic, I can maybe see a use for some of these classes.  I am all for more education for EMS personnel, but I believe it should be in something useful; we really don't use genetics and mollecular biology too much in the field.  How about more education on the illnesses, injuries, and diseases we see in the field and the skills we use to treat them.





brentoli said:


> Do you think a paramedic should be on par with a nurse? They have a year of chem, micro biology, a year of a&p, along with other math, science, and english classes.



I would say that a Paramedic would benefit greatly from a year of A&P and taking a Micro class. The prereqs to be able to take those would also mean that chem, math, and english writing would also be required along the way. Once those topics are out of the way, far more could be taught in a Paramedic Theory course than presently is found. More importantly, pathophys would be stressed far more because you'd already know what "normal" is. At the end of the program, you'd be able to come up with care plans easily for patients that do NOT fall into a pre-approved protocol.

A Nurse might not directly utilize the info from a Chem class or a Micro class... but when thinking about pathophys, it helps.


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## Akulahawk (Nov 27, 2010)

A firefighter probably could do better with an understanding of chemistry and physics...  It's cheaper & easier to hire and train a firefighter who is already a Paramedic than it is to take a FF and turn 'em into a Paramedic. So, you take the well educated Paramedic... and put them through a Fire Academy... Now you've got a well educated Fire Paramedic who now has a degree to go along with the FF stuff, and possibly additional pay for having a degree on top of being a Paramedic. 

Furthermore, if call trends don't reverse any time soon, I could easily imagine a Fire Department that does EMS transitioning to an EMS Department that does Fire...


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## Symbolic (Nov 27, 2010)

Akulahawk said:


> . So, you take the well educated Paramedic... and put them through a Fire Academy... Now you've got a well educated Fire Paramedic



Pretty much how most departments are hiring around these parts.


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## Akulahawk (Nov 27, 2010)

Symbolic said:


> Pretty much how most departments are hiring around these parts.


Yep. All because it's cheaper. Potentially MUCH cheaper...


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## Journey (Nov 27, 2010)

Akulahawk said:


> Let's see: College level A&P, Micro, Math, Chem... got'em all. I got all but one of those classes during the first Allied Health program I went through. Pharmacology may or may NOT be required prior to entry, depending upon the program. It would certainly be part of the program though.
> 
> Not all programs are identical, nor require the same number of hours to complete. The program I took required about 68 units in core coursework, of that, about 6 were directly listed in the core work. The rest of my prereqs for a nursing program came from prereqs for those required core classes. After reviewing the core work and prereqs for them for my local ADN and RN programs, it appears that they're done after about 40-44 units. But an ATC program is NOT an RN program and the reverse is also true. An RN does not possess the educational foundation to be able to become an ATC or to safely function in that environment without a LOT more education.



Does every Paramedic program require those same classes in your state? I didn't think California required a degree from a college to be a Paramedic.  Don't confuse the classes which tech or trade schools call A&P, Pharmacology or math. These abbreviated classes are not the same as a college class and will not transfer to a university or even a community college. You can get a few credits for your Paramedic cert but that is about all.   

A Paramedic can get a degree but it is not required. Usually only a certificate is required. You can advance in some agencies if you have a degree but few EMS employers will state degree preferred. A nurse can get a BSN or MSN although just an ADN is required for entry. Employers can also state they prefer a BSN in their employment ads and it is not considered unual to require more education than the state or national minimun in that profession or most of the other health care professions. It is unual to require a degree to be a Paramedic unless you are in Oregon. 

 A BSN can be required for Public Health or School RN positions along with some specific requirements. A Paramedic can be called a community health Paramedic with the bare minimun certificate plus a few extra hours of training. A title can be misleading especially if there is not a minimal standard to back it up or some consistent regulations at the state level. 

The other poster stated it would take less than a year to become a nurse with a Paramedic cert. If the student did not have any of those science classes, it will definitely take longer than a year and that is just to complete the science classes. I do not know any nursing program that will allow entry without the basic sciences like A&P from an acceptable source such as an accredited college.  It also is not just about the number of credit hours or units. The units must be in the program. 

You can not compare an ATC to an accountant either just as you can not assume that if someone has a two year degree with a few sciences they can be either a Radiology Technologist or a nurse. The core courses must be taken and the specialization for each is what sets them apart. 



> A Nurse might not directly utilize the info from a Chem class or a Micro class... but when thinking about pathophys, it helps.



Nurses do utilize these classes almost everyday. The chemistry gives them an understanding as to why lipids can not be ran in the same lines as other medications and why certain meds are light sensitive. They may not remember all the little details or equations but they will know enough to check the compatability chart when they see various meds that have a composition which might raise a red flag from the info stored somewhere in their memory.  It can keep the nurses from making a dangerous mistake.  If they are getting an inservice on a new medication, they will have a better understanding why it is more compatible or what makes it different from the others.   As far as microbiology, it would have to be a very, very stupid nurse to not know what bacteria or viruses the patients have and how they are being treated.  In microbiology you also learned which microorganisms were more resistant which should indicate some areas require special handling or cleaning.  These classes are included in all the other health care profession programs for a reason.


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## Journey (Nov 27, 2010)

Symbolic said:


> Also, its really not necessary to take a micro biology or chemistry class, or even anatomy and physiology in order to become a competent Medic.



This statement would explain some of the topics on this forum where there is confusion about BSI, PPE and the body's response to pain.  Anyone can be a competent technician and follow orders. But to know the whys behind the orders, you must extend beyond the tech mentality.


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## JPINFV (Nov 27, 2010)

frdude1000 said:


> I do not agree with making medics take hard science courses.  To perform the current role of Paramedic, most of the information presented is not relevant.  Its not like we're going to have all sorts of specimen (urine and blood) testing equipment on a rig anytime soon.  We practice under protocols; for the most part, we treat what we see.  How does the ecology topic in a Biology class have to do with working a code in the middle of the street.  If we changed the role of a paramedic, I can maybe see a use for some of these classes.  I am all for more education for EMS personnel, but I believe it should be in something useful; we really don't use genetics and mollecular biology too much in the field.  How about more education on the illnesses, injuries, and diseases we see in the field and the skills we use to treat them.



...then paramedics need to accept that they're just trained technicians and not professionals. They need to follow the protocol to a T with no variation or thought about it and check with medical control on every call, especially everything not textbook. My personal opinion is that working with a philosophy that strict is actually pretty dangerous as patients don't read the text book. 

