# Controversy in the field of EMS



## EMT204 (Oct 31, 2010)

ok heres the deal, I have to write a persuasive essay on something that interests us for my college composition class. And of course i picked EMS but im not sure what i should write about. Please help me out on picking a topic!!


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## C.T.E.M.R. (Oct 31, 2010)

im sure you will think of something. Possibly how many people think we should be able to do more medically advanced things in the field, or the fact that every state in the U.S. has differetn certs. only one common is emt/emtparamedic. I Hope this helps. Good luck!


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## JPINFV (Oct 31, 2010)

The efficacy of supplemental oxygen or spinal immobilization would be 2 choices.


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## MrBrown (Oct 31, 2010)

The growing body of evidence that supports Paramedics disposing of patients other than to ED


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## citizensoldierny (Oct 31, 2010)

Lots of controversy lately in re: advanced airway, check out Jems about 3 months ago to help get started.


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## DarkStarr (Oct 31, 2010)

LIGHTS AND SIRENS! o:


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## firetender (Nov 1, 2010)

Why do people enter a field with an average burn out period of FIVE years?


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## JPINFV (Nov 1, 2010)

Source for average burnout in 5 years? Does that count people who leave, but aren't burnt out?


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## firetender (Nov 1, 2010)

JPINFV said:


> Source for average burnout in 5 years? Does that count people who leave, but aren't burnt out?


 
Good catch, let's say average shelf-life...I'll see where that came to my attention from.


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## MrBrown (Nov 1, 2010)

Low pay and poor working conditions?


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## DarkStarr (Nov 1, 2010)

Volunteer vs Paid


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## usalsfyre (Nov 1, 2010)

DarkStarr said:


> Volunteer vs Paid



He said controversial not something approaching Jihad 

How about college based degree vs community based certificate educational models?


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## fortsmithman (Nov 1, 2010)

DarkStarr said:


> Volunteer vs Paid





usalsfyre said:


> He said controversial not something approaching Jihad
> 
> How about college based degree vs community based certificate educational models?



Yeah Volly vs paid threads have a nasty habit of getting locked.  Whereas threads regarding education levels are less likely to get locked.


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## TransportJockey (Nov 1, 2010)

fortsmithman said:


> Yeah Volly vs paid threads have a nasty habit of getting locked.  Whereas threads regarding education levels are less likely to get locked.



Not a whole lot less likely, cause those also usually turn into volly or paid arguments


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## Veneficus (Nov 1, 2010)

fortsmithman said:


> Yeah Volly vs paid threads have a nasty habit of getting locked.  Whereas threads regarding education levels are less likely to get locked.



So true,

but I never understood the volly vs paid argument. Simply put, if there is no money to pay people, they do not get paid people. 

If they have the money but don't want to pay people, they will get the level of service and proficency of equal value.

There is no way to force people to value medicine enough to pay for it. There is no way to force people to value EMS either.


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## abckidsmom (Nov 1, 2010)

MrBrown said:


> The growing body of evidence that supports Paramedics disposing of patients other than to ED



this one.  The more medics going around with the facts about this topic, the better.


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## JPINFV (Nov 1, 2010)

Veneficus said:


> So true,
> 
> but I never understood the volly vs paid argument. Simply put, if there is no money to pay people, they do not get paid people.
> 
> ...



I think the problem a lot of people have with volunteers is that, while you can't pay people if there's no money, similarly, it's hard to meet appropriate education requirements for EMS if EMS is something you do on the side of a real job and family. It would be like someone going through medical school just because they want to volunteer with Doctors Without Borders, and then complaining that medical school is too hard and expensive while holding down a full time job.


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## Veneficus (Nov 1, 2010)

JPINFV said:


> I think the problem a lot of people have with volunteers is that, while you can't pay people if there's no money, similarly, it's hard to meet appropriate education requirements for EMS if EMS is something you do on the side of a real job and family. It would be like someone going through medical school just because they want to volunteer with Doctors Without Borders, and then complaining that medical school is too hard and expensive while holding down a full time job.



Nobody stops EMS providers from creating higher education levels.

Nobody stops employers from demanding more than just the 12 week medic mill certificate. 

Nobody stops medical directors from granting higher scopes of practice to more capable providers than ones who meet the minimum criteria.

At the same time, nobody forces medical directors to sign off on various procedures for people who do not meet  a reasonable level of education, competence, or experience.

