Advancing EMS & Paramedicine

[thegreypilgrim]

I think we're all aware of the "hammering" of paramedics that goes on around this site - about how we're all uneducated, incompetent, and not to be trusted with "real" medicine, etc. Now, I admit to being among those who've done this. I acknowledge full well that the educational standards for EMS are seriously lacking and must be improved to college degree-appropriate level if we're going to be recognized as medical professionals from our colleagues. However, I think it must be said that these other medical people (physicians & RN's) do bear at least some level of responsibility for the overall sorry state of EMS education. After all, they're the ones in charge of developing and carrying out the educational process of prehospital personnel. Somewhere along the line they agreed that it's adequate.

Further along these lines, it seems (at least in my experience) that a large center of resistance to expanding the role of paramedics through education and, thus, scope of practice have been nursing associations. Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.

So, it seems like those of us who would like to see EMS professionalized, and paramedics advanced as medical professionals are fighting a multi-front war. We have fire services and private sector agencies that want to maintain the status quo of having paramedics mass produced every 6 months or so to keep the supply/demand curve in their favor by keeping costs down. While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on. It's hard to see where this will leave us, and incredibly frustrating.

 

[VentMedic]

After being in EMS for over 30 years, I can tell you it is not nursing, RT, PT, OT, SLP, RRT or any of the others that are to blame for this mess. Many of these professions are a lot younger than EMS which is now middle-aged but the others have achieved so much more in professional and legislative recognition by not whining about "nurses picking on them". They also took over many of the duties that had been done by nurses for decades and once they showed their education and professional status, they became health care team members FOR THE PATIENT and not hated enemies. EMS providers need to get over this "what everyone else should be doing for them" and take some responsibility for their own future.

I think we're all aware of the "hammering" of paramedics that goes on around this site - about how we're all uneducated, incompetent, and not to be trusted with "real" medicine, etc. Now, I admit to being among those who've done this. I acknowledge full well that the educational standards for EMS are seriously lacking and must be improved to college degree-appropriate level if we're going to be recognized as medical professionals from our colleagues. However, I think it must be said that these other medical people (physicians & RN's) do bear at least some level of responsibility for the overall sorry state of EMS education. After all, they're the ones in charge of developing and carrying out the educational process of prehospital personnel. Somewhere along the line they agreed that it's adequate.

One of the reasons nurses still have some control in the educational programs and in the state legislative offices is that there are not many EMS providers who have advanced their education enough to assume the roles. The same for the role of educators. Few have advanced to where college programs are common and thus you have certified teaching certified classes in the tech schools where the instructors are not required to have higher education of even a 2 year degree.

RNs and doctors did not force anyone to go to a medic mill instead of to a college. Every other health care profession saw what needed to be done and started advancing their education long before anyone MADE them get a degree. Unfortunately in EMS "if it ain't required I ain't gonna do it". It is amazing that in 2009 when some find out I have a 2 year degree in EMS from 1979 they are shocked and ask "did someone make you get that degree?" "Why on earth would you get a degree if no one made you get it?" or "That was stupid to waste your time getting a degree when you could have gotten a cert and still joined the FD for good pay and a pension." These are comments made to me by EMS providers and are repeated over and over today on many of the EMS forums.

Further along these lines, it seems (at least in my experience) that a large center of resistance to expanding the role of paramedics through education and, thus, scope of practice have been nursing associations. Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.

Did you happen to check your public health rules and regulations for your state? This is not a "not gonna let them do it" decision by nurses. The rules have been made by higher authorities than them. Also EMS agencies did help determine what they did and did not want to do when some of these rules were being designed. Florida has very liberal statutes for Paramedics and public health but many agencies have chosen not to expand into that area because "it's boring" as it involves more than just sticking a needle into someone's arm. This one "skill" mentality has been what has keep EMS out of expanding into other avenues.

So, it seems like those of us who would like to see EMS professionalized, and paramedics advanced as medical professionals are fighting a multi-front war. We have fire services and private sector agencies that want to maintain the status quo of having paramedics mass produced every 6 months or so to keep the supply/demand curve in their favor by keeping costs down. While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on. It's hard to see where this will leave us, and incredibly frustrating.

Can you show me anything in the Paramedic curriculum that prepares you to work in a critical care unit?

It is amazing at how other professions have over come being stepped on by becoming the peers of other professionals rather than alienating themselves as enemies with the "us against them" crap attitude. Get over it. Every allied health professsion has had to meet the challenges expected by nursing and set by their own state and national accrediting/certifying agencies. The other agencies also knew there was not substitute or shortcuts to education. They pushed for their degrees and encouraged as many in the profession to become educated so that when licensing standards were raised, very few were left out with only a diploma or tech cert.