As far as genetics and molecular bio, paramedics should at least have a general understanding of it. Genetics can change things as simple as the proper dose of medication and having a understanding of the underlying mechanics prevents bouts of mass stupidity that is, unfortunately, all too common in EMS. There are way too many threads here which leaves people scratching their heads thinking, "Umm, the body/science doesn't work that way," and considering I think that the average forum participant is smarter than the average EMS provider, I can't imagine some of the misconceptions that the average provider has. After all, if you don't understand free radicals, and pulmonary equations, it's hard to imagine how supplemental oxygen isn't a cure all and how oxygen can hurt.


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## Shishkabob (Nov 27, 2010)

Journey said:


> By your reasoning, Respiratory Therapists, Radiology Technologists and Sonographers are also the equivalent of a nurse. The difference in these professionals and the Paramedic is that their minimum entry level is a two year degree. For your state of Texas, you only need  600 hours of traiing.



I actually tend to think of each one ABOVE the average new grad nurse in their respective field.  2 years specializing in what they do.  Just as (in general terms) a Paramedic spends 2 years specializing in prehospital management.  A nurse spends 2 years learning a little bit about all aspects of medicine, not one specific area.   Where's the error in thinking?



(And don't you try and compare a BSN to another profession that only needs 2 years, as in most areas I know a BSN is a nice to have and not a requirement.  Compare like things, which in it's current form is 2 years of education)




> As a specialist trained specifically in Emergency Medicine, you do not have the same core education as a nurse and therefore you are not a nurse or like a nurse.




A nurse trained in OB/GYN cannot compare to my knowledge in pre-hospital emergency medicine, correct?  So I, again, fail to see the error in thinking.



I have not once, in my two years on this forum, declared that education in ANY aspect of what we do as "more than enough".  However, you need to realize that it is not our primary duty to be jacks of all trades, as a new grad nurse IS.  




PS-- Not all accredited nursing schools require, nor teach, pre-reqs, and can require nothing more than a GED.  Example in my short search, not too far from me.   http://www.dni.edu/index.php?option=com_content&view=article&id=154&Itemid=32


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## Akulahawk (Nov 27, 2010)

I don't think there is anything in your post that I didn't already know. I also didn't state that my undergrad program was in EMS. I am a Paramedic that happens to have a Bachelors in Sports Med. Paramedic school was easy. 

The rest of my comments are bolded, in-line.



Journey said:


> Does every Paramedic program require those same classes in your state? I didn't think California required a degree from a college to be a Paramedic.  Don't confuse the classes which tech or trade schools call A&P, Pharmacology or math. These abbreviated classes are not the same as a college class and will not transfer to a university or even a community college. You can get a few credits for your Paramedic cert but that is about all.
> *California does not require a degree to be licensed as a Paramedic. I do understand the difference between the A&P stuff taught by a trade school and that taught at the collegiate level. Why is that? I actually attended a College that is well known for their Sports Med program.  *
> A Paramedic can get a degree but it is not required. Usually only a certificate is required. You can advance in some agencies if you have a degree but few EMS employers will state degree preferred. A nurse can get a BSN or MSN although just an ADN is required for entry. Employers can also state they prefer a BSN in their employment ads and it is not considered unual to require more education than the state or national minimun in that profession or most of the other health care professions. It is unual to require a degree to be a Paramedic unless you are in Oregon.
> *I have seen that everywhere I go. Oregon has a better program that what I've seen elsewhere precisely because they require their Paramedics to have a higher level of education than what's required anywhere else.*
> ...


Please do understand that I possess a MUCH better education than most Paramedics do.


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## brentoli (Nov 27, 2010)

Linuss said:


> (And don't you try and compare a BSN to another profession that only needs 2 years, as in most areas I know a BSN is a nice to have and not a requirement.  Compare like things, which in it's current form is 2 years of education)



Obviously you haven't met a new grad ASN on their job search. The nursing shortage was hype by nursing schools. While a BSN isnt required it cuts down the job search 3-6 months because employers know they are getting more for their money. Some department directors at our local hospital require their RNs to do x amounts of research a year... something an ASN isn't prepared for.



> A nurse trained in OB/GYN cannot compare to my knowledge in pre-hospital emergency medicine, correct?  So I, again, fail to see the error in thinking.


But you won't compare to their education in chemistry / biology / pharmacology / mathematics straight out of a paramedic program




> However, you need to realize that it is not our primary duty to be jacks of all trades, as a new grad nurse IS.



How does this help your case? You are saying a nurse has a much more broad education. By extrapolation it means the nurse is more adapatable to specialization.


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## Shishkabob (Nov 27, 2010)

brentoli said:


> But you won't compare to their education in chemistry / biology / pharmacology / mathematics straight out of a paramedic program



Aside from math, which I publically admit I suck in and wish math would die a horrible death, you don't know WHAT my background is on those other ones, WHAT my school required, or anything of that nature.  Assuming you do just shows you as foolish.



> How does this help your case? You are saying a nurse has a much more broad education. By extrapolation it means the nurse is more adapatable to specialization.



I have ALWAYS said nurses are more generalized in their medical education.  I have also always said that paramedics are more specialized in their education.



Is an orthodontist any less of a professional than a dentist just because the dentist is a generalist when it comes to medicine of the mouth?  (Answer: No)


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## brentoli (Nov 27, 2010)

Linuss said:


> Aside from math, which I publically admit I suck in and wish math would die a horrible death, you don't know WHAT my background is on those other ones, WHAT my school required, or anything of that nature.  Assuming you do just shows you as foolish



No but I know what the standard paramedic program is. No one brought YOUR education into question. Quit being sensitive.


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## Shishkabob (Nov 27, 2010)

brentoli said:


> No one brought YOUR education into question. Quit being sensitive.



Hmmm?



			
				YOU said:
			
		

> But *you* won't compare to their education in chemistry / biology / pharmacology / mathematics straight out of a paramedic program





Maybe YOU (you, as in brentoli) didn't mean "you" in a specific sense but in a more general sense, but that's not what you wrote, so that's the response you got in return.  Don't be so sensitive to replies that your post warranted.


