Martyn
Forum Asst. Chief
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Just read out my above post to my wife (US citizen). Her reply? 'I'm sorry but nurse practitioners and physician assistants would NOT work for $10 an hour'
Delete American paramedics.
- Thread starter mycrofft
- Start date
No. Let's keep thing's honest here without any embellishment. Average for PA's and NP's is more around 50 per hour; NP's generally seem to average more, though that may be skewed by the number of CRNA's out there. Feel free to check that if you like.
It wouldn't neccasarily be a bad idea to put a true midlevel provider in the field in some form, but a better idea, especially before that is even considered would be to:
1) create a true national standard for what a paramedic is, and what the requirements are to become one
2) enforce those standards by tying medicare/medicaid reimbursement to following along
3) increase the educational requirements for both EMT's and paramedics
4) get rid of the idea that every single person needs to be seen by a paramedic and that every person going to/from a healthcare center needs to be in the "care" of medical personell.
5) create a state and federal group that actually monitors and enforces regulations harshly
That would be a start. After that was done (ha!) maybe it would be time to look at what else could be done.
Having a limited number of PA's doing field responces would appear to be a good idea at face value; though aside from the funding issue similar problems to what is going on currently would probably pop up: instead of being used and reserved for the types of cases where they are actually needed, I bet PA's would end up being sent on EVERY call; after all, everyone should be seen by the highest provider, right? The issues of oversaturation and skill/knowledge degredation could also very well come into play. I'd say the educational curriculum might also be dumbed down as the demand increased, but I think (hope) that the PA profession is well enough established and grounded that it wouldn't be an issue.
In short, no, PA's shouldn't replace all paramedics. There could be a place and use for them, acutally I'll go further and say there IS a place/use, but there are many other problems that need to be resolved first.
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I disagree, there is no reason why individual states cannot provide for having physicians working the field. Why do we need a national standard? Many agencies have they Medical Directors respond to calls and there are some areas of the country that already maintain "Physician Response Vehicles." Every doctor needs a state license to practice anyway.
The issue I see with implementing a program like this is finding doctors willing to work in such a program, as most specialties are going to pay better.
I think a universally recognized set of provider standards would be useful, but that's kind of the least of this country's EMS woes. I see no issue with statewide licensure, especially considering the unique challenges faced by individual states.
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Why no to NP and yes to PA? If I'm not mistaken there are a few HEMS agencies that use NPs already.
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I don't think anyone imagines they would. Their education far exceeds that of EMS providers, so they already deserve better compensation.
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HS students working at mcdonalds make more than that.
It amazes me how low the wages are in the US.
In a way the complete lack of a nationwide standard for what a paramedic is (or EMT for that matter, though not to the same extent) really is the root of the problem; how can you change and fix a system when there is no reason for everyone to abide by your changes, and no standard for what the system should be?
The new NREMT standards are a perfect example; so many people tout them as the best thing since sliced bread, when, in reality, if a state decided to not follow them, they wouldn't need to. Contrary to what some may think, the NREMT is a TESTING AGENCY; it is not a government agency that has any standing with anyone who doesn't feel like playing with them. If Oregon (to pick a random state) decided that their standard for what a paramedic is would now be less than what the NREMT requires, then that is their choice. It would just mean that paramedics there couldn't get "nationally" certified.
How paramedics and EMT's are taught needs to change; but how can you change that and ENFORCE those changes if there is no national standard? Recommendations are fine, but at the end of the day it's still a recommendation, not a requirement.
The EMS system in the US doesn't need to be rebuilt from the ground up, but it does need to be overhauled from the ground up; and that starts with deciding exactly what a paramedic is and isn't and forcing everyone to play by the same rules.
Far as the "unique challenges" faced by different states...medicine is medicine. You might see different aspects in different places (probably not a lot of frostbite in West Texas) but that is a problem for individual services to deal with, not a statewide licensure issue.
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Ok I'll retract my statement to a degree. I agree with what your saying, but I think the true root problem is the lack of education at all levels, and no state is presently immune from this. If the national standards are no different than what they are now, how much improvement in terms of care delivery are we going to see?
OP
OP
mycrofft
Still crazy but elsewhere
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Wow, thanks for the response! Keep going.
A person can become a nurse with NO degree, just a certificate. Good luck finding a job above condo or corrections or some such. During Vietnam the Army commissioned nurses with certificates for a while; later, if they stayed, they had to finish a study course and get the degree if they wanted to get past Captain. Some were promoted to Major, then had to drop back and were docked the difference/overpay they received! (Happened to my chief nurse once!).