Maybe you should review the history of nursing to see exactly how far they have come and the changes they have gone through since the 1970s. EMS had every opportunity to become stronger than nursing in the 70s but too many in the profession, providers and agencies, fell for the quick cert mentality. If you notice, many of us that did start in the 1970s in EMS have a 2 year degree from a college in Paramedicine. That was the way it was intended to be. Nursing still hadn't acheived its goal at that time. Nurses and the other allied health professions have streamlined their professions to just a couple of levels. They don't keep adding a cert level for each "skill" until there are over 50 different certs. Nursing also doesn't force everyone to be a nurse as FDs want every FF to be a Paramedic. They do encourage their lower levels such as the CNA and the LPN to become RNs and do not allow the lowest level (CNA) to dictate what direction RNs should take their professional status.

Do the RNs tell agencies not to monitor the QA/QI of Paramedic performance for certain skills? Do they tell EMS medical directors not to be involved with their Paramedics? Do RNs tell your agencies not to provide you with continuing education? Are RNs responsible for all the publicity Paramedics are getting for not recognizing misplaced tubes? Do you actually blame nurses each time you miss a tube? The one advanced skill that was given to Paramedics in the 1960s by physicians (not nurses) and somehow some have managed to muck it up?

It is also amazing that at one time the Paramedic could do central lines (including subclavian), intracardiac epi, chest tubes and pericardiocentesis and not once did any RN give me grief about what I did as a Paramedic. Evidence based medicine took those things out of EMS and NOT nurses.

However, don't expect anyone to allow you or support you to do something you have NEVER been trained and educated for.

Here's some good reading for you and it wasn't written by a nurse.
2,000 Hours to train a Paramedic?

http://www.fd-doc.com/2000Hours.htm

You might also review some of the EMS history in the states that increased their "hours of training" by a whopping 100 hours. It was the EMS providers that thought it was scandalous to require that many more hours. Maybe you should go to a few of your state meetings and see who is against the changes. Usually educated people like RNs and MDs support education and rarely if ever tell people to do less or stay at a low level. Unfortunately, the numbers in EMS with only a cert out number those with education and that includes the RNs and MDs who have tried to help. The whole issue that RNs and MDs have with EMS providers is that they DO NOT have the education to expand their roles. If RNs do not want LPNs with 2x the education and training of Paramedics in the ICUs and EDs, what makes you think they should make the exception for someone with 624 hours of PREHOSPITAL taining? The hospitals didn't want RTs in the ICUs to manage the ventilators until we had some proof of education. How about Radiology Technologists? Why do some in EMS believe they are the exception and that they are being picked on "just because"?


There are many, many articles for you to look up as this is a topic that has been in EMS journals for decades and there is nothing mentioned about the mean nurses picking on the poor Paramedics. Problems were identified in the early 80s and the EMS agencies that responded to the problem areas went on to be successful. Those who whined about education and blamed everyone else are those that still feel that way today and still have gone nowhere.

Just do a search on EMS training on any medical search engine and start reading. Enlighten yourself about what EMS has been and where it tried to go.

So no, EMS did this mess all by itself. Until EMS providers stop blaming everything on others and take some responsibility for their own education, there is nothing nursing, RT or MDs can do to help you. Hell some in EMS see absolutely no need for any college level A&P and are perfectly happy have a 10th grade reader for a Paramedic text and an 8th grade book for EMT-B.

 

[VentMedic]

Here were some of the better discussions on the topic way back when Rid was here.

Progression of EMS

http://www.emtlife.com/showthread.php?t=5495&highlight=progression+EMS

Basics before Advanced
http://www.emtlife.com/showthread.php?t=4830

Decent JEMS article:
EMS Needs a National Brand Identity

http://www.jems.com/news_and_articles/articles/EMS_Needs_a_National_Brand_Identity.html

As a profession, EMS has a lot of work to do to create a respected image or "brand identity" on a state and national level. Perhaps the most poignant comment to illustrate this point came from an elected official in the Florida Senate when several of us were lobbying for an innovative change to the statutes that would dramatically improve patient care. One senator said, "We cannot vote to pave a road for you EMS people when you all want to take different roads." Painful. But you know, she was right. The measure failed.

We've been so busy pursuing the public vs. private agenda that we've lost credibility on a national front. We've invested so many resources battling each other that we've almost lost the war.