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## brentoli (Nov 28, 2010)

Linuss said:


> Is an orthodontist any less of a professional than a dentist just because the dentist is a generalist when it comes to medicine of the mouth?  (Answer: No)



This corollary doesn't make sense. An orthodontist is a dentist with a couple more years of education and training. I don't see how this relates to the nursing/paramedic topic.


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## Shishkabob (Nov 28, 2010)

brentoli said:


> This corollary doesn't make sense. An orthodontist is a dentist with a couple more years of education and training. I don't see how this relates to the nursing/paramedic topic.



A Paramedic has more education in pre-hospital emergency management than a new grad nurse.


It's not to be taken at a 1:1 ratio..... Not my best comparison, but it gets the point across.


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## MrBrown (Nov 28, 2010)

and with talk like this it comes as a suprise that Paramedics in the US are not respected and get paid minimum wage to sit at a gas station for 12 hours then go work another two jobs?

*Brown gets in his helicopter and flies far, far away


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## SerumK (Nov 28, 2010)

Linuss said:


> So you're telling me a Paramedic can't adapt either?  You're telling me Community Paramedicine is a hoax?


Yes... the Community Paramedicine idea is a JOKE of a hoax until paramedicine becomes a profession with a collegiate educational underpinning as its basis. 

Community Paramedicine is not a field for a technician.



> What makes you think a Paramedic is completely and totally incapable of transitioning to other areas as well, with the same orientation?  What makes a new grad nurse any more capable at working in an ER than a Paramedic with the same educational requirements?


3-7 years of college education, depending on the RN's degree. 

The basic ADN usually has 3-3.5 years of college, 1-1.5 year of gen-ed + prereqs, then 2 years of nursing. Most ADN programs are actually 75 credits or more required, and the students have to take more than that in order to get their prereqs. BSN? 4-5 years. ABSN? 4-5 years depending on the previous degree + prereqs, then another 1.5-2 years crammed into 1-1.5 years.

But when you look at what do they want for public health nurses, the closest "equivalent" to the "community paramedic," they want a BSN.



> Anyway-- medicine is full of specialized professionals.  Respiratory therapist, rad techs, sonographers, etc etc.  Why is it so bad that we are specialized in emergency medicine?  No one has YET to explain that to me.



RTs are associates minimum with most being or heading towards bachelors now. They are therapists, specialized clinicians, not technicians.

Know what the difference is? Techs don't get to change fields with an orientation. Sonographers don't read their echos. Rad techs don't read their x-rays. They take pictures of a patient and hand it off to a doctor who interprets them then decides what to do.  If paramedics decide they are specialized techs, then that is all they ever will be.

But you don't want to be. Paramedics want to assess, diagnose, determine an outcome, perform interventions, plan, evaluate their actions, etc. These are NOT the actions of a technician. These are the actions of a clinician and *EMS is that LAST place in medicine where anyone is still allowed to do that without a college education.*


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## SerumK (Nov 28, 2010)

Linuss said:


> A Paramedic has more education in pre-hospital emergency management than a new grad nurse.



You fail to understand that there is a difference between specialist training versus educational foundation.

Paramedics have more specialized training. The requirements to be a paramedic do NOT include in-depth educational foundations to build truly advanced understanding of their specialty or general expansion into other specialties.

That is why the average ED RN has much more after a few years than a paramedic after few years, all other things being equal... and the ED nurse still has the foundations to go become an ICU nurse, an OB nurse, whatever. The basic paramedic does not.


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## Shishkabob (Nov 28, 2010)

This whole thread is just turning in to a broken record.

I have never, not once, said "We don't need to learn any more".  So if you continue to insinuate as much, you will continue to be wrong.




Why is it SO bad that Paramedics specialize, while nurses generalize?  Why is it ok for other professions to be specialist in their respective fields, and no one doubts that they know more about that stuff than the average nurse, yet it's so "Oh my God" horrible when the same is said about Paramedics?


Oh, and please tell me... is a new grad nurse instantly a 'higher level of care', then say, Akulahawk, because he's a lowly Paramedic?  Is someone fresh out of nursing school instantly better than someone with years of experience, just because THEIR chosen profession doesn't require English lit?  Heck, is someone fresh out of nursing school better than someone fresh out of Paramedic school, every single time?



I don't know about you, but I've met just as many fallible and idiotic nurses as I have Paramedics.  Just having the title "RN" does not make you better than someone with NREMT-P.  You may disagree with me, you are free to do so, but I've made my point abundantly clear whilst you have yet to answer my one simple question I've asked multiple times in this thread alone.


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## MrBrown (Nov 28, 2010)

SerumK said:


> You fail to understand that there is a difference between specialist training versus educational foundation.
> 
> Paramedics have more specialized training. The requirements to be a paramedic do NOT include in-depth educational foundations to build truly advanced understanding of their specialty or general expansion into other specialties.
> 
> That is why the average ED RN has much more after a few years than a paramedic after few years, all other things being equal... and the ED nurse still has the foundations to go become an ICU nurse, an OB nurse, whatever. The basic paramedic does not.




Praise the Lord, preach it brother!

*Brown knows who is going to win the 2010 Orange Jumpsuit award


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## SerumK (Nov 28, 2010)

Linuss said:


> Why is it SO bad that Paramedics specialize, while nurses generalize?  Why is it ok for other professions to be specialist in their respective fields, and no one doubts that they know more about that stuff than the average nurse, yet it's so "Oh my God" horrible when the same is said about Paramedics?


It's all about what you want a paramedic to be:
It's OK to be a specialized technician, but not if you want pay equal to an educated medical professional. 
It's OK to be a specialized technician, but not if you want to have expanded roles that require advanced diagnostic thinking. 
It's OK to be a specialized technician, but not if you want to expand out of your specialty.

That's why paramedics won't be community paramedics or as well paid as nurses as long as they remain HS Diploma + 6mo Trade School as the minimum entry.



> Oh, and please tell me... is a new grad nurse instantly a 'higher level of care', then say, Akulahawk, because he's a lowly Paramedic?  Is someone fresh out of nursing school instantly better than someone with years of experience, just because THEIR chosen profession doesn't require English lit?  Heck, is someone fresh out of nursing school better than someone fresh out of Paramedic school, every single time?



