# Using EMS education as a stepping stone?



## BuddingEMT (Apr 16, 2009)

A lot of people I know are going to EMT school because they think the certification on their resume would look good to medical school admissions officers. They have no intention of actually using the certification unless they think it would benefit them in some way (i.e. some university campuses let the student EMS service be on the field during football games in case somebody needs immediate medical help).

Are these people becoming EMTs for the wrong reasons? Or are they just being smart?


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## JPINFV (Apr 16, 2009)

If you get a certification just to have a certification then you're doing it wrong. If you don't put any work experience down on your AMCAS (either volunteer or job job) and you can't articulate any experiences during an interview, then it will be a non-issue. In general, though, EMT cert (B or P) is a slight benifit, but will never make up for bad grades or poor MCAT score.

http://forums.studentdoctor.net/showpost.php?p=5994783&postcount=3
http://forums.studentdoctor.net/showthread.php?t=556556


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## Ridryder911 (Apr 16, 2009)

Yes, they are only card carrying members. They raise the numbers up and administrators can use that for levy to pay lower because of the already over saturated market. 

Personally never seen any medical school that looks at being an EMT as anything more than a first aid class. Working will give some credibility due to the patient contact. 

One of the reasons we need more of a screening process. 
R/r 911


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## JPINFV (Apr 16, 2009)

Ridryder911 said:


> Personally never seen any medical school that looks at being an EMT as anything more than a first aid class. Working will give some credibility due to the patient contact.




Yep. My work as a basic was asked about in most of my interviews, but it wasn't really dwelled upon or anything. More of a "I see you've worked as a..." than anything else. It was essentially lumped in with my hospital volunteer experience.


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## Sasha (Apr 16, 2009)

People using EMS as a stepping stone? Good for them, they're moving on to bigger and better things.


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## EMTinNEPA (Apr 16, 2009)

Sasha said:


> People using EMS as a stepping stone? Good for them, they're moving on to bigger and better things.



Well, thanks for pooping all over my chosen profession. ^_^


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## Ridryder911 (Apr 17, 2009)

Sasha said:


> People using EMS as a stepping stone? Good for them, they're moving on to bigger and better things.



Actually, I wonder really how much bigger and better things are in comparrison?. Remember, it all depends upon the definition of what better really is? I have been accepted to medical school, started P.A. school and even NP, all to purposely remain in the EMS without regrets. 

I have very many friends that are physicians that tell me daily, how they miss EMS and hated ever  becoming ER Docs. Of course tey enjoy the lifestyle but hate the job as they now have no choice with such a commitment that has been made. Yes, I like the clinical practice and in hospital form of professionalism as I can have but I made the choice on my own to be back in EMS. I have found I can have both worlds, but professionally; much rather be happy and enjoy my profession than just getting a pay check.

I don't know standing on my feet 12 hours, listening to whining griping patients most that should never been allowed to be tx in the ED and to have to apologize to family because residents want to perform all the tests before admitting the patient. To never get to see all your patients your supposed to chart on every 15 minutes (or you will receive a warning) really a step up? 

Make a commitment of studies and profession over family, yourself and all other things for at least 6 years really worth it? It has to be done to make such positions as a move up.. Alike all other stuff sacrifices are made before success. 

I believe EMS is and can be a profession. Is it Universal at this time no, but I do believe it will sooner than most think. As more States are going to start requiring education, we will see it be a step up instead of a lateral movement or used as a movement at all. 

R/r 911


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## TransportJockey (Apr 17, 2009)

Ridryder911 said:


> Actually, I wonder really how much bigger and better things are in comparrison?. Remember, it all depends upon the definition of what better really is? I have been accepted to medical school, started P.A. school and even NP, all to purposely remain in the EMS without regrets.
> 
> I have very many friends that are physicians that tell me daily, how they miss EMS and hated ever  becoming ER Docs. Of course tey enjoy the lifestyle but hate the job as they now have no choice with such a commitment that has been made. Yes, I like the clinical practice and in hospital form of professionalism as I can have but I made the choice on my own to be back in EMS. I have found I can have both worlds, but professionally; much rather be happy and enjoy my profession than just getting a pay check.
> 
> ...