Oh, and as for creating yet anther type of prehosptial EMS (PEMS) worker, hold out for hands and feel the ruler! One more way to dilute the pay pool.
People complain PA's and FNP's make so much more money than paramedics, they ought to suck it up and go get their degree! Step out of the tech ghetto.
A person can become a nurse with NO degree, just a certificate. Good luck finding a job above condo or corrections or some such. During Vietnam the Army commissioned nurses with certificates for a while; later, if they stayed, they had to finish a study course and get the degree if they wanted to get past Captain. Some were promoted to Major, then had to drop back and were docked the difference/overpay they received! (Happened to my chief nurse once!).
Oh, and as for creating yet anther type of prehosptial EMS (PEMS) worker, hold out for hands and feel the ruler! One more way to dilute the pay pool.
People complain PA's and FNP's make so much more money than paramedics, they ought to suck it up and go get their degree! Step out of the tech ghetto.
Oh sure, that is absolutely part of the problem too, a huge part of it in fact. What I'm saying is that until there is one true national standard for what a paramedic and EMT is, and until that standard is rigidly enforced, then it doesn't matter what the educational level is, because each individual state can opt out.
First determine what a paramedic is, and what it takes to become one.
Then mandate that each state fall into line.
Then start increasing the requirements.
If the requirements are "too hard" or "not needed" and there is no incentive for every state to use them...many won't.
tacitblue
Forum Crew Member
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I have heard of this too, but you have to ask yourself, who did this study? What did the investigators of this study consider ALS? did they have a bias when publishing these data?
I find that a majority of my patients get a better assessment tha. They would if EMTs were the sole responders. Also, I have the ability to give analgesics and antiemtics to patients who may not be critical, but it goes a long way in relieving suffering. These people benefit more from paramedics than traumatic arrests do, even though a traumatic arrest will be considered ALS and gastroenteritis BLS in many systems. You can frame call data to support almost any conclusion you come up with.
bigbaldguy
Former medic seven years 911 service in houston
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Where's the money going to come from?
because there has been enough encroachment from "doctor" nurses and the BON. I wouldn't want someone who took their masters programme online and has a year of CCMed working me up in a medical emergency, sorry. PA or degree medic and no more I got my medic to be a FF types.
In fact ask a lot of PA's what they were before PA school and a lot were EMT-B/I/P's who already have a working knowledge of being on the ambo.
I hear you. Just because many calls CAN go BLS doesn't mean they should, but also that not every call needs to be upgraded to ALS skills, although having the assessment is absolutely crucial. This data comes from private service billings-- and the realization that they were billing BLS for medic truck transports a fair amount. I really wish I could cite something more scientific... let me do some research.
FourLoko
Forum Lieutenant
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Does LA Fire ever downgrade to BLS, I think they actually have BLS ambulances. And I'm agreeing with emt.dan on this one.
One of the busiest ERs we frequent gets a pretty steady flow once the sun goes down. Most patients roll out of the back just sitting nice and calm as can be. Lights and sirens though, be sure of that.
911, stubbed toe, etc
One of the busiest ERs we frequent gets a pretty steady flow once the sun goes down. Most patients roll out of the back just sitting nice and calm as can be. Lights and sirens though, be sure of that.
911, stubbed toe, etc
In my opinion EMT-B is too easy / simplified. HS students can pass this is 14 days. I don't know the EMT-I scope but I've always felt that EMT-B was too basic. It doesn't have to be an AA degree but I think we can all agree that there are a lot of ALS calls that don't require much actual ALS. Expanding the scope to 3 Lead and a handful if IM meds could allow EMT-Bs to be more hands on and, more important, more useful.
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I think the idea of the Austrian / NZ system appeals to me. A 4 year degree to be a paramedic. If we made that step, we might then be able to look nurses in the eye and be considered their equals.
Problem with this? Fire. Fire Departments, Fire Unions, and Fire Fighters. More training will cost more, and salaries will cost more.
Problem with this? Fire. Fire Departments, Fire Unions, and Fire Fighters. More training will cost more, and salaries will cost more.
RocketMedic
Californian, Lost in Texas
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I strongly disagree with the general direction of this thread, and here's why.
1. Paramedics are currently the highest common prehospital provider, and we're barely paid with respect to what we do. There is no economic incentive for a PA or NP to work for our wages- even high-end jobs.