Certainly not a "higher level of care!" Apples and oranges... but to your overall point:

Arguably, a NEW paramedic is more competent in their field, on average, than a new grad RN in the ED. But an ED RN with 1-2 years of experience is more capable in their realm than the 1-2 year paramedic in their realm, on average, and the disparity can grow. 

-------

Lastly, going on about how college educated medical providers aren't worth it because "English Lit doesn't make you better" is based in only one of two things:

1. Ignorance of what a college education actually entails and instills. You don't know what you don't know.
2. An intentionally disingenuous attack... honest debate, please!


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## SerumK (Nov 28, 2010)

Let's go on another journey to screwed-up-metaphor-land for craps and grins!

The paramedic comes out of training with a doublewide home. It's nice, but you can only do so much to it.

The nurse comes out of school with the singlewide from which to supervise the construction upon the large concrete foundation created through school. 

For humor: the EMT comes out of school with two sticks, a flint, and a canvas tent... the CNA comes over to sleep with him because his tent is nicer than hers, and the exercise warms up the sleeping bag.


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## Shishkabob (Nov 28, 2010)

> But an ED RN with 1-2 years of experience is more capable in their realm than the 1-2 year paramedic in their realm, on average, and the disparity can grow.


  That's largely debatable and intangible.  I know 'newer' medics who can school 'more experienced' nurses.  I know newer nurses that can run laps around some medics. 


You want to compare like things?

Oregon requires Paramedics to have an AAS minimum.  Same exact pre-reqs, only difference between the two is what is taught in their specific classes.  Now, instead of apples to oranges, it's more like apples to red oranges.  



Is the nurse still "better" because they are generalized?  Or are they then the same level of care, commensurate in pretty much all aspects but specialist in their desired field of study?  THAT, my friend, is what I have been trying to get across this whole thread.


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## Journey (Nov 28, 2010)

Linuss said:


> I* don't know about you, but I've met just as many fallible and idiotic nurses as I have Paramedics.  Just having the title "RN" does not make you better than someone with NREMT-P. * You may disagree with me, you are free to do so, but I've made my point abundantly clear whilst you have yet to answer my one simple question I've asked multiple times in this thread alone.




Now you are resorting to the use of personal attacks or experiences to drag down professions based on a few incidents involving individuals you have seen.   You have also stated to being a very new Paramedic and it seems like very little experience applying your newly acquired skillset or knowledge  based on some of your posts.   You may also only comparing nurses for their ability to do the same skills you do. 


To answer your question simply, an RN requires a degree which means at least a two year committment for study. The minimum requirements are national and graduation from an accredited program is required to take a national exam.   When  RNs come out of a degree program, they know they will probably need an orientation program which includes more training and education. The additional training learning specific skills and protocols may even be longer than the 3 or 6 month Paramedic program.  

To achieve the same level of base knowledge with the education, the Paramedic would need to have at least an Associates and then spend several more months specializing. I believe other countries do have something similar for their Paramedic programs where they get a solid education and then spend 1 - 2 years interning to become clinicians rather than technicians. 

The NREMT-P is a certification which is not even used or accepted in all states. Some Paramedics believe it is useless and don't get it or keep it if they don't have to.   Each state determines its own levels and minimum hours of training.  RNs and a few other professionals can also challenge the Paramedic exam in a few states. 

A 3 month medic mill product should not be equal to an RN or anyone in the health care professions who has a degree in their chosen profession.  Would you expect a PCT with 600 - 800 hours of training to be equal to an RN? Would you expect the LVN with 1200 - 1500 hours of training to be equal to an RN?  Would you expect an MA with 800 - 1000 hours of training to be equal to an RN?  These techs also do several skills and provide valuable patient care but they are not RNs.  

The job a Paramedic does is very important which is why it is puzzling that so many believe a few hundred hours of training are enough and that some are allowed to do so much with so little education behind them to support the whys of doing advanced skills and protocols.


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## Level1pedstech (Nov 28, 2010)

SerumK said:


> Let's go on another journey to screwed-up-metaphor-land for craps and grins!
> 
> The paramedic comes out of training with a doublewide home. It's nice, but you can only do so much to it.
> 
> ...



 Do you live in fantasy land or are you just completely oblivious to what is available as far as pay and benefits to people who do take the initiative and improve their educational pedigree? I like your way of thinking but are you willing to put in all that time then try and raise a family on under 100k a year. I don't see very many people in any area of EMS making that kind of cash unless they are putting in massive amounts of over time. I'm sure someone can honestly say that they make that kind of money without living at work but its not the norm and is probably the result of many years of hard work. I just don't see any of the privates or the fire service prying open their wallets and offering up wages that reward the educational efforts of those that really want to improve. 

 I have said it before and until you can give me concrete proof that the system will change you are preaching to people who would love to get an advanced education (myself included) but are not willing to work for chump change. Please don't even try and make it about taking pride in being considered a medical professional rather than a technician thats an insult to all of those that have given years of excellent service as lowly technicians. Try telling that to an employer when you ask them to double what they have been paying their technicians for years. I'm glad you would get a warm feeling with your new found stature but can you pay your bills with your new title. 

 I'm curious what kind of money you think a person should expect to make if you had your way and could change the current system? I can help you out a little, I as a teamster truck driver with no advanced education but after a lot of hard work make right at 90K add in my benefits and its a 130k package give or take a few grand. I struggle to make ends meet and support a family of five and by no means do I live a fancy life. When I think of a salary that reflects the time your asking people to commit I think 150k+ to start, I don't think your going to see that in our life time.

  I don't know how much real world experience you have but many of the folks on this board have very little and they need to know the cold hard facts about what awaits them. Felling great about your professional status is nice, providing outstanding patient care is job one but people need to be able to find jobs that provide a base to not only improve their professional life but their family life as well. I don't see a whole bunch of those jobs out there maybe you could help me out. I do applaud your efforts and really have changed my way of thinking about how the system needs to be improved over the years but sadly especially in this economy you truly are living large in fantasy land. Maybe wait and give it a shot after 2012 when we regain control of our country and the economy returns to where it needs to be if you want your visions to come to fruition.


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## SerumK (Nov 28, 2010)

Linuss said:


> ancdotes anecotes anecdotes and OR


That's why I said "largely" an "ON AVERAGE." There's always individually exceptions.

As far as OR, educated generalists are NOT "better" than educated specialists, just different (and more versatile in the long run). Three realities remain in this debate:

1. Generalists can specialize far easier than specialists with no generalist foundation and education can switch specialties.