I personally would love to stay in EMS if we could become a real profession instead of a hobby for some volunteer to play at


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## JPINFV (Apr 17, 2009)

Ridryder911 said:


> I don't know standing on my feet 12 hours, listening to whining griping patients most that should never been allowed to be tx in the ED and to have to apologize to family because residents want to perform all the tests before admitting the patient. To never get to see all your patients your supposed to chart on every 15 minutes (or you will receive a warning) really a step up?



Instead of low pay in most areas, poorly educated partners more concerned about skills than medicine, overall lack of understanding of A/P which makes discussing new treatments hard, lack of understanding of the scientific method and studies (someone on JEMS Connect actually posted that he didn't understand why so many people discounted anecdotal evidence in favor of controlled studies), the insistence of calling medical control anytime a decision needs to be made in most systems, running emergently everywhere, the fire department, and several other issues facing EMS.


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## Ridryder911 (Apr 17, 2009)

JPINFV said:


> Instead of low pay in most areas, poorly educated partners more concerned about skills than medicine, overall lack of understanding of A/P which makes discussing new treatments hard, lack of understanding of the scientific method and studies (someone on JEMS Connect actually posted that he didn't understand why so many people discounted anecdotal evidence in favor of controlled studies), the insistence of calling medical control anytime a decision needs to be made in most systems, running emergently everywhere, the fire department, and several other issues facing EMS.



True, but I have physicians as well that are burned out before residency is over. One of the major factors of me not entering medical school after I was accepted was because I only found one physician that described they would do it all over again. This was from many specialities ranging from cardiology, radiology, internal medicine to emergency medicine. All respected professionals, but looking back they described they much had rather chose a profession they could have more of a personal life, less student loans and not "fixed" in. 

Are we behind the curve ball in EMS? You bet. You and I know that is what many of us are attempting to change and ignoring and not pursuing changes will never cause such occurrences. 

Just alike many other health care professions not that long ago that has changed within a few years we definitely have room to grow. 

I do disagree though, more and more are going to online controls as I only hear of that very seldom and even there is more evidence base medicine and scientific controls on the care and treatment we perform. Are there still ignorant medics? You bet. Will they just suddenly disappear? No. But, apathy will not change things either. 

I do believe we do not see many of the professional EMS providers on the EMS forums. I know of many that do very well and only have one job, have a formal education and understand medicine. Let's not dismiss and discount the several thousands that perform good quality emergency medicine everyday; and they do it very well and perform outstanding care. 

Compare those that now have a formal education that are within the profession of EMS to that of even 15 years ago. I read and see more formal research by those directly or having experience within EMS. 

As one that works on both side of the fence let's be truthful and expose both sides. I can assure you Vent & AJ can although discuss education they can also tell you of short supply of staffing, areas that require mandatory overtime and now hospitals that discussing hiring freezes and or lay offs leaving a more demand upon staff. Albeit it maybe ancillary staffing, someone has to pick up the slack. As well, alike any other profession there is internal politics that is very heavy.  

What I am alluding to is every profession has its pros and cons. I definitely agree EMS has its share of both and yes it is usually weighted on cons. But, lets not also display the hidden cons of the medical profession on the other side of the fence. 

I am seeing more and more of those that entered the nursing profession returning back to EMS full time and nursing part time. It has nothing to do with their roles or responsibilities but being happy at their job. Sometimes, that is worth a lot more than one can appreciate. 

I do believe EMS is at their pivotal area. Economics and at the same time scrutiny upon the profession for justification ... "basically getting the best bang for their bucks". The procedures will require more and more education to provide care, accreditation and changes of curriculum along with even the changes of the titles will be not noted immediately but within a few years. 

I believe we need to focus upon that EMS can and is a profession. Yeah, even a profitable one. Even being in a region of lower pay for EMS; most of our Paramedics make comparable to RN's and schedules allow more time off. 

Not debating EMS has room to grow, but so does all areas of medicine. 

R/r 911


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## bstone (Apr 17, 2009)

Rid, if you started PA and NP school why did you drop out?

Also, my uncle is a trauma and CC NP. I asked him about becoming a PA after being an RN and he near tore my arms out. What's up with that?


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## karaya (Apr 18, 2009)

Sasha said:


> People using EMS as a stepping stone? Good for them, they're moving on to bigger and better things.


 
Spoken from years of experience?


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## daedalus (Apr 18, 2009)

bstone said:


> Rid, if you started PA and NP school why did you drop out?
> 
> Also, my uncle is a trauma and CC NP. I asked him about becoming a PA after being an RN and he near tore my arms out. What's up with that?



