Age-related speciality certification

[bstone]

An idea- bare with me, I just thought about it walking up the steps.

Specialty age-related certification for EMS professionals.

Example: Pediatric-specialty certification. I worked at a children's hospital for 2 years on the NICU/PICU ambulance with nothing more than my EMT-B. There were two other providers- one NICU/PICU RN and one RRT who was certified in neonates and pediatric patients. I felt completely out of my element and would have loved to benefit from not just ConEd but an actual formal and systematic course of study, leading to specialty certification.

Nurses have pediatric specialties. Doctors have residencies in those areas. Why not EMS providers?

The way I see it it breaks down to:
Neonatal
Pediatric
Adult
Geriatric

Each has it's own huge set of information that is specific and directly applicable with not too much cross-over.

So, does it exist? If not, has it been considered?

 

[Veneficus]

An idea- bare with me, I just thought about it walking up the steps.

Specialty age-related certification for EMS professionals.

Example: Pediatric-specialty certification. I worked at a children's hospital for 2 years on the NICU/PICU ambulance with nothing more than my EMT-B. There were two other providers- one NICU/PICU RN and one RRT who was certified in neonates and pediatric patients. I felt completely out of my element and would have loved to benefit from not just ConEd but an actual formal and systematic course of study, leading to specialty certification.

Nurses have pediatric specialties. Doctors have residencies in those areas. Why not EMS providers?

The way I see it it breaks down to:
Neonatal
Pediatric
Adult
Geriatric

Each has it's own huge set of information that is specific and directly applicable with not too much cross-over.

So, does it exist? If not, has it been considered?

I think there are no specialties for 2 reasons.

1st. with the average range of equipment on an ambulance, the types of pathology that are diagnosable and treatable are severely limited.

2nd. With potential response times and the variety of patients, how could an EMS system economically field such diverse providers and how could they practically make sure the specialist got to the type of person they were specialized in?

What hppens of all of your geriatric specialists are out on a call and all you have left are peds specialists?

With NP and MD/DO specialists, they are in environments that facilitate their specific patients go to them.

What good would a geriatric or pediatric specialist be in a mass casualty where their specific populations are pretriaged to "no care rendered" in some cases?

 

[bstone]

Veneficus, good points. Seriously.

First, the certifications are entirely options unless the system/medical director demands otherwise. But can you imagine the amount of ConEd awarded? ::drool::

Second, 80% of US EMS is in rural areas with longer response times. Having an age-certified EMT/medic may just help a lot.

I understand the reasons not to have age-related certifications, but what about the reasons to have such certifications.

 

[Veneficus]

Veneficus, good points. Seriously.

First, the certifications are entirely options unless the system/medical director demands otherwise. But can you imagine the amount of ConEd awarded? ::drool::

Second, 80% of US EMS is in rural areas with longer response times. Having an age-certified EMT/medic may just help a lot.

I understand the reasons not to have age-related certifications, but what about the reasons to have such certifications.

I think that already exists in the form of CCT.

 

[JPINFV]

Each has it's own huge set of information that is specific and directly applicable with not too much cross-over.

So, does it exist? If not, has it been considered?

A few problems that I can see.

A physician who specializes in peds or OB/Gyn, or any other specialty isn't going to be expected to work outside of that specialty. However, short of specialty transports, are you going to try to make sure that you have enough specialist paramedics to be available to respond in a timely manner to the entire response area? After all, being a pediatric specialist doesn't do anyone any good when the 1 pediatric call that night is 30 minutes across town with 3 other paramedic units closer than you are.

Second, assuming that paramedics get their act and education together to put a decent challenge that they are the masters of transport of all forms to the extent that they can challenge RNs for all CCTs, still how many people are going to be actually fit into the category of needing the training. The neonate transport team providers (essentially everyone but the EMT or paramedic driver) I know of aren't full time transport teams. Outside of the transport part of their job, they're also working in the NICU or somewhere else in the Children's Hospital and hop onto the ambulance when needed for a retrieval. They aren't just sitting around passing time until the next transport. I'd argue it's much easier to take someone who's full time job is critical care and teach them the nuances of transport than take someone who's job is transport and teach them the nuances of critical care.

 

[bstone]

A few problems that I can see.

A physician who specializes in peds or OB/Gyn, or any other specialty isn't going to be expected to work outside of that specialty. However, short of specialty transports, are you going to try to make sure that you have enough specialist paramedics to be available to respond in a timely manner to the entire response area? After all, being a pediatric specialist doesn't do anyone any good when the 1 pediatric call that night is 30 minutes across town with 3 other paramedic units closer than you are.