 

[jgmedic]

Vent, you make some great points here. Until we as a profession can show that we are willing to take on that extra education and show that we are medical professionals we can't expect people to just give us that respect we crave. It's not all about big, bad fire and nursing and all that. It's about us being ok with the status quo. People continue to flock to medic mills, because(esp. in SoCal), it's seen as a fast ticket to FD, and why not, when that's where the benefits and pay are. If students all of a sudden stopped being willing to pay the money for a quick P-card and demanded a better educational standard, these places would not exist.

 

[Summit]

Here's some good reading for you and it wasn't written by a nurse.
2,000 Hours to train a Paramedic?

http://www.fd-doc.com/2000Hours.htm

That's a bunch of crap.

 

[VentMedic]

That's a bunch of crap.

I agree but if you read some of the posts written by EMTs and Paramedics on the forums who are trying to differentiate or justify street smarts over college level courses, it all comes out the same "don't need no book learnin' stuff" to get the job done.

 

[thegreypilgrim]

VentMedic, I strongly suggest you take a long deep breath, go back and re-read my OP. You're on auto-pilot mode here.

I really don't know where to begin here, except to say that I'm not whining about "nurses picking on EMS". I don't know where you got that from. I realize that we (that is, prehospital providers) are largely the problem. We are very naive to think that 6 months in a medic mill qualifies us to practice advanced medicine independently whereas others in allied health hold 2-4 year degrees to do what they do. Since you apparently missed my being clear about this in the OP, let me be even clearer now: If there is going to be change it has to come from us first.

Now, my point was that I think there is a growing population of EMS providers who actually are tired of being looked down on and want to change their circumstances. I did not go to a medic mill - I went to a college paramedic program that could confer an AS degree. I'm currently working on a BS degree in EMS at a university as well. I would like to see other people start doing this as well. I believe I also made it clear in my OP that FD's and private companies represent the largest barrier to EMS advancement - a point you entirely passed over in that rant of a response.

For the record, I don't believe paramedics should be allowed to do XYZ procedure despite not having degrees "just because". I don't know how you could have formed that impression, but as it is I most certainly don't. I don't think that as things currently stand paramedics have the right to enter into critical care medicine. I never said that - I merely stated that we should expand our education first. Nor did I ever state that RN's & MD's should "force us" into getting degrees...another suggestion from way out of left field. No, we should push for this ourselves.

As for this:

Did you happen to check your public health rules and regulations for your state? This is not a "not gonna let them do it" decision by nurses. The rules have been made by higher authorities than them. Also EMS agencies did help determine what they did and did not want to do when some of these rules were being designed.

As a matter of fact I have. By all means, however, feel free to lecture me about what's happening in my own state while you're not even from here. Of course, the decision to not have paramedics help out with this was not "made" by nurses. I doubt any individual RN in the area actually gives a :censored::censored::censored::censored: about who's giving H1N1 vaccines. I'm simply saying, that this suggestion came from public health & EMS and probably met a whole lot of resistance from FD's & ambulance services in the area because "it's boring" like you said. But the nursing association about had a seizure and raised a hellstorm about the idea as well - the combined efforts are what resulted in it not happening. The point was, it was an example of what is the general atmosphere in my state. People - both in EMS and in healthcare - just seem apathetic about the system, and would rather things just stay as they are. This was the inspiration for this thread - I'm simply reporting what I'm experiencing in my region. Sure, there's probably less resistance from RN's, MD's, etc. than FD's & private ambulance but nevertheless there is some resistance from those areas as well. Remember I said this is a multi-front battle? You're responding as though I'm bashing nurses and trying to say it's all their fault, which is a horrendous misrepresentation of what I said.

Having read a fair amount of your posts here, I have a good deal of respect for you as a medical professional and as a person; but, your reply to me here was entirely inappropriate, and turned my OP into a straw man. Please, for future reference, don't twist my words or take something you read in a post and in a reactionary fashion just run away with it. It's just unwarranted.

 

[VentMedic]

Now, my point was that I think there is a growing population of EMS providers who actually are tired of being looked down on and want to change their circumstances. I did not go to a medic mill - I went to a college paramedic program that could confer an AS degree. I'm currently working on a BS degree in EMS at a university as well. I would like to see other people start doing this as well.

Unfortunately you are looked upon by the minimum education standard for your profession. That standard is still the "hours of training" cert present in all states but a couple.

I believe I also made it clear in my OP that FD's and private companies represent the largest barrier to EMS advancement - a point you entirely passed over in that rant of a response.

Did you bother to read my posts? The link I posted, "2000 Hours to Train a Paramedic?", was by a FD medical director.