Dont listen to your uncle, he clearly has childish prejudice against another provider for no real reason, and is not looking out for your interests. PAs are just as good as NPs, and the two cannot be accurately compared. Some PAs hate NPs with a passion, and some NPs hate PAs with a passion, and the infighting will never stop. Stay away from these people.


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## Ridryder911 (Apr 18, 2009)

daedalus said:


> Dont listen to your uncle, he clearly has childish prejudice against another provider for no real reason, and is not looking out for your interests. PAs are just as good as NPs, and the two cannot be accurately compared. Some PAs hate NPs with a passion, and some NPs hate PAs with a passion, and the infighting will never stop. Stay away from these people.



Around here they work well with each other. My state was the first that had a graduate degree P.A. program. It has a very successful program and truthfully harder to enter the P.A. program than to be accepted into the medical school. Ironically, the local program here has the same requirements for medical & P.A.; as again a premier program. 

The university also has a NP program. The popularity in it is not as much. Most of the NP's are not graduates from local though. 

Again, as I have described I have done thesis on comparison data of each and both and many other factors and they are very similar. 

There was multiple reasons for my choice of dropping out of P.A. school. First, I really did not care sitting in the same class of medical students; taking the same course work only required in a shorter time element and emphasis placed upon the medical model and I do appreciate holistic medicine which the medical model does not emphasize; rather treat symptoms in lieu of treating the patient in whole. 

The other reason is more simplistic: divorce. One usually cannot work a full time, attend class and the clinical time (40 hrs a week). 

I had been considering the NP route prior but the program I entered for P.A. emphasis was on acute care and really preferred that area. I took a break to save up money and instead of returning I enrolled into the NP program. 

Ironically, I have seen a drastic change in the role of NP's locally. Forever the P.A. had dominated the areas of clinical setting. It is now reversing. Major ED's in my areas are now hiring the NP in lieu or with the P.A. One of the reasons is that they work upon their own license and hence also carry their own malpratice insurance. In other words they are responsible for themselves and is cheaper for the group. Also, I am seeing more and more NP's and CNS being utilized with specialized physicians.

For example, a CNS or NP that has worked inside a CCU or agressive unit with direct patient contact then expand their education and knowledge strictly into that area. Not focusing on general medicine alike the P.A. but only into the specialized branch. 

Now if you were a physician and wanted an assistant which would you look at? A person that has a B.S. degree in anything then graduates P.A. school to enter the market or a RN that has a degree with a medical background, has documented clinical experience, then enters advanced studies focusing only in that specific area? Both expecting the same pay and responsibilities, but the NP is not going to affect your license, your malpractice rate, and still can bill appropriately? I was approached by many physician groups of contracting with them they would pay for my education and have a guarenteed position in a ED. As I stated the numbers are beginning to speak for themselves. 

Due to recent and ongoing health problems, I realize there is no way I could meet the demands of being a NP specially in a clinical setting. It was with great hesitation and sorrow, I will not even consider completing the NP program. I am focusing changing into the education arena, I was very close to the end of the program. Personally, I believe both the P.A. & NP are getting abused in most clinical settings. Many are only getting cases or procedures in which the physician feels that they do not want to do not solely based upon their qualifications or screening of the patient.    

There are several articles in comparison of both. Personally, I appreciate each of the profession. Both have a role and can be an asset to the health care. 

I believe AJ recently worked close with both in the military and maybe can give a personal view as well. 


R/r 911


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## curt (Apr 18, 2009)

R/r911, I've got to say that I agree. I haven't been around long, but I'm expecting a major shift in US EMS from "Treat what you can and get 'em to the hospital" to more of a primary-care style as ERs get more and more bogged down as the patient population soars in disproportion to ER capacity. As an example, say someone gets a pretty decent gash along their arm. It's not deep enough to cut to the bone, but it's a doozy. EMS was nearby, has the bleeding under control, and the man is showing no signs of hemodynamic instability. Under a primary care program, medics are trained in suturing under the appropriate situations, so they call up the doc, get orders to clean and suture, preform the procedure, refer the guy to his personal doctor for a follow-up and release him. Immediate treatment, release in the field, referral to a primary care physician, all without tieing up an ER unnecessarily.