2. There isn't really much to be gained by putting a PA on every truck- probably nothing that wouldn't be gained with the (much cheaper) empowerment of paramedics. A few PAs for advanced preventive medicine makes sense- a PA on every truck in a 911 system is going to be prohibitively expensive and won't make a lick of difference.
3. Staffing will be a huge issue. Pay as well. How is a service supposed to employ several hundred PAs on budgets even remotely feasible in this economy?
4. What really changes in terms of practical interventions? Without changing our deployment models to stay-and-play-and-release, there's really not much more indicated in the field, and if we were to act as some European systems do, we now need many more physicians and trucks to cover all of those calls that a crew is now spending an hour or two on.
5. Again, what's the medical benefit to our patients? A PA is, at their core, simply a well-trained paramedic with wide protocols. Granted, they've got more training and a wider set of 'best-guess' ruleouts, but without labs and imagery, their assessments are the exact same as a paramedic assessment, and they're going to say basically the same thing. What is gained by putting a very expensive mid-level provider on a truck when that exact role could be filled by a seasoned paramedic?
There are places for PAs in EMS, but those roles are niche roles in community paramedicine, not a wholesale replacement of paramedics. By the logic of the OP, why not replace every RN with an NP?
1. Paramedics are currently the highest common prehospital provider, and we're barely paid with respect to what we do. There is no economic incentive for a PA or NP to work for our wages- even high-end jobs.
2. There isn't really much to be gained by putting a PA on every truck- probably nothing that wouldn't be gained with the (much cheaper) empowerment of paramedics. A few PAs for advanced preventive medicine makes sense- a PA on every truck in a 911 system is going to be prohibitively expensive and won't make a lick of difference.
3. Staffing will be a huge issue. Pay as well. How is a service supposed to employ several hundred PAs on budgets even remotely feasible in this economy?
4. What really changes in terms of practical interventions? Without changing our deployment models to stay-and-play-and-release, there's really not much more indicated in the field, and if we were to act as some European systems do, we now need many more physicians and trucks to cover all of those calls that a crew is now spending an hour or two on.
5. Again, what's the medical benefit to our patients? A PA is, at their core, simply a well-trained paramedic with wide protocols. Granted, they've got more training and a wider set of 'best-guess' ruleouts, but without labs and imagery, their assessments are the exact same as a paramedic assessment, and they're going to say basically the same thing. What is gained by putting a very expensive mid-level provider on a truck when that exact role could be filled by a seasoned paramedic?
There are places for PAs in EMS, but those roles are niche roles in community paramedicine, not a wholesale replacement of paramedics. By the logic of the OP, why not replace every RN with an NP?
RocketMedic
Californian, Lost in Texas
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We are, role-wise, their equals. I've sunk the last five years into becoming the best paramedic I could be, and I've picked up quite a bit of knowledge along the way. Granted, I haven't been to college or learned the ins and outs of changing bedsheets or building a nursing care plan, but I have learned tactical medicine, triage, and a host of other skills.
If a nurse ever wants to get uppity with me about my "lack of education", I tune them out. I know my job very well, and although I love learning and learn new things every day, I really don't need a paper diploma from a college to do my job and learn new things. I'm pretty sure that a year strolling around Iraq seeing and treating everything from sprains to crazy Third-World bacterial infections is at least the equal of college English.
Should a bachelor's degree be mandatory to work as a paramedic? If our wages justify the expenditure and we can make the education relevant to our work, absolutely. If wages don't justify the education, there will never be a push towards higher education.
Additionally, what does the evidence say? Do OZ/NZ/UK EMS systems do better by their patients then American "technician" paramedics?
Although I'm not the biggest fan of fire-based EMS, it does have some strong points. Departments that do EMS well are every bit as good as many of the private services.
did you read these studies?
The first one is whether or not paramedics provide "care on scene" which in no way equates to that of a doctor and concludes with: paramedics should scoop and run trauma patients.
The second one shows a clear demonstration of superiority in physician intervention to brain function in the critically ill. Additionally it demonstrates that better care is superior to faster response times, and in critically ill patients.
As mentioned, the major benefit of a doctor on an ambulance is so as not to transport everyone to an exceeding expensive and unhelpful ED.
The first one is whether or not paramedics provide "care on scene" which in no way equates to that of a doctor and concludes with: paramedics should scoop and run trauma patients.
The second one shows a clear demonstration of superiority in physician intervention to brain function in the critically ill. Additionally it demonstrates that better care is superior to faster response times, and in critically ill patients.
As mentioned, the major benefit of a doctor on an ambulance is so as not to transport everyone to an exceeding expensive and unhelpful ED.