I don't think that as things currently stand paramedics have the right to enter into critical care medicine. I never said that - I merely stated that we should expand our education first.

Then what did you mean by this comment?

While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on.

Or this?

Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.

I also don't know what state you are from to even pull up your public health statutes to see where EMS stands in them.

Nurses will defend the statutes and as I stated before, they do not allow other lesser trained individuals to do patient care without proper supervision so why should EMS be the exception? RT and other professions (Radiology, Ultrasound, Nuclear Med, Radiation Therapy, PT, SLP) were able to put restrictions on RNs from doing certain assessments and skills without the term "education" being properly defined. Thus, it is about who is the most qualified to do what is best for the patient.

 

[thegreypilgrim]

Unfortunately you are looked upon by the minimum education standard for your profession. That standard is still the "hours of training" cert present in all states but a couple.

Don't I know it.

Did you bother to read my posts? The link I posted, "2000 Hours to Train a Paramedic?", was by a FD medical director.

Yeah, I read that swill. I don't understand your point, though, as I said FD's often stand in the way of increasing paramedic education standards...

Then what did you mean by this comment?
Quote:
While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on.

Obviously, if paramedics education was augmented to the university level, then they could feasibly engage in critical care medicine. The vibe I get from nurses associations in my area leads me to believe that they would fight against increasing EMS education if they thought paramedics would be involved in CCT's. Hence the "stepping on their toes" metaphor.

Or this?

Quote:
Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.

I think this is pretty self-explanatory.

I also don't know what state you are from to even pull up your public health statutes to see where EMS stands in them.

California.

Nurses will defend the statutes and as I stated before, they do not allow other lesser trained individuals to do patient care without proper supervision so why should EMS be the exception? RT and other professions (Radiology, Ultrasound, Nuclear Med, Radiation Therapy, PT, SLP) were able to put restrictions on RNs from doing certain assessments and skills without the term "education" being properly defined. Thus, it is about who is the most qualified to do what is best for the patient.

Well, I don't know about where you're from, but around here paramedics can give medications via the IM and/or IN route...the fact that it's a vaccine we're talking about here doesn't make the process any more mysterious. I gave tons of vaccines in my clinical rotations - as far as I know nobody died from this. Then again, I am a paramedic so therefore must have screwed it up somehow right?

 

[Aidey]

thegreypilgrim - We had the same issue with vaccines in the state where I first started. While I was in paramedic school the county received a grant to put together a mass vaccination plan in the event of a pandemic or attack of some sort that required vaccinations to be administered.

While putting the plan together the suggestion was made to utilize Paramedics and the EMTs whose normal scope covered IM medications. The State RN association had what I can only describe as a hissy fit. They did not care that we were already trained in how to administer IM medications. They didn't care that the plan stated we would have to attend a class/briefing in the vaccine being given prior to being able to give it (I think that provision covered everyone in cases of vaccinations not normally given). I honestly never heard a reason besides "They aren't nurses".

The whole thing finally got resolved when the local medical directors got involved, and the state eventually decided to let Paramedics participate and that the RN association had no say in what happened because of how everything was organized in the state. The state ended up adding the EMTs who normally have IM medications this year with all the H1N1 issues.

 

[Akulahawk]

Advancing Paramedicine: My Rant

Education is a WONDERFUL thing. Somehow, I get the very distinct impression that all the non-nursing alphabet letter folks (RT, PT, OT, and so on) weren't able to just suddenly be able to provide patient care within their scopes in hospital at an almost overnight pace. I suspect that it took a while to get things going, even after the educational level for an entry into those fields was raised significantly. I also get the impression that nursing (as a profession and lobby) tends to resist sharing portions of their scope to non-nurses because they're not nurses and weren't trained as a nurse, even though the educational level is comparable, if not superior in that specific area. I just don't get the feeling that all those "younger" professions were welcomed with open arms at first, even with the increased education requirements. Now they're well-regarded and well-respected fields.

Nursing is an old profession. It has been around for a long time. EMS has also been around for a long time, longer than some/most of the other allied health care professions. What was it that got nursing and those other professions going like gang-busters to increase their educational standards and professional recognition? Those groups banded together, acknowledged that they needed to increase their standards to improve their level of care, and here's the kicker: they also formed/became powerful lobbying groups to get the State Legislatures to write laws and regulations to more specifically define their scopes. Now, those lobby groups are protective over what they fought to secure. It's little wonder why they'd have a hissy fit from time to time over what they'd view as an encroachment into their accomplishments.