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## VentMedic (Apr 18, 2009)

Ridryder911 said:


> Personally, I believe both the P.A. & NP are getting abused in most clinical settings. Many are only getting cases or procedures in which the physician feels that they do not want to do not solely based upon their qualifications or screening of the patient.
> 
> There are several articles in comparison of both. Personally, I appreciate each of the profession. Both have a role and can be an asset to the health care.
> R/r 911


 
The national associations for both have worked together to improve each other's profession and have been able to strengthen their clinical positions because of each other's support. They also have approached it from the "what can we do for the patients and public" rather than a what can the public or patients do for use mentality. That has won them much legislative support.




curt said:


> R/r911, I've got to say that I agree. I haven't been around long, but I'm expecting a major shift in US EMS from "Treat what you can and get 'em to the hospital" to more of a primary-care style as ERs get more and more bogged down as the patient population soars in disproportion to ER capacity. As an example, say someone gets a pretty decent gash along their arm. It's not deep enough to cut to the bone, but it's a doozy. EMS was nearby, has the bleeding under control, and the man is showing no signs of hemodynamic instability. Under a primary care program, medics are trained in suturing under the appropriate situations, so they call up the doc, get orders to clean and suture, preform the procedure, refer the guy to his personal doctor for a follow-up and release him. Immediate treatment, release in the field, referral to a primary care physician, all without tieing up an ER unnecessarily.


 
This "skills mentality is what is holding EMS back. Suturing is a "skill". It is the education to know when more than a couple of stitchs are needed as well as a tetnaus shot and antibiotics. Patients also like one stop shopping. If they now have to wait 3 - 4 weeks to see their PCP, they may put it off and just wait until an infection could cost them life and limb. Also, the time you spend in the field properly preparing the suture site may take a Paramedic truck out of service may be defeating the cause.

On the other hand, if a PA or NP was available as in some areas they actually are, they could suture as well as prescribe. If they are also associated with a clinic, they may be able to have the patient seen sooner than a PCP will see them. Also, not everybody has a PCP or even insurance. 

There are alot of factors and one MUST consider the patient and not just the convenience of EMS or a way to get more "skills" without the education for the Paramedic. Take a lesson from the paths that both the PA and the NP have taken and are still progressing on. They didn't just focus on a few "skills". They are placing a foundation for the future.


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## Veneficus (Apr 18, 2009)

curt said:


> R/r911, I've got to say that I agree. I haven't been around long, but I'm expecting a major shift in US EMS from "Treat what you can and get 'em to the hospital" to more of a primary-care style as ERs get more and more bogged down as the patient population soars in disproportion to ER capacity. As an example, say someone gets a pretty decent gash along their arm. It's not deep enough to cut to the bone, but it's a doozy. EMS was nearby, has the bleeding under control, and the man is showing no signs of hemodynamic instability. Under a primary care program, medics are trained in suturing under the appropriate situations, so they call up the doc, get orders to clean and suture, preform the procedure, refer the guy to his personal doctor for a follow-up and release him. Immediate treatment, release in the field, referral to a primary care physician, all without tieing up an ER unnecessarily.



I have suggested that style of EMS would be the only way that EMS will be economically viable. However, currently there is no way to bill for it, and all the "mid level" providers will go crazy and claim that is their role. 

As was discussed many times, it will require substantially more education on the part of EMS providers, and will be met with strong resistence especially from the fire service when the money from that kind of treatment is diverted from new fire trucks and othe rmore technical duties. 

In order to move EMS forward we need leadership that can get people to "buy in" to the plan, rather than attempt a totalitarian takeover via educational and legislative channels. Everytime in the past that has been tried EMS has lost more ground then it gained. Like "skill based" EMS classes, or "ALS procedures"

It was even pointed out on this forum that even in the educational institutions, lesser quality prereqs are being accepted. Like A&P for non science majors. But EMS is not the only group guilty of that. I have seen "Physics for health care professionals." classes.

Furthermore, I was employed in an institute of higher learning. One day the instructors and medical director got together and decided we wanted upper level prereqs, a degree and no certificate courses, and several coreqs. In a year's time we went from several very qualified instructors to 3. Enrollment went from selecting people for 2 fulltime classes to having barely enough people for the college to keep one class even open, and medic mills sprung up like flowers.Years later the program still struggles with barely enough.