In fact I remember reading somewhere it was the medical director's responsibility for ensring those operating under direction were competent. 

I think we would both agree to give more standing orders and a larger scope to a paramedic with a BS in a healthcare related science than a volunteer who went to how fast can we teach the registry test academy? 

Am I wrong?

I know most systems in the S don't work that way, but honestly, the only things stopping it are apathy and laziness.


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## FreezerStL (Nov 1, 2010)

I recently wrote a research paper about CPR for my comp 2 class.

I began with its creation, then cited its evolution through the years, and finished with possible upcoming changes.

Heck, I even got to include the new 2010 guideline changes 

My professor is a first aid nut, so I thought CPR would spark his interest. Try not to forget your target audience. Think of something your professor would enjoy and write accordingly.


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## EMSLaw (Nov 2, 2010)

MrBrown said:


> The growing body of evidence that supports Paramedics disposing of patients other than to ED



I've always thought the side of the road was a good place to dispose of certain patients, but unfortunately, dispatch keeps track of our calls, so I'd never get away with it...


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## MrBrown (Nov 2, 2010)

New Zealand relies upon nearly 3,000 volunteer Ambulance Officers who operate at or are studying towards the Technician (BLS) level and around 1,000 paid Officers who are either Paramedic (ILS) or Intensive Care Paramedics (ALS).  There are a few paid BLS Technicians but they are few and far between and eventually no paid Technicians will exist.

Volunteer training has been a significant problem for at least the last decade with increasing expectations both from within Ambulance and external (eg public and allied health professionals).  Previously our volunteers had mainly operated at a level called Primary Care which was a five day course and would be equivalent to an EMT in the US; they could administer oxygen, paracetamol, entonox and aspirin as well as perform a basic primary survey and package the patient.  Beyond Primary Care one became a qualified Ambulance Officer which took anywhere up to a year requiring completion of an ethics course, driving, two large blocks of A&P assignments and 2x 10 days in class to learn the practical aspects of the AO scope of practice.  By nature of its design it was difficult if not downright impossible for volunteers to complete all the requirements, although some did and it often took a year or more.

In 2005 Ambulance in New Zealand began a total overhaul of our education system and introduced a new qualification known as the National Diploma in Ambulance Practice.  This is our volunteer qualification, one which all volunteers are required to complete within a set time-frame and it gets them up to a good base level of skill and knowledge which is appropriate for thier role as a volunteer.  It gives volunteers a range of high benefit, low risk treatment modalities and allows them to both support a Paramedic or Intensive Care Paramedic (or another Technician) and to be supported in thier clinical development by a higher qualified Officer.

This new course uses the internet to deliver the bulk of the theory material and has a range of interactive materials designed to deliver learning outcomes so that when students meet for practical sessions they are more hands-on and simulation based rather than sitting there learning about cells and tissues and bronchoconstriction.  

A student will complete the course in four phases and it takes around a year.

Phase 1 (four weekends):  Local orentation, professional communication, personal safety and driving.

Phase 2 (five days):  First Responder and Ambulance Assistant courses

Phase 3 (six weeks): Core skills

Phase 3 (eight weeks):  Medical

Phase 4 (eight weeks):  Trauma

There is ongoing clinical mentoring, a clinical workbook and intergrated reflection/development exercises built into the course which culimates in final simulation and viva-voce assessments.  When all these are passed satisfactorily the student recives Authority to Practice as a Technician and has the following scope of practice:

- Oxygen
- OPA, NPA, LMA
- Entonox 
- Methoxyflurane
- GTN
- Aspirin
- Salbutamol
- IM Glucagon
- Ondansetron 
- Paracetamol
- Glucose 10% (PO)
- Semi auto defib
- Acquire and perform basic 3 lead interpretation

It would seem if we can produce comptent Officers who can use such a scope of practice in a standardised timeframe that even with the delineated education model used in the US surely it is not that difficult? 

*Brown shakes his head sadly and climbs back into his helicopter

Ambulance, Medivac airborne


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## Outbac1 (Nov 2, 2010)

Can you clairify a little. What exactly do you mean by 6 or 8 weeks? Are these weeks five eight hour days or one or two nights evening time? I'm thinking 22 x 40 hr weeks is a lot of time to put in for a volunteer, especially if they have a full time job somewhere.


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## MrBrown (Nov 2, 2010)

It's an hour or two studying each day and then eight weekends in class per block


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