To be completely fair, I have yet to meet an individual health care provider who wasn't supportive of someone increasing their education. Most have even been willing to educate me about their profession. I've enjoyed every minute of it.

What did EMS do? Well, EMS had the potential to become a pre-hospital parallel to nursing or go even beyond that... but stalled in it's infancy. EMS attracts a certain personality... and getting EMS people to agree on anything can be a lot like herding cats. That doesn't help. For a variety of reasons and causes, EMS stuck to maintaining the status quo, which kept the profession from improving itself.

Would I like to see a degree be required for someone to become a Paramedic? Absolutely. Would I like to see the time required for a Paramedic be increased to at least 4 semesters of at least 11 units average each? Yes. I'd also like to see clinical and field time better interspersed throughout that time period to more properly and thoroughly ingrain the knowledge and skills into the student? Yep. Would I like to see prerequisites for entry into a degree program mirror those of most other allied health care fields? Yep.

You know what? ADN/BSN (and others) programs have a good model... I was educated in just a similarly modeled program, where I earned a bachelor's degree. That kind of program does work. Given a proper base education, a Paramedic could truly function as a physician extender, in a manner more like a PA, and would have the knowledge and skills necessary to do ICU-ICU transports as a team leader. That provider would still be able to work on the street just as effectively and efficiently. The only higher level of care possible (as I envision it) would be a Physician accompanying and caring for the patient during transport.

I don't see this happening overnight... but should this level of care and ability be what we aim for? Personally? I think so.

 

[VentMedic]

The whole thing finally got resolved when the local medical directors got involved, and the state eventually decided to let Paramedics participate and that the RN association had no say in what happened because of how everything was organized in the state. The state ended up adding the EMTs who normally have IM medications this year with all the H1N1 issues.

Where were your EMS officials when these Public Health statutes were being formed? Did anyone represent EMS or care enough about these issues? Why is it you think the RNs are wrong for following the laws of your state especially if your EMS representatives didn't feel some things were important enough to address? These are not new issues. Florida redefined many of their statutes for EMS after Hurricane Andrew in Public Health. Other states got busy after Katrina and 9/11. Massachusetts was one of those states with an extensive statute recently put through its governing bodies for approval. Why is it the nurses' fault if EMS in your state chose to sit on its butt when Public Health issues were being addressed but then for some to whine when something does happen and they feel ENTITLED to that "skill" also?

It is no different either when EMS statutes are written by EMS officials to include the word PREHOSPITAL and then for some to whine that their titles don't extend into the hospital. Again they will blame the hospital and NURSES for what their own EMS statutes state.

 

[Aidey]

Vent do you even have the ability to reply to a post without blaming EMS/EMTs/Paramedics every single? You don't even sound rational anymore, every thing you say is a rant based on how someone in EMS was at fault.

It wasn't an EMT or Paramedic that suggested Paramedics and EMTs could be used, but one of the local MD sponsors who was on the committee. None of us demanded anything. A suggestion was made in an attempt to use all resources available.

I don't see how RNs getting upset at what the state is allowing paramedics to do is "following the law". The RNs got upset because they saw it as an encroachment on their "territory" not because it was against the law. In fact, it turned out that it was perfectly legal for Paramedics to participate.

The laws governing RNs and the laws governing Paramedics and the laws governing EMTs are all separate, and each group is goverened by separate boards. RNs have no right to get pissy over what the medical board lets paramedics do and the EMS board lets EMTs do.

Did you ever consider the fact that the public health codes/laws/regulations may have been written prior to a structured EMS system being in place? Why does it have to be that the EMS representatives were at fault?

 

[MrBrown]

I think a radical shift in the very core of what must be ambo's business is required before the service gets anywhere. For so long it has been "prehospital" care, i.e. before the hospital; I'd much perfer the term "out of hospital" to recognise that ambulance treatment and decision making takes place outside the hospital and possibly before it but treatment and transport are not mutually exclusive!

The argument to keep education down is "oh well we only have the patient for a half hour while we take them to the hospital" and "I'll never use that stuff, I don't need to know it, I don't want to be a doctor".

I personally think there must a serious foci change within EMS in the next decade or two. 90% of the patients I have seen do not require emergency treatment, they don't need an ambulance and most are not managed best by presentation at a hospital emergency department. There will come a time for the requirement of a RN/ambo hybrid "super-medic" who does low priority primary care just as much as (if not more than) high priority life threatning calls.

Recently I had the pleasure to listen to Prof. Malcom Wollard from the UK who said while trauma and cardiac arrests are fun they are not the real ambulance service. If we are honest, I mean really honest, that's probably 5-10% of the ambulance services' work. Most of the "skills" that Paramedics and Ambo's are taught are to deal with high priority, life threatning cases.