2. As long as OR remains a national anomaly re EMT-Ps, the insurance/government policy reflecting reimbursement will not allow commensurate pay with their education, although surely it is better vs standard of living than some other areas in a given facet of their employment, if only by reducing the influx of fresh meat.

3. EMS is debating whether to require AAS degrees to become a paramedic, while only a few paramedics are getting degrees and nobody is requiring it. Meanwhile, nursing is debating whether to require BSN as the MINIMUM with BSNs rapidly approaching 50% of new grads, employers requiring or preferring BSNs, AND a slew of ASN to BSN programs out there which are OFTEN FUNDED BY THE NURSE'S EMPLOYER.

To think, my ambulance service was incredibly progressive because they would reimburse EMTs to take A&P. What a rare concept!


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## SerumK (Nov 28, 2010)

Level1pedstech said:


> Do you live in fantasy land or are you just completely oblivious to what is available as far as pay and benefits to people who do take the initiative and improve their educational pedigree? I like your way of thinking but are you willing to put in all that time then try and raise a family on under 100k a year. I don't see very many people in any area of EMS making that kind of cash unless they are putting in massive amounts of over time. I'm sure someone can honestly say that they make that kind of money without living at work but its not the norm and is probably the result of many years of hard work. I just don't see any of the privates or the fire service prying open their wallets and offering up wages that reward the educational efforts of those that really want to improve.
> 
> I have said it before and until you can give me concrete proof that the system will change you are preaching to people who would love to get an advanced education (myself included) but are not willing to work for chump change. Please don't even try and make it about taking pride in being considered a medical professional rather than a technician thats an insult to all of those that have given years of excellent service as lowly technicians. Try telling that to an employer when you ask them to double what they have been paying their technicians for years. I'm glad you would get a warm feeling with your new found stature but can you pay your bills with your new title.
> 
> ...



You have absolutely pegged the catch 22 of the system... and the solution sadly has to come from the political/professional organization realm at this point. The infrastructure of the EMS reimbursement system at this point is built around vocational technicians and certain parties have found that these low standards can be good to their bottom lines. The paradigm shift required to go from the current system to something like NZ or Canada requires such a shift in professional requirements, system structure, and reimbursement guidelines, that I do NOT pretend to know how it can be done without a government mandate brought on by professional organization political lobbying.

That, however, will never happen without political will on the part of us, the rank and file EMS provider. So in a way, yes it is about pride... and about having a sufficient educational base built into the EMS system that we can say: "yes, make the requirements (and duties) higher, there are enough of us there already, the rest will rise up or bow out. The higher requirements and service will reduce cost in the whole healthcare system, command better reimbursement, reduce labor turnover (and supply), all of which will economically justify the wages that justify the requirements we are asking EMS to meet."

That's about the only way I see the "chicken or the egg?" quandary being solved on the subject of EMS professional education and reimbursement.

And yes, I realize I ACTUALLY live in reality. That's why I have detoured from EMS into a BSN program. I did it knowing I'd be humped for the short run because of the RN job market, but set for the long long run. Of course, if I really wanted some money, I never would have left my plush IT job for EMS. I guess that's why I went back to IT when I realized my prospects in working in EMS, and just volunteered while I worked and went to school for nursing. I freely admit such a course is the luxury of being a working professional with no family to support.


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## Journey (Nov 28, 2010)

Linuss said:


> Oregon requires Paramedics to have an AAS minimum.  Same exact pre-reqs, only difference between the two is what is taught in their specific classes.  Now, instead of apples to oranges, it's more like apples to red oranges.




I also thought Oregon required an Associatates degree but that is not the case for  reciprocity so I am correcting any previous statements that may have led you to believe this is an absolute truth. 

In Oregon, a person transferring from another state must just show submit proof of having worked for at least three years out of the last five years as a paramedic in either another state or in the Military at the Paramedic level.  If you don't meet either of those requirement and  you don't have a degree you can also still apply for a provisional license. 

The website is also not specific if the Associates degree has to be in EMS or the health sciences.

Without a set entry requirement, it would still be difficult to use Oregon as an example for the  degree based Paramedic.


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## Journey (Nov 28, 2010)

Level1pedstech said:


> I just don't see any of the privates or the fire service prying open their wallets and offering up wages that reward the educational efforts of those that really want to improve.



I don't know much about private ambulances but FDs do offer monetary rewards for education.

Here's an example and this is a very low one.  Many FDs base their promotions with an educational requirement.



> The following is additional incentive pay available if an employee meets the following certification or degree requirements:
> $300 a year for ACLS Instructor
> $300 a year for IV certification (Emergency Medical Technicians only)
> $300 a year for 12 lead certification (Emergency Medical Technicians only)
> ...


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## Level1pedstech (Nov 28, 2010)

SerumK said:


> You have absolutely pegged the catch 22 of the system... and the solution sadly has to come from the political/professional organization realm at this point. The infrastructure of the EMS reimbursement system at this point is built around vocational technicians and certain parties have found that these low standards can be good to their bottom lines. The paradigm shift required to go from the current system to something like NZ or Canada requires such a shift in professional requirements, system structure, and reimbursement guidelines, that I do NOT pretend to know how it can be done without a government mandate brought on by professional organization political lobbying.
> 
> That, however, will never happen without political will on the part of us, the rank and file EMS provider. So in a way, yes it is about pride... and about having a sufficient educational base built into the EMS system that we can say: "yes, make the requirements (and duties) higher, there are enough of us there already, the rest will rise up or bow out. The higher requirements and service will reduce cost in the whole health care system, command better reimbursement, reduce labor turnover (and supply), all of which will economically justify the wages that justify the requirements we are asking EMS to meet."
> 
> ...



 Good to see you have given some thought to what lies ahead. You have to admit that there are many out there who share your vision but have absolutely no idea on how to make it happen. To many the idea of an MD and an RN on every EMS unit would be a wet dream come true but lets come down out of the clouds and take a look at what reality has to offer and what needs to be done for them to realize their visions of grandeur for the EMS service.