Moreover, while I support and applaud the goals of current "EMS leaders" the latest powerplay of altering administrative code will only have short term success. There is no realistic long term goal to hold such gains and the inevitable attempt to reverse such gains is going to massive and devastating. They will be luck to hold onto what they have.

Where I am from the local NAEMT reps are all fire Union officers too. I'll wager many places are the same based on the number of fire based EMS providers. EMS has no identity, considerable "leadership" with an obvious conflicts of interest, and big dreams. The leadership fights with zeal, but doesn't fight to win.

Even though you or I may have a great idea how to make it happen. The leadership avoids these places like the plague I am told. For us mere mortals are beneath the good ole boy circle. They are hold up in the tower throwing stones at tanks. I wish them all the luck, but i expect victory to be very one sided, and certainly not theirs. Makes me wonder who exactly they are leaders of?


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## VentMedic (Apr 18, 2009)

Veneficus said:


> I have suggested that style of EMS would be the only way that EMS will be economically viable. However, currently there is no way to bill for it, and all the "mid level" providers will go crazy and claim that is their role.


 
And rightfully so. 3 months of training (for some) vs a Master's or Doctorate degree? Statements like this that give EMS providers to blame others for their own shortcomings are just more excuses to justify it is not worth the trouble to get a proper education. EMS has used this excuse for a long time as they have blamed the nursing profession for keeping them down. However, most of the complaints come from those with only 3 months of training and do not have any real knowledge about education.




> Furthermore, I was employed in an institute of higher learning. One day the instructors and medical director got together and decided we wanted upper level prereqs, a degree and no certificate courses, and several coreqs. In a year's time we went from several very qualified instructors to 3. Enrollment went from selecting people for 2 fulltime classes to having barely enough people for the college to keep one class even open, and medic mills sprung up like flowers.Years later the program still struggles with barely enough.


 
The colleges realized they had to be competitive which is why they have the "academies" for certificates in EMS. To keep their degree programs alive, they have dramatically reduced the general/science education requirements and played with the numbers for the worth of the Paramedic classes in order to get keep the degree programs alive. Physics for Healthcare is not even a thought for Paramedic programs since many do not have the entry level math class to take that course. 

If education standards were changed for entry level, the FDs and county/private ambulance services would have little choice and may have to evaluate their position in EMS. For other healthcare professions, the employers started expecting higher education long before the minimum education standards were set at a higher level.


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## Veneficus (Apr 18, 2009)

VentMedic said:


> And rightfully so. 3 months of training (for some) vs a Master's or Doctorate degree? Statements like this that give EMS providers to blame others for their own shortcomings are just more excuses to justify it is not worth the trouble to get a proper education. EMS has used this excuse for a long time as they have blamed the nursing profession for keeping them down. However, most of the complaints come from those with only 3 months of training and do not have any real knowledge about education..



I specifically addressed this in the subsequent paragraph






VentMedic said:


> The colleges realized they had to be competitive which is why they have the "academies" for certificates in EMS. To keep their degree programs alive, they have dramatically reduced the general/science education requirements and played with the numbers for the worth of the Paramedic classes in order to get keep the degree programs alive. Physics for Healthcare is not even a thought for Paramedic programs since many do not have the entry level math class to take that course.



So it is ok to have 'certificate programs, because the end justifies the means and maybe a handful of people will get a degree? How does anyone (not you specifically) support advanced education and determine that accepeting lesser standards from some (who will be equally employable) justify that?



VentMedic said:


> If education standards were changed for entry level, the FDs and county/private ambulance services would have little choice and may have to evaluate their position in EMS. For other healthcare professions, the employers started expecting higher education long before the minimum education standards were set at a higher level.



I wish it were that simple, but the fact remains that those organizations represent a considerably stronger lobby than the few EMS providers supporting education. In the zeal of those education based EMS leaders they have bascally excluded everyone except themselves. So while they may actually make a change, it is almost certain to be repealed by a coalition of the groups they excluded as not worthy. as you mentioned NPs and PAs worked together. Supported each other. Right or wrong, when a group of disaffected people get together to lobby and legislate against what "EMS leaders" are going to do, they have the ability today to legislate those making exclusions off the map. When they are stepped on in a few months, it will come to pass and EMS will be lucky enough not to be set back another decade.