Let me list the drugs in the Advanced Paramedic drug roll and thier uses ...

- Adrenaline, for compromising bradydysrhythmias and life threatning croup, asthma, anaphylaxis and cardiac arrest
- Atropine, for compromising bradydysrhythmias
- Amiodarone, for compromising tachyarrythmias and life threatning cardiac arrest
- Asprin, for potentially life threatning myocardial infarctions
- Fentanyl, for sedation pre-induction (RSI), for life threatning ventilatory emergency
- Frusemide, for compromising cardiogenic pulomonary edema
- Glucagon and glucose; for severe hypoglycemia
- GTN (nitro), for angina and compromising cardiogenic pulomonary edema
- Ketamine, for induction (RSI) during life threatning ventilatory emergencies
- Midazolam, for life threatning status epilepticus and sedation post-intubation (for life threatning ventilatory emergency and pre-cardioversion for life threatning tachydysrhythmias[/b])
- Naloxone, for life threatning narcotic overdose
- Salbutamol nebules, for compromising and potentially life threatning asthma

Do you see a trend here; most of what ambo does has been built up around 10% of it's patients; nearly every drug and piece of equipement carried (airway kit, defibrillator, suction etc) is primarily designed for life threatning, high priority emergencies.

While they are important I can't argue that, they neglect the other 90% of patients who do not have high priority, life threatning emergencies. Most paramedics and ambo's have neither the knowledge nor options to deal with these patients other than to take them to an already overcroweded hospital.

I see a radial change being required to equip the ambulance service to deal with not only high priority life threatning emergencies but also low risk, unschedule care patients.

This change will require a massive shift in the education of ambo's away from "skills" and a "gloss" over of patho and pharm to a proper Degree based education of college level science and the pathways to allow ambo's to refer patients to other options than going to the hospital.

Only when this occurs can Paramedicine truly advance as a speciality and a profession.

I got ahold of the A&P section of my Essentials of Paramedic Care and Paramedic A&P by the AAOS (ironically - makers of the original orange book) and became so frustrated with thier content (and lack of it) I almost had a stroke.

I've gotten so annoyed and so angry with the tiny amount of science being taught to ambo's that I am seriously considering getting a Masters Degree in physiology, finding a Pharmacologist and rounding up a few RN friends of mine and writing a textbook.

Talking with my American friends who are EMT-Intermediate and EMT-Paramedic and the lack of knowledge they have at how the body and drugs works makes me so mad ... it's dispicable. I voluntarily spend my time reading medical journals, going through my textbooks, podcasting and the internet to learn more, they say knowledge is power!

 

[NJnewbie]

I've gotten so annoyed and so angry with the tiny amount of science being taught to ambo's that I am seriously considering getting a Masters Degree in physiology, finding a Pharmacologist and rounding up a few RN friends of mine and writing a textbook.

I hope you do write that book. I know I'd buy it, and so would a lot of other people. It's sorely needed. I'm not even in school yet for EMS, but I've been looking for books to read that match the description of what you're describing and haven't been able to find anything.

 

[HuiNeng]

Systems

I'm all for education.

How many people with nursing degrees choose to add paramedicine to their careers? Also, how many go the other way, adding MD or nursing after paramedicine? (Not counting tv characters! )

What data are available to answer the question, "Do morbidity and mortality differ among patients treated by those paramedics who hold nursing or medical degrees versus those paramedics without such degrees?"

 

[VentMedic]

What data are available to answer the question, "Do morbidity and mortality differ among patients treated by those paramedics who hold nursing or medical degrees versus those paramedics without such degrees?"

In a word, yes. Paramedics are not doctors.

Since the OP is in California, that is a good (bad?) example to use. The Paramedics' protocols in that state are very, very limited even for what they considered "advanced" or "expanded". In some areas the Paramedics must still take a suspected STEMI (very few 12-lead ECGs in much of CA) to the nearest facility. If any medicated drips are started, an RN from the ED must then accompany the patient to the more appropriate facility which might be just another mile down the road. Most of their Flight teams and their CCTs do use RNs with 2 EMTs to drive and help move the patient. Again, it is because of the limitations the states has placed on the Paramedics and they are essentially catering to the lowest denominator among the Bubba EMS managed counties.