 Where on the list of must do's to get this country back on the road to prosperity do you see the importance of vast improvements to the EMS system. I'm sure your well aware that federal state and local budgets are hemorrhaging money at an alarming rate. To realize your vision you are going to need revenue along with cooperation of both parties in Washington. Revenue for the changes you seek comes largely from taxes,I don't know about you but I'm taxed to death and until I see a more disciplined government I'm not going to offer up any more and I think most of the country are in my corner. Tax levys are getting passed but at a rate much lower than in previous years. People see waste and fraud and a complete lack of respect for our hard earned money and they are growing very tired.

 Privates as well as municipal agencies need to have money coming in in order to pay wages and right now there is are not enough sources of revenue to satisfy the commitments already made. The American people are tired and fussy and in general have no idea what problems their EMS services suffer from. You dial 911 and boom you get help from a provider, maybe not with the educational pedigree that some desire but in the heat of the moment do you think Mr John Q Public really gives a rats rump. I do think change is possible but we have bigger eggs to crack before we ask for something as huge as a full remodel of our EMS system. Your a stand up guy for taking the time to see the problem from both sides and for understanding what a major job its going to be to reach your goal. Like I said I think to many people want change but have not thought the process thru to the finish.

 Good job making the move to the BSN program I know its alot of work but there is a pay off and you will truly be a more satisfied health care professional. Dont be discouraged there are RN jobs even ER RN jobs for the right people especially with a pre hospital EMS back round. You may have to work on call or per diem at more than one hospital but take heart you wont be the only one and at least you wil be working. I can only hope to get there myself someday but the window is almost closed and its not looking good. I only work in the ER at this time and I can tell you I'm not as frustrated at the end of a shift like I sometimes was after a shift at the fire house. I do keep in touch with people working on the outside and they seek change but most are glad to have a job these days even one that pays chump change it's sad but I feel a change is coming.


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## Level1pedstech (Nov 28, 2010)

Journey said:


> I don't know much about private ambulances but FDs do offer monetary rewards for education.
> 
> Here's an example and this is a very low one.  Many FDs base their promotions with an educational requirement.



 As a former fire guy I truly do appreciate your example but as you know the fire service is not exactly flush with jobs at the present time and that's probably not going to improve any time soon. And when jobs are available your looking at a very competitive career choice so its really not fair to put it in the mix. Even with all the add on's and assuming you top out at a captain or above you will not generally break that 150k barrier unless like I said before your swimming in OT. Of course BC's and other Chief staff are up there but that's not a likely scenario for most even the ones that manage to get a fire job in the first place. The examples you used add up to about 76 dollars a week which is a start but far from where it needs to be even in the fire service which we all know generally pays far better than private agencies.

 The kind of money I'm talking about is 150k for a normal work week if your going to invest 4-7 years of time to advance your education.  To be honest the fire service would be the first to secure resources to reward their employees that seek the higher EMS education being discussed but you have to remember it all goes back to revenue which comes from taxes and you know that drill.


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## gicts (Nov 28, 2010)

The biggest hindrance I see is even if it was decided we deserve more, where would it come from? Ambulance bills can reach $1,000 or more, departments are cutting back, insurance companies will only foot so much, and many people transported simply never pay. 

How could your agency get the funds to essentially double their staff budget? Heck, ours can barely keep the trucks on the road.

That is the reason IMO EMS will never be a well paying gig. :wacko:


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## Level1pedstech (Nov 28, 2010)

gicts said:


> The biggest hindrance I see is even if it was decided we deserve more, where would it come from? Ambulance bills can reach $1,000 or more, departments are cutting back, insurance companies will only foot so much, and many people transported simply never pay.
> 
> How could your agency get the funds to essentially double their staff budget? Heck, ours can barely keep the trucks on the road.
> 
> That is the reason IMO EMS will never be a well paying gig. :wacko:



 Well said, I guess there are more people out there that question where all the money to pay for these changes is going to come from. You can also factor in the hundreds of smaller departments that would love to be able to staff a full time ALS rig with a paid crew but even at today's wages its not happening for many.


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## 46Young (Nov 28, 2010)

Good luck with organizing. Most employers across the board want to keep EMS salaries as low as possible. Who's going to advocate degrees if it'll mean a pay increase? Meanwhile, many in the profession are transient as it is.


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## SerumK (Nov 28, 2010)

Level1pedstech I appreciate your thought out posts.



46Young said:


> Who's going to advocate degrees if it'll mean a pay increase?


Worked for OT, PT, RT, PA, and RN... each stood up as a profession and decided it and then worked for it. The process took YEARS. Why is EMS so different?



> Meanwhile, many in the profession are transient as it is.



That's what I'd call a symptom.


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## Veneficus (Nov 28, 2010)

*I was trying really hard not to get involved in this thread*

But I would like everyone to consider:



Level1pedstech said:


> Well said, I guess there are more people out there that question where all the money to pay for these changes is going to come from. You can also factor in the hundreds of smaller departments that would love to be able to staff a full time ALS rig with a paid crew but even at today's wages its not happening for many.



I see your point, and I agree largely, but I ask you to consider the side I see it from, which is basically the opposite side.

Because the healthcare system funding is unsustainable. There most certainly will be major retraction. No political party will be able to stop that. You cannot create money that doesn't exist and get away with it for long.

When that retraction comes, budgets will go down and people will lose their jobs. Especially in my opinion, low and midlevel providers. In any industry in contraction they are always first to go. 

At that point in addition to competition for jobs, a provider who can demonstrate versatility or value above the average will be the prime choice. 

Because this provider will actually be replacing several providers or operating in a capacity that saves money in the long run, they will be paid higher. 

$150K/year I doubt very much.

But if you pay on average $24K/4 years for a degree that gets you a job making ~75K a year when you figure in benefits, that is a hell of a good investment if your alternative is 24K a year at the local burger joint without benefits. Infact it pays for itself in 1 year. 2 if you add in your time at minimum wage. 

As I am sure you know, there aren't a lot of high paying union positions open. I figure many of those will soon be going the way of the UAW positions as the economy worsens or the healthcare bubble pops. 

I saw on monday that the average unemployment numbers. (you know the reported ones) are 10.4% for people without a degree and 4.9% for those with a bachelors or above. 

$24K/ 4 years to have a job is even better than no job at all, not competative, or competing with 10,000 people for 1 position.

For those hoping to make a future in EMS, even for a short time, I think it is only responsible for those already established to encourage not only a degree, but a change in thinking about the system.


