That made me crack up! The joke is, most places require you to have most of these certs just to apply. It's not like you're going above and beyond by getting these, or giving yourself an edge in hiring, or anything.
ACLS/PALS/iTLS VS AMLS/EPC/PHTLS
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That made me crack up! The joke is, most places require you to have most of these certs just to apply. It's not like you're going above and beyond by getting these, or giving yourself an edge in hiring, or anything.
medicRob
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firecoins
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Standards are set by the Dept of Tran in the federal gov. otherwise its set but the indivudual states. NREMT is a private company.
firecoins
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Most if not all of the material in these little classes were taught in my paramedic class. Its good to take the classes to refreash all the knowledge I do not use regularly enough. I don't get excited by having them. The certs just show I completed and understood what we discussed.
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ERMedic
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I agree with firecoins. In my medic class we did ACLS, PALS, PEPP, GEMS and PHTLS. Atleast in the Philadelphia area most medic schools will include all of these courses.
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Melbourne MICA
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"Add-ons"
I never meant to infer systems in the US were dumb but from an outsiders point of view you would have to agree it all looks pretty confusing. I appreciate many (most/all?) of these courses are supplements or refreshers. Nonetheless, and correct me if I'm wrong, but:
a) it seems the most of these courses are run outside your service organisations many by the private sector for profit? - Why is that?
b) most involve getting a certificate of some sort which many here seem willing to include as some sort of new or extra credential on top of their existing qualification. - How is that allowed to happen and mustn't it confuse people dealing with EMS who don't understand the system?
c) nobody has made it clear whether there are standard additional refresher/supplemental or mandatory programmes for all EMS staff in the US.
Just to look at the pages of this thread as Vennificus pointed there are more letters next to peoples names than you can poke a stick at. And why can't organisations carry out all these programmes with their own tutelage and sign off staff who are up to date under local regional or state based standards requirements? (I am well aware you have state and national standards)
In our system everything is done in house with certain items like RSI, defib etc requiring mandatory periodic re-accreditation. We have a continuing education programme which provides face to face lectures two or three times a year updating knowledge, explaining changes to guidelines etc on top of regular information bulletins, external lecture invitations, group lecture nights and an education department (in which I have worked) that ships out education packages every other week.
I'm just asking questions and making comments to learn a bit more. That's all.
MM
I never meant to infer systems in the US were dumb but from an outsiders point of view you would have to agree it all looks pretty confusing. I appreciate many (most/all?) of these courses are supplements or refreshers. Nonetheless, and correct me if I'm wrong, but:
a) it seems the most of these courses are run outside your service organisations many by the private sector for profit? - Why is that?
b) most involve getting a certificate of some sort which many here seem willing to include as some sort of new or extra credential on top of their existing qualification. - How is that allowed to happen and mustn't it confuse people dealing with EMS who don't understand the system?
c) nobody has made it clear whether there are standard additional refresher/supplemental or mandatory programmes for all EMS staff in the US.
Just to look at the pages of this thread as Vennificus pointed there are more letters next to peoples names than you can poke a stick at. And why can't organisations carry out all these programmes with their own tutelage and sign off staff who are up to date under local regional or state based standards requirements? (I am well aware you have state and national standards)
In our system everything is done in house with certain items like RSI, defib etc requiring mandatory periodic re-accreditation. We have a continuing education programme which provides face to face lectures two or three times a year updating knowledge, explaining changes to guidelines etc on top of regular information bulletins, external lecture invitations, group lecture nights and an education department (in which I have worked) that ships out education packages every other week.
I'm just asking questions and making comments to learn a bit more. That's all.
MM
Outsourcing. On my time off from school I work for a hospital and part of my job is teaching these classes. The hospital does not charge employees for the classes and they are required for continued employment. So technically they are in house.
However, many smaller organizations cannot afford to have all this done in house. So there creates an opportunity for independant contractors to use the same standard curriculum an service many agenices. Many agencies together can usually make steady work for a small group of individuals. The time and expenses do not always make fiscal sense to have in house.