As well, Paramedics who do get their RN degrees can be Flight RNs provided they get at least 3-5 years of ICU experience regardless of how many years they have an a Paramedic even if it is as a Flight Paramedic. Canada's system is set up much differently in that the Paramedics do get extensive education and then the critical care experience they need to function at that level. However, in the U.S., the Paramedic who does hold a degree as a Paramedic might have a better shot at becoming part of a very progressive EMS system be it ground or flight. It is much easier for a medical director to have confidence in his/her Paramedics if he knows they have already extended themselves to get at least the "basics" of a medical education. There was actually a couple of counties in TN that was hiring only those with a degree. Their feeling was that those who went the distance for an education probably won't be as likely to job hop looking for the perfect company if the job isn't like what the medic mills promised. They may know there's more to patient care with the many disease processes and it isn't all about the trauma stuff. You also don't see many Paramedics from OR complaining about education and how unfair nurses are to them.

Essentially, a better educated Paramedic has the opportunity to do advanced skills and accept the responsibilty of critically ill patients for transfer to where that patient has a better of survival. If the medical director feels the Paramedics are capable of doing expanded protocols, patient out come can be affected. You don't see 600 hour medic mill grads working with Seattle's finest. So yes, education can improve patient outcomes.

However, until ground EMS improves its education, few studies can be done on how patient outcomes can be improved since the protocols still cater to the lowest denominator which is the most minimal trained/educated Paramedic that the state allows.

We also haven't even begun to explore the role of the Paramedic in the role of public health to any great extent. FL did have a couple of involved counties but that side has been quiet over the past few years even with the statutes in existence that allow them to take a more active role. Since the Paramedic curriculum does not address many of the issues needed in preventitive medicine or public health, it might be a long time before we see a change there.

 

[VentMedic]

Vent do you even have the ability to reply to a post without blaming EMS/EMTs/Paramedics every single? You don't even sound rational anymore, every thing you say is a rant based on how someone in EMS was at fault.

It wasn't an EMT or Paramedic that suggested Paramedics and EMTs could be used, but one of the local MD sponsors who was on the committee. None of us demanded anything. A suggestion was made in an attempt to use all resources available.

I don't see how RNs getting upset at what the state is allowing paramedics to do is "following the law". The RNs got upset because they saw it as an encroachment on their "territory" not because it was against the law. In fact, it turned out that it was perfectly legal for Paramedics to participate.

The laws governing RNs and the laws governing Paramedics and the laws governing EMTs are all separate, and each group is goverened by separate boards. RNs have no right to get pissy over what the medical board lets paramedics do and the EMS board lets EMTs do.

Did you ever consider the fact that the public health codes/laws/regulations may have been written prior to a structured EMS system being in place? Why does it have to be that the EMS representatives were at fault?

Again you blame the RNs for following the law. Guess who would have to supervise the Paramedics at the Public Health clinics? The RNs. Even at the places here where the Paramedics did give the flu shots, the Public Health RNs oversee the whole process and were responsible for the education. It falls on their RN licenses when they are in that role of supervising others during this process regardles of what title you hold. Thus, RNs have every right to get pissy if they are given people who do not have the proper training or by law, do not have the right.

Believe it or not a lot of other health care providers can give IM injections such as the LPN and MA, but even with more "hours of training" than the Paramedic and while working in some of these clinics they can not participate in every Public Health act either. However, they do what their role calls for in the time of a disaster or pandemic and don't waste time blaming RNs for their own lack of education in other areas. Also, who some forget, it is a little more than just the "skill" of sticking a needle in someone's arm. You also have to be able to ask and answer the questions correctly and not jsut from hearsay on an anonymous EMS forum which means a little addition training. If some in EMS complain about all that training stuff they are required to do now, what makes you thing some are up for more?

The fact that as you state, EMS didn't even want to get involved by a physician thought of you does show a lack of initiative on EMS to participate. Again with the "make us" thing.

Actually from your post I have no clue what you and your EMS system wants. Do you want to be involved or do you just want something to complain about nurses?

Most states in the U.S. have updated their Public Health Statutes since 9/11 especially where it concerns EMS. Pull up your statutes and read them because there will probably be more disasters to come either by nature or man made.

Also, if you have ever attended a state or national EMS conference, you will find at almost everyone there will be political representatives from some part of government and those in high ranking position in state EMS offices. However, out of 10,000 conference attendees only about 20 will show enough interest in any of that boring stuff to attend one of these scheduled meetings. The other 9,980 will be at the pool griping about the very same issues being discussed in that meeting but don't care enough to vocalize their opinion where it might count.

 

[thegreypilgrim]

Again you blame the RNs for following the law.