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## SerumK (Nov 28, 2010)

Veneficus, I agree 100% with everything you said except that there is some i[YOUTUBE][/YOUTUBE]nevitable mass firing in EMS... now if you said in Fire, Id believe it.


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## Veneficus (Nov 28, 2010)

SerumK said:


> Veneficus, I agree 100% with everything you said except that there is some i[YOUTUBE][/YOUTUBE]nevitable mass firing in EMS... now if you said in Fire, Id believe it.



When medicare/medicade is cut, I very much doubt it will be physicians that take a major hit. 

However, I can see a significant decrease in both the reimbursement for IFT as well as the required level of providers and equipment. 

Let's face it, most routine IFT really is nothing more than a really overpriced taxi. Nowhere in EMS education outside of critical care transport is there focus on it. 

Other than spending the trip taking 2 sets of completely unnecessary vitals that will change nothing in the patient management at destination, and figuring out how to fill out the paperwork so it gets automatically paid, what special skills or medical training/equipment is really required?

A stretcher and 2 guys to lift it?

Oxygen that the same patients manage on their own?

looks like a prime place to be cut to me.


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## RunnerD1987 (Nov 28, 2010)

Sort of in the same boat. Just about finishing up college and not satisfied with directions can take me. So trying to branch out with taking an EMT-B course to help find where to go. Not great at math, but still considering going towards an area in the medical field. If it is what you want go for it and apply yourself. Just make sure it is what you want before you put in the hard work. Best of luck.


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## Shishkabob (Nov 28, 2010)

46Young said:


> Good luck with organizing. Most employers across the board want to keep EMS salaries as low as possible. Who's going to advocate degrees if it'll mean a pay increase? Meanwhile, many in the profession are transient as it is.



Meh, as Gen Y gets more in to the leadership roles, and the baby boomers move on out, it should get a bit better (hopefully...) but then again when I see my generation I wonder how we're ever going to avoid blowing the Earth up.





Veneficus said:


> Let's face it, most routine IFT really is nothing more than a really overpriced taxi.
> 
> A stretcher and 2 guys to lift it?
> 
> ...



Vast majority of BLS IFT needs to be gotten rid of, plain and simple.  The only BLS IFTs I can see as legit are the paralyzed / comatose, psychiatric, MAYBE the overweight.  Pretty much every other transfer should be ALS in nature.  

That would save the government, and insurance companies, a crap load of money right there.

Think of a single dialysis patient.  Last I read, $100 per treatment, was the norm, plus $300 ambulance ride.  Many need dialysis 3ish times a week.  That's $1200 a week.  That's nearly $60,000 per year, just in dialysis.  Let's face it, they aren't the healthiest people, so they visit the hospital quite a bit as well, also picked up by Medicare.  That's just a single person.  Think of all the money that could be saved by stopping ambulance transports (3/4 of the cost)

Granted I've oversimplified it a bit, AND not all patients are like that, but food for though.  






Journey said:


> Linuss said:
> 
> 
> > I don't know about you, but I've met just as many fallible and idiotic nurses as I have Paramedics.  Just having the title "RN" does not make you better than someone with NREMT-P.  You may disagree with me, you are free to do so, but I've made my point abundantly clear whilst you have yet to answer my one simple question I've asked multiple times in this thread alone.
> ...



 I don't know you, I don't know your qualifications.  To me, you're a brand new poster.  You can be an MD, you can be an RN, you could be a medic, you could be a first responder, or you could be one of the many phonies we have running around this site claiming they know stuff.   Don't question my professionalism and don't question my knowledge base just because you disagree with one of my views.  You don't know me personally, therefor you do not have any room to stand on with those views.  There are a few people on this site who DO know me personally, and I haven't seen a one go the route you have.  

 I not once stated our education was more than adequate, or that we know too much, or that we should stop learning, or that we're Gods gift to the world, or any variation thereof.  Quit making it seem as such.  I not once said we shouldn't get an associates minimum.  Quit making it seem as such.  I not once belittled entire professions.  Quit making it seem as such.


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## Aidey (Nov 28, 2010)

Linuss said:


> Think of a single dialysis patient.  Last I read, $100 per treatment, was the norm, plus $300 ambulance ride.  Many need dialysis 3ish times a week.  That's $1200 a week.  That's nearly $60,000 per year, just in dialysis.  Let's face it, they aren't the healthiest people, so they visit the hospital quite a bit as well, also picked up by Medicare.  That's just a single person.  Think of all the money that could be saved by stopping ambulance transports (3/4 of the cost)



Just a quick correction, dialysis patients cost around $25,000* a month for the dialysis and directly associated costs. That is about $2,000 per treatment, with the average patient doing 3 treatments a week. Kidney failure is an automatically qualifying condition under Medicare, meaning expenses are easy to track. When you start looking at the equipment, medication and staff costs it adds up quick. 

Sidenote - If this country can't reduce the levels of kidney failure due to type II diabetes and HTN the cost of paying for dialysis for all of those people will sink this country faster than any other health condition. 


*That was the number given to me 2 years ago when I was working at the dialysis clinic.


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## JPINFV (Nov 29, 2010)

Aidey said:


> Sidenote - If this country can't reduce the levels of kidney failure due to type II diabetes and HTN the cost of paying for dialysis for all of those people will sink this country faster than any other health condition.



Alternatively, I would be interested to see how much peritoneal dialysis costs compared to dialysis. This study ended up looking at 100 patients (50 HD matched to 50 PD) and found that PD was a little over 40k cheaper on average. Granted, not all HD patients are eligible for PD, but it would be interesting to see what could be done, especially if a system can be found for PD to be done with continuously cycling throughout the day instead of the current 3-5 cycling sessions.


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## Aidey (Nov 29, 2010)

Not only is it cheaper, it is healthier for the patient, and for the most part has lower complications. It also allows people to continue to work, go to school etc because of the more flexible schedule. There are the people who continually cycle during the night, and then exchange fewer times during the day too. Home hemo has a lot of the same benefits, but the learning curve is steeper, and complications can be more emergent. 

/hijack


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## Aidey (Nov 29, 2010)

Veneficus said:


> When medicare/medicade is cut, I very much doubt it will be physicians that take a major hit.
> 
> However, I can see a significant decrease in both the reimbursement for IFT as well as the required level of providers and equipment.
> 
> ...