Many of the organizations these classes come from spend millions of dollars to research, update, and come up with these curriculums. It is beyond the means for independant organizations. Don't forget, the US is a pay to play system. Hospital A makes money by having superior service to Hospital B. Certainly they will not give away trade secrets.
(I don't agree with the system, but it is what I have to work with)
The certificates simply state you met the criteria for the class. It is up to the individual agencies to determine their value. None of these classes gives you the authority or right to practice anything you learn in them. It is your primary educational credential that does. So for example if you learn how to do a DPL in ATLS class, then unless you are a qualified physician, you are not permitted to perform one. The same if you were a nurse who learned to intubate, your employer determines your scope.
As for the extra titles, the only people they impress are nonmedical providers.
Because the US is a federation of states, the individual state decides on the required refresher for the primary credential. The federal government cannot control that. However, many states choose to use the same standards for the purpose of reciprocity between them. MD, DO, RN, PA, Parmedic, EMT, etc. merit badge courses are sometimes required. For example in Ohio, in order to meet the refresher qualification for paramedic you must have a current ACLS card. (to demonstrate you are current with the skills of what is viewed as the primary job of the paramedic) Credentialing agencies will recognize a certain amount of hours for the course for various reasons. So while you may spend 16 hours in an ACLS course. You licensing authority may not recognize all of it or may give you more credit. (usually it is much less)
However,non governmental hospital accrediting agencies, like JCAHO, have a real power to instill their will upon organizations. They are basically recognized as an authority, and the loss of their graces, by not meeting their recommended standards, will cause a facility to not be eligible for federal healthcare monies like medicare and medicade. (which is more than 25% of all payments nationwide) Additionally any healthcare organization not meeting these standards will find that private insurance will not pay for their services either. In short, they are not a government body, they are used by the government as a standard.
It is also one of the reasons EMS tries to firmly plant itself in public safety. A publc safety agency is immune to a considerable amount of standards even outside healthcare.
As detailed above, many organizations (hospitals, EMS agencies, etc) cannot afford to have their own educational departments. It is much cheaper to use an already established curriculum than it is to research and create your own. (which on the cheap can run hundreds of thousands of dollars a year when you factor in the salaries of the people doing it)
However, your agency can choose not to recognize some or any of these classes. For example, at my employer, they only recognize BLS, ACLS, and PALS from AHA. they do not recognize any other curriculum from any other agency.
In all fairness, many of these classes are put together to be concise information in order to give healthcare providers what they need to do no harm or at least help a little until an expert can be found.
The trouble is, they are not meant to be definitive education. Many people also like the format so everytime somebody has something new to say, they copy the 2 day "do this until somebody who knows shows." It is impossible to maintain all of them and a new one shows up every year. (Like advanced burn life support)
Places that can afford that do. It's all about the money.
Shishkabob
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Because people like money?
The PEPP class jimi and I are taking tomorrow is free, and being put on by a pediatric hospital... and we are getting free lunch! (woot!)
Who cares if they don't understand why we do the classes beyond knowing it's "continuing education"?
It's essentially continuing ed, and the "certificate" they give is essentially proof that you took and passed the continuing ed class, incase you get audited by your credentialing agency.
Every single Paramedic job I've seen requires ACLS. Most other Paramedic jobs usually wants PALS/PEPP for pediatrics, and PHTLS/ ITLS for trauma, and of course CPR.
EMTs don't require any 'additional" courses aside from CPR.
But those classes only refresh what every Paramedic should already know... and maybe teach something new when new guidelines come out.
Because ACLS and PALS are from the AHA, and PEPP/PHTLS are from NAEMT. Our agencies, be it fire, private or whatever, don't own the AHA or NAEMT. The people who teach ACLS/PALS/PEPP/ whatever have to be credentialed by the agency that puts on the class.
