Common Nomenclature

[Summit]

Hmm. If you blokes in the US are going to tie yourself up in knots over it, why just not call everybody a "Paramedic". The Nurses are all just "Registered Nurses" although they might work in different areas, e.g. an orthopaedic RN or aged care RN. You could just be a Paramedic (primary care) or Paramedic (critical care) or whatever ... you'd just have to change your rank slides or something just like how the Charge Nurses wear a different coloured top or whatever but as far as the profession is concerned they are still an RN.

If it's that important why not just have, as I said earlier, Primary Care, Advanced Care and Intensive Care? then you know, you can have Specialist Paramedics (title is very common in the UK) for example in Retrieval or whatever. Easy!

You point would be great, but you keep forgetting the two great disparities in education...

1. The disparity in education between your country and ours (IIRC you are Aussie):
Australian BLS Paramedic or Ambulance Cert IV or whatever you call it for your minimum to work BLS on an ambulance has more education than a US AEMT.
Most Australian ALS Paramedics have a Bachelors or Masters degree at minimum while most US Paramedics do not even have a 2 year degree.

2. The disparity in entry education between US ambulance provider levels:
An US EMT (who can work on an ambulance) has about 140 hours of class and clinical while a US Paramedic has on average 1200 hours but no degree in healthcare field.

A new US RN typically has 2.5-4 years of college education with 2 years of that being in nursing specific and the rest being prerequisite courses. They are all called nurses... specializing occurs after schooling.

 

[EpiEMS]

My EMT course currently runs 220 hours. so if EMT is technician level training, then what is paramedic?

Frankly, it is also technician level.

They are all called nurses... specializing occurs after schooling.

Caveat - LPNs are also called nurses (much as the whole practical/vocational nursing concept seems to be falling away). And a new grad RN is called a nurse just like a CRNA with a DNAP or NP with DNP is, no?

 

[DesertMedic66]

Paramedic
1100 hours including clinicals (although it depends on the program, I found the 1100 number at St Johns University's program, although I have found between 1200 and 1800 listed elsewhere)
EMT textbooks are written at the 10th grade level
High School diploma is all that is required
Treatment is complaint based
Very little time is spent on research an evaluating evidence
Textbooks are still 3 to 5 years behind much of modern medicine
Only high school level A&P, if you even consider it that level. Programs are still offer a week long (meaning two or three classes in a week) , or entirely online A&P program, and use that for the A&P requirement.
Several paramedic are taught many psychomotor skills available in class, as well as drug techniques (RSI and intubation come to mind), but many medical directors don't let their crews do them, and there is a push to remove said skills from our scope of practice.

My EMT course currently runs 220 hours. so if EMT is technician level training, then what is paramedic?

My paramedic program was not set up like that...

 

[Summit]

Frankly, it is also technician level.



Caveat - LPNs are also called nurses (much as the whole practical/vocational nursing concept seems to be falling away). And a new grad RN is called a nurse just like a CRNA with a DNAP or NP with DNP is, no?

I agree with this with 4 points of emphasis:
1. I agree on the point that LPN/LVN are going away
2. The majority of new RNs are coming from BSN programs
3. Nobody really calls or groups APNs (CRNA/NP) with nurses in the RN/LPN sense because APNs hold higher level licenses than RNs with totally different roles and autonomy.
4. Now there are plenty of MSN/DNP/PhD nurses who are nurses (RN as their highest license) because their graduate education is in leadership, management, informatics, education, etc.

 

[Summit]

so if EMT is technician level training, then what is paramedic?

Your point is well taken. I'd argue that most paramedic programs are technician programs. More accurately, they are strongly trained to be emergency specialist technicians.

Many programs, though they consider complaint based treatments, teach diagnostic thinking and have strong prereqs like college level A&P. They are in the minority but not an outlier... and those who didn't go that route can still push and transform themselves to that clinician level individually.