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## VentMedic (Apr 18, 2009)

What many in EMS fail to see is that just because your employer doesn't require or support education, doesn't mean one can not get it for themselves. When more people see this, a positive trend might start. If the 3 month wonder is applying for a job at an agency with mostly degreed Paramedics, they might start to be viewed differently even though their resume says they have "skills". 

EMS is also one profession that wants a reward first before they do something. They want the money first and then they might consider the education. Unfortunately, that again leads to a tech school mentality and does not foster higher education. There is little thought about the level or quality of care they could provide with additional education. Most are content to believe they are "physician extenders" because they do a few physician-like skills and that also includes memorizing ACLS protocols.



Veneficus said:


> I wish it were that simple, but the fact remains that those organizations represent a considerably stronger lobby than the few EMS providers supporting education. In the zeal of those education based EMS leaders they have bascally excluded everyone except themselves. So while they may actually make a change, it is almost certain to be repealed by a coalition of the groups they excluded as not worthy. as you mentioned NPs and PAs worked together. Supported each other. Right or wrong, when a group of disaffected people get together to lobby and legislate *against what "EMS leaders"* are going to do, they have the ability today to legislate those making exclusions off the map. When they are stepped on in a few months, it will come to pass and EMS will be lucky enough not to be set back another decade.


 
NPs and PAs supported each other for the benefit of the people. The focus was on patient care. If Paramedics had a viable plan for the public, they might help the cause and support them also. As it is, EMS is too busy fighting amongst themselves to care about patients.


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## Veneficus (Apr 18, 2009)

VentMedic said:


> NPs and PAs supported each other for the benefit of the people. The focus was on patient care. If Paramedics had a viable plan for the public, they might help the cause and support them also. As it is, EMS is too busy fighting amongst themselves to care about patients.




That is exactly my point.


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## Ridryder911 (Apr 18, 2009)

One has to remember, you could be a P.A. with only a certificate until about 8 yrs ago. I know, the program I was in offered either a degree or certificate. The same with NP's; especially Neonate NP's was mainly OJT with additional classes. Now, alike EMS should go with most will now require a degree. Not only a degree but a formal post graduate. 

In regards of EMS not billing, really there is. It is has been approved for Medicare to extend teh payment structures for advanced level of care such Advanced Paramedic/Practitioner. Details are still being worked out as the levels of education, scope, etc is still being evaluated. This has been drafted a while back by American Ambulance Association. There are other options in billing that will off set costs but will require more education than is provided and as well clinical skills to accompany them. 

Again, the future of medicine and Prehospital care (not EMS) will be changing; it has to; to meet the future demands of the patient load and alternative way to provide care. 

R/r 911


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## Sasha (Apr 18, 2009)

karaya said:


> Spoken from years of experience?



Sorry, I didn't know you needed years of experience to recognize the better pay, professionalism and higher standards of another profession.


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## curt (Apr 19, 2009)

So the first step would be raising our educational standards as a whole, but how do we do that without calling in the politicians? I mean, even if every one of us went on to be five-star instructors turning out a class of twenty or so each year, we wouldn't come close to throwing a monkey wrench into how badly these 'three-month-wonder' and 'zero-to-hero' programs are degrading the integrity and the quality of care of the profession.

 Also, I didn't necessarily mean that EMS needs more 'skills' under its belt so much as I meant that I'm both hoping and expecting the EMS curriculum to begin dipping its hands into the cookie jar of 'treat-and-release' in order to both streamline medical treatment and systems and to reduce undue strain on ERs. As for middle-level providers (I'm assuming these are going to be I85's/I99's) demanding some of those treat-and-release 'skills', I'm fine with it. A basic truck, headed by an intermediate under these sorts of protocols I'm talking about, could handle most 'minor' emergencies while leaving the ALS units to the big fish, so to speak, or only calling them in once they're lead to believe in the presence of a higher emergency.

( I'm not sure if any of that made sense. I'm not revising it, though. I hope it's legible, but it's been one of those days, and definitely the worst day in recent years, I'm mentally and spiritually battered, and I'm hoping I'll feel better with some sleep. )


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## VentMedic (Apr 19, 2009)

curt said:


> As for middle-level providers (I'm assuming these are going to be I85's/I99's) demanding some of those treat-and-release 'skills', I'm fine with it. A basic truck, headed by an intermediate under these sorts of protocols I'm talking about, could handle most 'minor' emergencies while leaving the ALS units to the big fish, so to speak, or only calling them in once they're lead to believe in the presence of a higher emergency.