You WILL often see some agencies that will put one of their people through the instructor course, for say ACLS or PALS, so that they can teach it inhouse to their employees, for free, and save money.
These classes are just like taking a CPR course... just different letters with a different subject matter.
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Gah! Get a bloody CT machine or nick the ultrasound from OB
I like to use that example. Everywhere I have been used FAST and CT.
The fact it is still in the ATLS book speaks volumes to how much effort goes into updates. Only in the 8th edition is permissive hypotension even discussed.
I guess if you were out in the Bush it might be a good skill to know. But then so would digging graves because if the DPl is diagnostic and you cut somebody open in the back country, you better have some wicked antibiotics with you too.
LucidResq
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I'm gonna throw a wrench in there... almost every single EMT-B job in CO requires IV and EKG.
jjesusfreak01
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Wouldn't that make them closer to EMT-IV's or EMT-Cs possibly?
medicRob
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Depends, are CO EMT-B trained to i/85 or above? EMT-IV is i/85, not just B with extra IV endorsement.
LucidResq
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The whole IV thing in CO is unique to the state. No, they are not EMT-Is. I've never heard of EMT-Cs. They are their own category for sure.
The full name for it is "EMT-B with IV authorization." I've seen it abbreviated several ways, such as EMT-B(IV).
They can administer crystalliods (NS, LR, D5W) D50, and Narcan.
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Melbourne MICA
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Questions answered
Funding and outsourcing. Two pretty common factors no matter where you are. It's an interesting contrast between the EMS agencies here with a heavily weighted government input and the more diverse privatised models in the US. At the end of the day it still comes to do dollars unfortunately.
So to Venny and Linus- thank you boys - questions answered. I appreciate the effort.
MM
Funding and outsourcing. Two pretty common factors no matter where you are. It's an interesting contrast between the EMS agencies here with a heavily weighted government input and the more diverse privatised models in the US. At the end of the day it still comes to do dollars unfortunately.
So to Venny and Linus- thank you boys - questions answered. I appreciate the effort.
MM
DrParasite
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it's not the input that causes the disparities
Bingo. in the US, most of the EMS system isn't publicly funded, or rather, isn't 100% publicly funded (EMS gets the left overs when the FD or PD are done pillaging the piggy bank, because they are the b@stard step child that no on wants except to get money).
I have PHTLS, and it's a pretty good course. PEPP was good too, but I really want to take an ABLS (advanced burn life support) class. But finding one that will let a lowly 120 hour person in is harder than I thought. plus they are only offered every other year doesn't help.
DrP EMT, DBP, PHTLS, EMD-I, CPR-I, BS SU '03, 911-I, PEPP, GEMS (I think I have this one), Teamsters Local 97 (I think).
Now that I think about it, I might make that my signature......
sir.shocksalot
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CO is apparently weird when it comes to EMT-B's starting IV's, it's pretty much standard that if you are an EMT-B on an ambulance, you can start an IV. It actually is extremely frustrating working with an EMT who can't start an IV because they are new and haven't finished the course yet.
But to answer your question a CO EMT-B IV is just an EMT with an extra day or two long class that can start IV's and administer crystalliods and D50. This is actually extremely helpful on an ALS ambulance, and horrifying if they are doing it on their own.
And as far as courses go I have PHTLS and PEPP aside from the required ACLS and PALS. I want to take ABLS but its like 300 bucks which to me is a little steep at this moment, I will also be taking AMLS and NRP soon so we'll see how useful I find them. I loved PEPP and PHTLS, I found it to me informative, a good review of school stuff and some intro to new research that has come out, but it seems like it could be very instructor dependent.
DrParasite
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Please explain this statement
if an EMT can check BGL, determine it to be low, and administer D50, without the aid of a medic, how is it horrifying?
or if they are just starting a line, for the sake of making things easier for the ER, again, how is this horrifying?
and how is it very helpful if they do it in the presence of a medic, but doing it on their own is a sin against nature and dangerous to the health and safety of humanity?