The cool thing about this forum is here we find many of those who did push themselves to be clinicians via whatever route and are a strong advocate of transforming EMS in that direction. (@ExpatMedic0 and I argue but he is an ardent advocate of EMS progression)

Sadly, many think that a license or job title is the defning feature of professionalism even if it is only earned by a 40 hour "community paramedic" class or an 80 hour "CC Medic" class. @VentMonkey really hit it on the head... you can title someone Emergency Bandaid Buddy or you can call us Prehospital Hippocrates Reincarnated... education, professionalism, knowledge, and evidence based medicine are what drives our true worth as well as the outcomes we create.

My EMT course currently runs 220 hours.

220 is an outlier as are the few 100 hour EMT courses that remain (non NREMT).
There are paramedic outliers too: TEEX pumps out tons of medics with 430 class hours (1030 total). Illinois has plenty of programs that are only 950 hours of class/clinical for medic.
Low end outliers are more significant because rules are made based on the lowest common denominator.
High end outliers are only significant systemically because we hope others will rise up to meet them, but really only market forces and regulations change standards.

 

[EpiEMS]

I agree with this with 4 points of emphasis:
1. I agree on the point that LPN/LVN are going away
2. The majority of new RNs are coming from BSN programs
3. Nobody really calls or groups APNs (CRNA/NP) with nurses in the RN/LPN sense because APNs hold higher level licenses than RNs with totally different roles and autonomy.
4. Now there are plenty of MSN/DNP/PhD nurses who are nurses (RN as their highest license) because their graduate education is in leadership, management, informatics, education, etc.

So on your point #3, then -- isn't this somewhat like the gap between EMTs and paramedics (as currently named)? And aren't the nursing fields regulated by state boards of nursing, thus, they are all practicing nursing?

Low end outliers are more significant because rules are made based on the lowest common denominator.

This is such an important point. We are (sadly) judged by our worst members, as a field.

 

[Summit]

So on your point #3, then -- isn't this somewhat like the gap between EMTs and paramedics (as currently named)? And aren't the nursing fields regulated by state boards of nursing, thus, they are all practicing nursing?

If we want to speak in practical terms, no.

If we speak in semantics and legalese, APNs are "educated on the nursing model" and are "nurses regulated by the board of nursing and the nurse practice act."

In reality, that is not the case. A CRNA is functionally indistinguishable in the standard of care they must deliver and the way they practice when compared to a more broadly educated Anesthesiologist. So to with a FNP vs a PA vs a Family Practice physician. APN education and practice reflects this reality.

With a CRNA or NP, the "nurse" in their title is a reflection of educational pathway, not function. They are more different from a RN in function and expectation than a Paramedic is from an EMT.

 

[EpiEMS]

@Summit, this is very helpful - I'm still trying to figure out if there are any EMS implications that I can see

All I can think of is that I'd like to be self-regulating at the end of the day...

 

[SpecialK]

1. The disparity in education between your country and ours (IIRC you are Aussie):
Australian BLS Paramedic or Ambulance Cert IV or whatever you call it for your minimum to work BLS on an ambulance has more education than a US AEMT.
Most Australian ALS Paramedics have a Bachelors or Masters degree at minimum while most US Paramedics do not even have a 2 year degree.

Cert IV is for non-emergency work i.e. patient transport. Won't get you near an emergency ambulance.

There is no such thing as "BLS" or "ALS" unless you are talking about the posters for cardiac arrest resuscitation. There's Paramedic and Intensive Care Paramedic. Paramedic is a Bachelor degree and ICP is a PGDip ontop of that. A PGDip is half a taught masters.

The exception is ASNSW who still have the old two-year Advanced Diploma because they can't recruit enough grads. Ending that is in the cards though.

I don't think what we call a piece of paper really matters though? Paramedics were called Paramedics in the UK back when it was the old vocational IHCD course, same here, and same in other places. If you want to use a uniform title, it's the title that is important no, not how you got it?

 

[E tank]

@Summit All I can think of is that I'd like to be self-regulating at the end of the day...