 
No, the mid-level providers discussed here are NPs and PAs.

The intermediate level for EMS just further complicates the education issues by providing a few more skills with very little education.


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## VentMedic (Apr 19, 2009)

I was just watching the news and saw Walgreens are promoting their in store clinics staffed by NPs. Their services will be free to the unemployed. Of course, the medications will not be free.

http://www.floridatoday.com/article/20090331/BREAKINGNEWS/90331055/-1/SEVENDAYS

http://www.huffingtonpost.com/2009/03/31/walgreen-free-care-for-jo_n_181178.html

Other news articles and the NP's involvement in community health issues.

http://www.smartbrief.com/news/aanp...tegoryid=7B651A9C-543B-43A9-909D-CC5F80F69335

This is an interesting report concerning the PAs proposal to raise their education requirements for entry level. 

*PA Clinical Doctorate Summit*
*Final Report and Summary*
*April 15, 2009*​

http://www.aapa.org/clinissues/PAClinicalDoctorateSummiFinalReportSummary.pdf

Video for promoting healthcare from the PAs' point of view. Great promotion. 
http://www.aapa.org/index.html#paha

Other healthcare professionals also have similar PR from the national associations to get the message out that they care about the patient and still promote their own agendas. 

While EMS might still want to promote the "treat and release" or "transport refusal" programs, there must be a higher level of care still available so the patient is not just left on the curb wondering how to get more definitive treatment. At this time EMS is too limited in education to make many definitive decisions or treatment care plans for their patients especially those with medical problems either diagnosed or new onset. Eventually EMS will have to get over the "what can the patient and healthcare do for me" mentality and view the issues for what is best in terms of patient care.


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## medic417 (Apr 19, 2009)

VentMedic said:


> While EMS might still want to promote the "treat and release" or "transport refusal" programs, there must be a higher level of care still available so the patient is not just left on the curb wondering how to get more definitive treatment. At this time EMS is too limited in education to make many definitive decisions or treatment care plans for their patients especially those with medical problems either diagnosed or new onset. Eventually EMS will have to get over the "what can the patient and healthcare do for me" mentality and view the issues for what is best in terms of patient care.



You are right it is about what is best for a patient.  But what is best for a patient may be leaving them at the curb.  But not leaving them wondering.  We would educate them as to the agencys they can get help from.  We will help get them scheduled with those services. Bit it will require better education.  When we do actually become Pre Hospital Medical Professionals we will do more good for our patients than we do now as the ambulance drivers that so many seem content to be.  I do see more services after making sure their medics are educated developing more treat/assist and release systems.  

I do push for the right to deny transport but more and more comments I read on here and other forums makes me see though that many Paramedics just are not educated enough to even do what they are currently allowed much less to add this important but dangerous protocol.


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## silver (Apr 19, 2009)

There is currently a discussion in the upper echelons of PAs to make it a requirement to have a residency, instead of it being optional like now. This would most likely get PAs to specialize more, and possibly expand what their scope is.
However there are like two factions (i think both are national organizations) and they can't agree on the subject.

So we will see...


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## VentMedic (Apr 19, 2009)

medic417 said:


> We would educate them as to the agencys they can get help from. We will help get them scheduled with those services.


 
Are you (Paramedics) making the actual appointments? 
Are you able to do an official insurance (private, state or Federal) referral form? 
Or, are the patients given a generic phone number to an agency that then puts them through a maze of unanswered extensions?
How much time are you allowed with each patient for a thorough assessment, filling out the appropriate referral forms and making the agency contacts as well as arranging for alternative transport? 
Taxi vouchers? Wheel chair van vouchers?  Who pays and where does the additional funding come from?
Any studies done as to how long between the time the patient sees you and the clinic or other agency? 


Are you (Paramedics) able to do nutrition and diabetic counseling after fixing that "little glucose problem"? 
Are you able to prescribe medications or recommend OTC meds? 
How much wound care knowledge do you have for educating the patient? 
How much indepth education do you have for teaching patients about their illnesses? 
Are you following the triage guidelines suggested by EMTALA even though it does not necessarily apply to prehospital situations but does address many questions for the proper level of care?