Good grief, this is getting ridiculous. You're just stimulus-response now. What "law" are you talking about? Paramedic scope of practice in every state includes IM/IN medication administration, every paramedic textbook ever published includes sections on proper techniques for doing this, and every paramedic program in existence (one hopes) teaches its students how to properly do this. Is it against the law for me to give my anaphylaxis patient IM epi? What about my narcotic OD pt with no vascular access to speak of? Is it illegal for me to give him IN narcan? Gee I hope not, maybe I should check with an RN though since they're apparently the only one's who have a clue about anything. Here's the thing, public health regulations can be amended by committee approval. If a local public health/EMS agency wants paramedics to give vaccines then all they need to do is vote on it, write up a proposal to the state authority, and get it approved. No one needs to break the damn law for something like this to happen. No one suggested circumventing this process and just throwing medics in clinics willy-nilly.

Guess who would have to supervise the Paramedics at the Public Health clinics? The RNs. Even at the places here where the Paramedics did give the flu shots, the Public Health RNs oversee the whole process and were responsible for the education. It falls on their RN licenses when they are in that role of supervising others during this process regardles of what title you hold. Thus, RNs have every right to get pissy if they are given people who do not have the proper training or by law, do not have the right.

Give me a break. So first you suggest RNs were doing nothing but being upscale citizens by defending the rule of law, now they're eternal professionals worried about someone revoking their license because some medic screwed up a vaccine admin on their watch? This strains credulity. Do you ever stop and consider for one second that even RNs in all their glory can act out of self-interest? It's patently clear that they raised hell over this because they don't want anyone encroaching on their territory - as qualified as they may be to have a right to it. In my area, this whole thing was over before it even started. I didn't even know about the proposal to have medics help out with vaccinating people against H1N1 until it had already been killed. It's hard to blame EMS for not being on the ball when the proposal is eliminated before most people even know about it. Finally, where on earth do you get the idea that paramedics are not qualified to do something like this? Or do you think that there's something about IM/IN admin that we don't know about.

Believe it or not a lot of other health care providers can give IM injections such as the LPN and MA, but even with more "hours of training" than the Paramedic and while working in some of these clinics they can not participate in every Public Health act either. However, they do what their role calls for in the time of a disaster or pandemic and don't waste time blaming RNs for their own lack of education in other areas.

Further forays into irrelevance. Intramuscular or intranasal medication admin are not areas paramedics are lacking in education. Neither is vaccination, necessarily. Like I said earlier, I was authorized as a paramedic student to give all sorts of vaccines during my clinical rotations. People didn't freak out about this - in fact, the RNs usually came and found me to do it for them when they had better things to do.

Do you want to be involved or do you just want something to complain about nurses?

Believe it or not, I don't have some sort of personal vendetta against nurses. I like nurses. I would like to be their peers. The impetus for this thread was not to bash nurses as I've repeatedly stated. I'm simply saying they're not always on the side of advancing EMS either, for which the H1N1 thing in my area was simply an example.

Also, who some forget, it is a little more than just the "skill" of sticking a needle in someone's arm. You also have to be able to ask and answer the questions correctly and not jsut from hearsay on an anonymous EMS forum which means a little addition training. If some in EMS complain about all that training stuff they are required to do now, what makes you thing some are up for more?

Ooh yeah, that sounds pretty involved. Asking people if they're allergic to eggs seems like something best left to the professionals.

 

[thegreypilgrim]

I got ahold of the A&P section of my Essentials of Paramedic Care and Paramedic A&P by the AAOS (ironically - makers of the original orange book) and became so frustrated with thier content (and lack of it) I almost had a stroke.

I've gotten so annoyed and so angry with the tiny amount of science being taught to ambo's that I am seriously considering getting a Masters Degree in physiology, finding a Pharmacologist and rounding up a few RN friends of mine and writing a textbook.

Talking with my American friends who are EMT-Intermediate and EMT-Paramedic and the lack of knowledge they have at how the body and drugs works makes me so mad ... it's dispicable. I voluntarily spend my time reading medical journals, going through my textbooks, podcasting and the internet to learn more, they say knowledge is power!

Not that I disagree, but you do realize that the A&P section of the Essentials of Paramedic Care is meant as a review right? It's meant for people who've already taken college A&P.

But I agree with you the AAOS A&P book is a travesty. I actually really enjoy physiology and was happy at how rigorous and in-depth it was covered in my paramedic program (I took college anatomy and physiology courses after medic school and aced them, hardly had to study). Still though I've felt the need to continue to study my college A&P textbooks and read through medical journals to keep up to date.

I would totally buy your book too!