Those regions would work. The medicine isn't really different, but I can see why operational policy would be different. The best example would be how EMT-IIs were limited to areas where they would not displace paramedics. While I definitely see them as a replacement for EMTs, most areas would use them as a cheap paramedic, which shouldn't be allowed to happen in places like OC or LA.
I feel that while AEMTs are valuable where they where tested, I want to say salano county, they should not be responding as the highest level provider. how about making AEMT a stepping stone requirement for EMT-P. right now i work in a dual medic configuration, there is no reason i cannot work with an AEMT to provide over site and guidance for when they promote (career ladder...) or they can be the first responders. I can tell you the firemedics i work with, however good they are almost never get past IV, NTG, EPI, LIDO before I get there, would our tax dollars be better spent sending them to 1/2 the schooling? this is an idea that WOULD be effected positively by the regional model, one which I had not previously thought about.
Additionally, another problem I see with state wide is that it could very easily dumb everything down to LA or OC level, instead of raising things up to the SF or RivCo level (RivCo, at least with how the protocol/policy manual is written, looks really nice when compared to some of their neighbors).
I will have to look at the OC protocols again, but there may only be a few things that an OC medic does that are above AEMT...
yes this will be a problem in both the regional and state wide model. I know there are alot of bad paramedics in LA co. however with a standardized deployement system we can take the good ones (which there are alot of) and make them primary. eg as above, EMT and AEMT on the engine. AEMT/medic squad or ambulance. we have now reduced the number of paramedics by 2/3 and can focus our training and education at the 1/3 who actually want to be paramedics. I think LA is the only county that still requires two on a 911 call.
I agree that ideally a BS should be required for paramedics, but I'd rather work towards getting them up to at least an associates. Sure, most programs aren't down at the 1080 level with minimal or no pre-reqs, but until systems begin to stratify their paramedics into different levels based on ability, all paramedics are going to get a similar scope outside of specific instances.
while I agree that an AA would be nice, I can tell you that a paramedic AA means nothing. I have one and am still going back to city college to get my transfer classes out of the way. all that was required for my aa-ems was HS algebra, english, art, history. there where no requirements for bio, micro-bio, pharm, patho, anatomy, physiology (which I got on my own thankyou

). if we want to make a paramedic AA we need to standardize it to at least be equal to a BIO degree (or nursing...). how about we make a requirement for a 4 year health science/bio degree to be a CCP/APP if that ever passes and then encourage it down the line.
There's good and bad. I definitely think that individual companies need to have their own medical director both to personalize protocols (Why should company A be punished because of the poor standards of company B?) and provide proper medical oversight. Why not go to a Texas model of delegated practice?
I feel that is exactly what the regional system would be working to get rid of. make all services in one region the same SOP/protocol. while a medical director is required to order supplys, provide a license to work under (kinda, not really. I work under the county medical director). right now I cannot tell you what my agency medical director does, he has no office, I have seen him once and he signed my 4 hour CE cert after the first hour and left, he did tell us to stay for 3 more hours and practice intubating though... I feel as though with the proper resources a regional office through the use of nurse educators:unsure:, PCCs, senior paramedics, ect could provide much more consistent oversight and training.
wow, jp we are having an actual conversation. I like it.