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## VentMedic (Apr 19, 2009)

silver said:


> There is currently a discussion in the upper echelons of PAs to make it a requirement to have a residency, instead of it being optional like now. This would most likely get PAs to specialize more, and possibly expand what their scope is.
> However there are like two factions (i think both are national organizations) and they can't agree on the subject.
> 
> So we will see...


 
There are 4 recommendations listed in the link I posted earlier.
http://www.aapa.org/clinissues/PAClinicalDoctorateSummiFinalReportSummary.pdf

1. The PA profession opposes the entry-level doctorate for physician assistants.

2. The PA profession endorses the master’s degree as the entry-level and terminal degree for the profession. As of 2012 the degree conferred upon completion of a PA program will be a singular degree entitled the Master of Physician Assistant Practice (MPAP).

3. The PA profession supports colleges and universities offering postgraduate, nonprofession-specific clinical doctorates (e.g., doctorate of medical science, doctorate of health science, or other non-PA-specific clinical doctorates) as options available to PAs.

4. The PA profession should explore the development of a model for advanced standing for PAs who desire to become physicians (sometimes called a "bridge program").​


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## medic417 (Apr 19, 2009)

My answers in line.



VentMedic said:


> Are you (Paramedics) making the actual appointments?
> Yes, or we call and tell the agency what we have then put patient on line to make final arrangements.
> 
> Are you able to do an official insurance (private, state or Federal) referral form?
> ...


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## VentMedic (Apr 19, 2009)

> Are you able to prescribe medications or recommend OTC meds?
> Actually we can recommend OTC meds. We also can treat and have them follow up with their doctor. *Another service actually carrys 3 day supplies of meds that they give the patient* and then schedules a follow up with a doctor or clinic for them to get the rest of the prescription filled.


 
What class of meds and what are the med dispensing regulations for your state? 

Even hospital EDs are restricted by the type of medication and amount they can give a patient under some dispensing regulations.   That will sometimes include inhalers such as Albuterol.

Are Paramedics specifically covered (although nowhere in the U.S. can Paramedics write scripts) or is this done purely through online med control under the physician's prescribing privileges? 

Are the meds clearly marked in case of search by PD since there may not be a script available to show proof of who the meds belong to?



> Actually we can recommend OTC meds.


 
What type of OTC meds?

Please don't say Sudafed, Primatene Mist or TUMS.


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## VentMedic (Apr 19, 2009)

medic417 said:


> I do push for the right to deny transport but more and more comments I read on here and other forums makes me see though that many Paramedics just are not educated enough to even do what they are currently allowed much less to add this important but dangerous protocol.


 

As you already probably know the agency in this thread boasted its "deny transport" protocol. 

http://www.emtlife.com/showthread.php?t=12274

This is not their first treatment of a patient that has come into question. Their protocol had been made available a few months ago on another EMS forum. However, with a look at their P&Ps now, it does not define their "deny transport" protocol.

Yes, the P&P you have previously posted is thorough but still, EMS providers are trained for Emergency Medical situations. That still leaves alot of other diagnoses that are less obvious. Those that may not seem to be emergent now like a young adult with flu like symptoms. However those symptoms may be the early signs of something that will later become deadly. The elderly person with an abrasion or a fever may also be at risk for something more serious even though it may seem minor now. These are also the reasons the NPs and PAs are promoting more education and clinicals for their entry level programs. Now if they believe a Master's degree is barely adequate, where does that leave the Paramedic with 700 hours of training who also wants similar treat and release responsibilities?


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## medic417 (Apr 19, 2009)

VentMedic said:


> What class of meds and what are the med dispensing regulations for your state?
> 
> Even hospital EDs are restricted by the type of medication and amount they can give a patient under some dispensing regulations.   That will sometimes include inhalers such as Albuterol.
> 
> ...



All meds are distributed by off line protocol under the doctors license.   I have not seen what type of notation is on the meds.  

We suggest OTC based on what is going on.


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## medic417 (Apr 19, 2009)

VentMedic said:


> As you already probably know the agency in this thread boasted its "deny transport" protocol.
> 
> http://www.emtlife.com/showthread.php?t=12274
> 
> ...



The problem that service had was Paramedics not following protocol and also the fact that the protocol did not make it harder to deny than to transport thus opening it up to abuse by the lazy ignorant Paramedics.  What I see in our case is most transport because they are to lazy to do all the work that is required when you deny transport.  

And vent you know I push for increased education.


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