Be careful what you ask for... I've never seen a bureaucracy that didn't want more bureaucracy. More requirements for re-cert, more money, more hoops. More business casual wear schmucks that don't do what you do. Double edged sword.

 

[SpecialK]

All I can think of is that I'd like to be self-regulating at the end of the day...

We are told in the Australasian push for registration that US Paramedics are already self-regulated i.e. have a professional registration with a professional body and are held to account for clinical and general conduct by this body who can censure you for bad clinical or other conduct? Is this not the case?

 

[NomadicMedic]

We are told in the Australasian push for registration that US Paramedics are already self-regulated i.e. have a professional registration with a professional body and are held to account for clinical and general conduct by this body who can censure you for bad clinical or other conduct? Is this not the case?

Not the case.

 

[SpecialK]

"

We are told in the Australasian push for registration that US Paramedics are already self-regulated i.e. have a professional registration with a professional body and are held to account for clinical and general conduct by this body who can censure you for bad clinical or other conduct? Is this not the case?

Not the case.

Interesting. I had a quick Google and it looks like everything is done on a state basis in US (that must be annoying, you blokes need to do like the UK and Australia and just have a single national scheme) ... so for example, I looked up California and they have an "EMS agency" which Paramedics must register with and there's a big button on their website for "complaints" about paramedics, and I had a look at their criteria which includes all manner of things including "lack of possession of that degree of knowledge, skill, and ability ordinarily possessed and exercised by a licensed and accredited paramedic". I'm not exactly sure what the difference between "licensed" and "accredited" means but that could include all manner of clinical things; such as not administering appropriate pain relief, to making an incorrect diagnosis (when it's blatantly clinically obviously not what you said it was) and everything in between.

Sounds very similar to how registration works in other places, and how we're going to get it?

Anyway ... doesn't matter the semantics of whatever you want to call yourself. If you want to call yourselves all Paramedics then just bloody do it. Get whichever agency of Government runs your show to just do it. Might take some wrangling but can't be that hard surely. And it'll probably a good thing.

 

[NomadicMedic]

It will be difficult and it's not a good thing.

In the US, a paramedic is the level of EMS defined by education level. Changing that will confuse everybody. Everyone keeps talking about improving education...UNDERSTAND THAT THIS IS NOT AN ELEMENT OF THIS PROPOSAL.

This is simply changing the name to call EVERYONE a paramedic. And that's a bad thing.

It's bad for the pubic, who will be confused by levels of care.

It's bad for hospitals, who will be confused by levels of care.

It's bad for our profession as we dilute the standard.

It's a swivel chair solution to a non issue. EMT and Paramedic should be the defining roles, clearly separated by education levels.

"
Anyway ... doesn't matter the semantics of whatever you want to call yourself. If you want to call yourselves all Paramedics then just bloody do it. Get whichever agency of Government runs your show to just do it. Might take some wrangling but can't be that hard surely. And it'll probably a good thing.

 

[EpiEMS]

Be careful what you ask for... I've never seen a bureaucracy that didn't want more bureaucracy. More requirements for re-cert, more money, more hoops. More business casual wear schmucks that don't do what you do. Double edged sword.

Absolutely true, but don't forget - professions, by definition, are self regulating. Attorneys, physicians, nurses, etc., they all police their own. Yes, it might entail bureaucracy, but don't we already have state EMS offices that are as bad as they can get?

We are told in the Australasian push for registration that US Paramedics are already self-regulated i.e. have a professional registration with a professional body and are held to account for clinical and general conduct by this body who can censure you for bad clinical or other conduct? Is this not the case?

Nope, we have the NREMT, which is a national certifying body - but it is not a licensure body (i.e. you gain no authority to practice, if you will) by being nationally certified. States license you to practice, and they all have different standards.

This is simply changing the name to call EVERYONE a paramedic. And that's a bad thing.

It's bad for the pubic, who will be confused by levels of care.