I would guess that fully 50% of the transfers I do could have been dealt with other ways. Hospitals calling us because they don't want to wait for the WC van, only the Medicaid WC van running at night (which they still don't call). SNFs sending out palliative care patients with fevers (who then also have to be sent back by amb). I could go on. 

Something I always ask myself when looking at transfer paperwork is "How does this patient normally travel?". Way too often the answer is WC van or as a passenger in a private vehicle. 

To combine my last post with this one, we had a lady at the dialysis clinic who was normally AOx2 due to a stroke, she broke her hip and went on to have at least one more stroke while in the hospital from that. When she came back she was AOx1 and nearly completely aphasic. She almost needed 1:1 attention to keep her from pulling her needles. She was being sent back and forth via WC van. The little old lady who can't remember if it is the 24th or the 25th does NOT need "medical supervision" for her dementia. 

There are so many places they could save money if they made the system more efficient and cut down on the insane amounts of unnecessary transports being done.


Edit: Also to combine my last post and this one, if it hasn't happened already, when are we going to start putting dialysis units in SNFs? Less transports, the patients could receive longer dialysis treatments, better continuity of care, less trauma to the patients etc.


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## Shishkabob (Nov 29, 2010)

Correction noted, Aidey.  I had just quickly looked up what Medicare reimbursed a while back and guess I got the wrong source 


There was SO much that this past healthcare "reform" could have done to actually fix the problems instead of just making more people pay for said waste, yet obviously the people we have making policy can't even tie their own damn shoes correctly, let alone use brain cells to solve a problem.

Here's a hint:  Ask the people who work in healthcare everyday what needs to be changed, not some pencil pusher who hasn't seen a patient in 30 years.


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## Aidey (Nov 29, 2010)

Part of the goals of the reform are cutting waste, but I agree that they need to ask the people currently working in healthcare. 

That may be what Medicare reimburses for one specific aspect of the treatment. Like I said, the different costs add up quick. There are the staff costs for the techs, nurses, dietitian and others; medication costs*, labs done twice a month minimum, heparin, tubing, needles, dialyzers, saline**, gloves***, biohazard waste****, disinfectants, the dialysate solutions. So Medicare might reimburse $100 for the treatment, but all the stuff needed for the treatment is another $1900.   

* Look up the cost of one dose of Epogen - holy crap.
** Yes, saline is cheap, but my 32 chair clinic went through a couple cases day.
*** About one box per tech, per 12 hour shift. 
**** Another thing that adds up REALLY fast.


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## Veneficus (Nov 29, 2010)

JPINFV said:


> Alternatively, I would be interested to see how much peritoneal dialysis costs compared to dialysis. This study ended up looking at 100 patients (50 HD matched to 50 PD) and found that PD was a little over 40k cheaper on average. Granted, not all HD patients are eligible for PD, but it would be interesting to see what could be done, especially if a system can be found for PD to be done with continuously cycling throughout the day instead of the current 3-5 cycling sessions.



There was a study done in Britian that shows there is no change in outcome between peritoneal and hemodialysis however there was tremendous cost savings, I will try to look it up later for you, on a quick break at hospital.


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## Veneficus (Nov 29, 2010)

Linuss said:


> Correction noted, Aidey.  I had just quickly looked up what Medicare reimbursed a while back and guess I got the wrong source
> 
> 
> There was SO much that this past healthcare "reform" could have done to actually fix the problems instead of just making more people pay for said waste, yet obviously the people we have making policy can't even tie their own damn shoes correctly, let alone use brain cells to solve a problem.
> ...



THe problem isn't not knowing what needs to be done, the problem is not having the guts to do it. 

If you are a politician with stocks invested in a pharm company, it hurts you to reduce pharm costs.

If you are a medical university, you don't want to hear that student loans won't be available to fund your outrageous tuition.

If you are a doctor, you don't want to hear you are not making enough to pay the $1400 a month school loan you got.

If you are a specialist you don't want to hear they are doubling residency spots meaning the wait list to see you goes down and you can't demand outrageous sums of money for only being able to perform an extremely limited medical practice and sending the patients to 10 other doctors none of whom commnicate.

the list goes on.


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## 8jimi8 (Nov 29, 2010)

Veneficus said:


> There was a study done in Britian that shows there is no change in outcome between peritoneal and hemodialysis however there was tremendous cost savings, I will try to look it up later for you, on a quick break at hospital.



My experience is biased by a year of working out our level 1 county hospital.  If you look at people that I've served that required hemodialysis, the vast majority of those are complications non-compliance and /or other bad habits.  You cannot tell people who skip dialysis to go drinking that they need to be managing a peritoneal dialysis rig several times a day.  This is the same for home hemodialysis.  These are management routines for only the most conscientious and compliant of patients.


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## usalsfyre (Nov 29, 2010)

8jimi8 said:


> My experience is biased by a year of working out our level 1 county hospital.  If you look at people that I've served that required hemodialysis, the vast majority of those are complications non-compliance and /or other bad habits.  You cannot tell people who skip dialysis to go drinking that they need to be managing a peritoneal dialysis rig several times a day.  This is the same for home hemodialysis.  These are management routines for only the most conscientious and compliant of patients.



Quite frankly, these folks need to take responsibility for their health, or they will die. We can give people the tools to take care of themselves, and if they don't, tough feces....

What would happen to the hemodyalisis industry however, I do not know.


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## Minnick27 (Nov 29, 2010)

Another thing you have to think of is that not all patients are able to do peritoneal dialysis. There needs to be enough room for them to be able to infuse the fluid every day. And the previous poster is correct about cost, it costs alot of money to do a dialysis treatment. And you have to have a nurse present.  You could do what they do in hospitals and bring a portable machine in the room, but then you can only do one at a time. I've never been into a nh that has the room to build a dedicated area along with a water system which takes up alot of room


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## Aerin-Sol (Nov 29, 2010)

Linuss said:


> Vast majority of BLS IFT needs to be gotten rid of, plain and simple.  The only BLS IFTs I can see as legit are the paralyzed / comatose, psychiatric, MAYBE the overweight.  Pretty much every other transfer should be ALS in nature.



I'd also throw in some post-orthopedic surgery patients, but yeah, most BLS transfers are people really need a wheelchair van or a regular taxi. Why is it that they get sent on ambulances? Does medicare not pay for wheelchair vans?


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