Yeah, doc is a bad example. Nursing is a better example. A nurse can nurse, but on occasion they decide/are required to get specialty certification.

Second, assuming that paramedics get their act and education together to put a decent challenge that they are the masters of transport of all forms to the extent that they can challenge RNs for all CCTs, still how many people are going to be actually fit into the category of needing the training.

The CCT certification is so ambiguous. Dr Bledsoe wrote how it's essentially useless as there is no standardization. Age-specific certification might just remedy that. I can imagine most medics would take adult-related certification, the private ambulance medics might take geriatric-related certification (because 90% of our patients are elderly) and medics working in a suburb with young families might do adult and peds.

The neonate transport team providers (essentially everyone but the EMT or paramedic driver) I know of aren't full time transport teams. Outside of the transport part of their job, they're also working in the NICU or somewhere else in the Children's Hospital and hop onto the ambulance when needed for a retrieval. They aren't just sitting around passing time until the next transport. I'd argue it's much easier to take someone who's full time job is critical care and teach them the nuances of transport than take someone who's job is transport and teach them the nuances of critical care.

That's exactly what we did. We sat around doing absolutely nothing until the next call came in. Never went up to the PICU/NICU, never helped out in the ER, etc. Then again I worked for a private service that was contracted to the hospital and our primary responsibility was to make sure to ambulance was working and equipment ready to go.

 

[JPINFV]

That's exactly what we did. We sat around doing absolutely nothing until the next call came in. Never went up to the PICU/NICU, never helped out in the ER, etc. Then again I worked for a private service that was contracted to the hospital and our primary responsibility was to make sure to ambulance was working and equipment ready to go.

Clarification: By "we" do you mean the RNs and RTs who comprised the team or just the driver (regardless of certification level)?

 

[bstone]

Clarification: By "we" do you mean the RNs and RTs who comprised the team or just the driver (regardless of certification level)?

The two of us EMT-Bs who operated the ambulance and participated in patient care.

 

[Veneficus]

The CCT certification is so ambiguous. Dr Bledsoe wrote how it's essentially useless as there is no standardization. Age-specific certification might just remedy that. I can imagine most medics would take adult-related certification, the private ambulance medics might take geriatric-related certification (because 90% of our patients are elderly) and medics working in a suburb with young families might do adult and peds.

I wasn't refering speficically to EMS providers. A dedicated CCT transport team can have specialty NPs, CNS, RRTs, and in some rare services even physicians. Given the education credentials of those specialists as well s the practice scopes, I think EMS providers have a long way to go before they can get some "critical care" training and measure up, standards or not.

As for the breakdown, in today's US demographic of extended families, I don't think it would work. Just my $0.02.

That's exactly what we did. We sat around doing absolutely nothing until the next call came in. Never went up to the PICU/NICU, never helped out in the ER, etc. Then again I worked for a private service that was contracted to the hospital and our primary responsibility was to make sure to ambulance was working and equipment ready to go.

That is done and works in hospitals where the transport team is busy enough to merit that and the practice is economically sound.

 

[medic417]

Second, 80% of US EMS is in rural areas with longer response times. Having an age-certified EMT/medic may just help a lot.

.

The areas that might truly benefit would have trouble hiring that many specialists. I work in one of the 911 services with very long transports to nearest hospital. Passing the costs to the patients is a neat ideal in theory but when the majority do not pay and medicaid/medicare pays so little and even with specialization would not pay much more you could not cover the costs. Even if you taxed the citizens they would revolt before paying the amount required for that many specialists.

 

[bstone]

So how would these certifications look?

I imagine a 40-60 hour course for each specific certification. In a very similar format to EMT/medic school with quizes, tests and final exam with both written and practical assessments. Recertification every 4 years.

Thoughts?

 

[firetender]

Just a point here. These types of certifications would ordinarily be "plugged in" to an existing program. It sounds like just "making" these certifications annd have people go for them. Don't think that would work. If within an existing Bachelor's program in EMS, I could see that as a sort of "additional" but it would have to be initiated by a higher authority, school or otherwise, and incorporated into a system that's already handling advanced extensions of emergency medical care.

 

[bstone]

It would make sense that a BS in EMS would require industry-standard certifications such as I desribed, but it obviously would not be the only way to gain such credentials. They could be taken as standalone courses. Ideally each certification would count as 2-3 undergraduate credits, as well.

It simply appears to me that just as nurses can do both general nursing and specialize, EMTs and medic ought to be able to do the same. Right?