It's bad for hospitals, who will be confused by levels of care.

It's bad for our profession as we dilute the standard.

It's a swivel chair solution to a non issue. EMT and Paramedic should be the defining roles, clearly separated by education levels.

I don't think the public knows the difference - and hospitals, while they may (or, you know, often don't) know the difference, will adjust as needed. It could be very helpful to have a unified title. Yes, it could be considered a non-issue, but I see it as a, shall we say, step in the direction of autonomy. Diluting the standard, I don't know - tiering can be done within a unified title structure (look at Canada - or Australasia).

 

[NomadicMedic]

I think we're going to have to agree to disagree on this.

If there was an educational standard and tiered levels (see Canada) I'd be in favor.

The way it is now? Nope.

And with that, I'll recuse myself from any additional comments.

 

[Carlos Danger]

It will be difficult and it's not a good thing.

In the US, a paramedic is the level of EMS defined by education level. Changing that will confuse everybody. Everyone keeps talking about improving education...UNDERSTAND THAT THIS IS NOT AN ELEMENT OF THIS PROPOSAL.

This is simply changing the name to call EVERYONE a paramedic. And that's a bad thing.

It's bad for the pubic, who will be confused by levels of care.

It's bad for hospitals, who will be confused by levels of care.

It's bad for our profession as we dilute the standard.

It's a swivel chair solution to a non issue. EMT and Paramedic should be the defining roles, clearly separated by education levels.

I don't need to bother typing a response because what Nomad wrote is exactly my position.

 

[NysEms2117]

It will be difficult and it's not a good thing.

In the US, a paramedic is the level of EMS defined by education level. Changing that will confuse everybody. Everyone keeps talking about improving education...UNDERSTAND THAT THIS IS NOT AN ELEMENT OF THIS PROPOSAL.

This is simply changing the name to call EVERYONE a paramedic. And that's a bad thing.

It's bad for the pubic, who will be confused by levels of care.

It's bad for hospitals, who will be confused by levels of care.

It's bad for our profession as we dilute the standard.

It's a swivel chair solution to a non issue. EMT and Paramedic should be the defining roles, clearly separated by education levels.

another thing adding onto what @NomadicMedic said above is, what if you show up and you need a paramedic's education level. I show up with an EMT knowledge base people call me a medic, and i sit there with my thumb in a certain spot... nomadic nailed it though. I would hate the idea of being called a medic, especially because i got into EMS saying I will never become a paramedic.

With a CRNA or NP, the "nurse" in their title is a reflection of educational pathway, not function. They are more different from a RN in function and expectation than a Paramedic is from an EMT.

I'm not trying to start a riot here, but if EMS decided to follow the same naming convention as nursing, wouldn't they take the LCD? making it so everybody is named EMT? Or did i misunderstand. I interpreted it as nursing picks the baseline education (RN most commonly?).

 

[Summit]

What Nomad said!

I'm not trying to start a riot here, but if EMS decided to follow the same naming convention as nursing, wouldn't they take the LCD? making it so everybody is named EMT? Or did i misunderstand. I interpreted it as nursing picks the baseline education (RN most commonly?).

I am slightly confused by this... also I don't know what LCD is... but think the answer is that keeping the EMT and Paramedic descriptors is separate as an EMT is more like a CNA while a Paramedic is more like a Nurse (without getting into the education/technician/LPN/RN comparison muddy waters). I think that is what they were going for with the changes in the 2010 SOP model growing out of the 2000 Educational Agenda endorsed by NREMT which if you recall both increased the the educational standards (if only slightly) and changed title/levels from:

EMT-B
EMT-I85
EMT-I99
EMT-P

to

EMT
AEMT
Paramedic

 

[NysEms2117]

am slightly confused by this... also I don't know what LCD is.

Least Common Denominator meaning the super baseline, the lowest level of education that is required.
I know 0 about NREMT, since the NE doesn't do much with it i feel no need to get it.