Design a new Paramedic Baccalaureate-Level Curriculum

Nobody would become paramedics if it required a bachelors degree because the pay is too low because we don't charge enough because the insurance won't pay more.

Why don't we do what the citizens of King County, WA did and make EMS a 100% tax-subsidized public service that isn't dependent on fees for service? Those socialistic, un-American Pacific Northwesterners might actually be onto something. Of course, that requires radical departure from the status quo, which is scary, but such a radical departure is necessary. As Vene rather eloquently pointed out, the current system is unsustainable for precisely the reason you state here.

Insurance won't pay more, and they will continue to refuse reimbursements while EMS cost of availability of service continues to increase. EMS quite simply must change or cease to exist. The pathway of change necessitates more educated professionals who provide true physician-extension with definitive care in the field, referral abilities, preventative wellness checks, etc.
 
Why don't we do what the citizens of King County, WA did and make EMS a 100% tax-subsidized public service that isn't dependent on fees for service? Those socialistic, un-American Pacific Northwesterners might actually be onto something. .
Some believe many state government and the federal government are unsustainable due to debt.

100% tax subsidized public service is simply not in out future. Don't expect it anytime soon. NY state has a $9 billion deficit. NYC has a $2 billion deficit. What is California's deficit? The first things cut are emergency services. NJ's state bugdet woes forced cities like Newark and Camden to cut police. Those are 2 of the most crime ridden cities in the US.
 
Last edited by a moderator:
EMS is not an occupation worthy of demanding more than an AAS not simply because the majority of calls are basic and because EMS workers refuse to organize themselves as professionals who are worth more.

Today, an AAS is worth no more than a a HS diploma was 15 years ago. The push is not become more edudated so much as it is to spend the money on the higher educational institutions as we change from a country of manufacturers to a country whose primary product is healthcare. The shift in our primary product requires a shift in skills necessary to maintain production.
 
EMS is not an occupation worthy of demanding more than an AAS not simply because the majority of calls are basic and because EMS workers refuse to organize themselves as professionals who are worth more.

Today, an AAS is worth no more than a a HS diploma was 15 years ago. The push is not become more edudated so much as it is to spend the money on the higher educational institutions as we change from a country of manufacturers to a country whose primary product is healthcare. The shift in our primary product requires a shift in skills necessary to maintain production.

For certain to the first part, but I don't think the primary product of the US will ever be healthcare. In order for that to be the case it must be exportable.

The only people who can afford from abroad are people with very deep pockets and those are too few to support a nation of 300 million.

As I pointed out before, healthcare does not create wealth, it maintains it. So something is going to have to change in what the wealth creation industries are.

Ideally it would be scientific advancement, but sadly we are fallnig behind the rest of the world in education as well.

the 2 realistic options as I see are:

1. continue with the status quo with a reduction in government services, and ever widening gap between the haves and the have nots similar to nations like India, Russia, or China where the non aristocratic class Americans have a much reduced standard of living from the current level.

2. Drop the every man for himself attitude and expend some effort and currency now in order to either soften the blow of that gap or to create a sustainable economy with a high level of educated people whos abilities cannot be exported.
 
Some believe many state government and the federal government are unsustainable due to debt.

100% tax subsidized public service is simply not in out future. Don't expect it anytime soon. NY state has a $9 billion deficit. NYC has a $2 billion deficit. What is California's deficit? The first things cut are emergency services. NJ's state bugdet woes forced cities like Newark and Camden to cut police. Those are 2 of the most crime ridden cities in the US.

Debt =/= deficit. Stable governments can rack up debt that represents a substantial portion of its GDP without losing investment (Belgium, for example, once had a national debt equal to about 110% of its GDP yet it's still functioning quite well). So, I'm not actually worried too much about debt, nor am I worried that publicly funding EMS will dramatically increase the debt of a state (much less federal) government.

Deficits are a different matter, and relate to a number of distinct variables but in the US it's mostly because of a lack of revenue due an archaic tax structure designed to benefit the most wealthy at the expense of advanced/modern social services. The details of each state's deficit problems are unique and while I can't speak to New York's problems, I can say that California's are mainly due to problems related to its ballot proposition system in which voters have enacted measures allowing budget allocations to be dictated by popular vote as well as tax rates (genius right?). This has resulted in laws which mandate certain amounts be spent in certain areas while tax rates are kept low at the whim of the fickle public. The state legislature is also horribly incompetent.

Having EMS continue to exist as a fee for service program adds costs to overall health related expenditures (since the largest payer is, low-and-behold, Medicare [i.e. the government]) thus defeating the whole purpose of delegating EMS planning to the states so it could be a self-contained system. Consolidating EMS into a publicly financed system would be a better option if we could overhaul the US tax code into a progressive system.
 
Last edited by a moderator:
For certain to the first part, but I don't think the primary product of the US will ever be healthcare. In order for that to be the case it must be exportable.

Hmmmm....now this one is a loaded statment. Have we ever measured the number of foreign students this country gives free/discounted educations to in total? The trades is why we give outsiders what we cannot (or refuse) to give our own. Not only is education up on the free trade market but the educations in healthcare are. People come here, get their freebie educations then go back home, very often. Colleges make a buck and we get the bill. So yes, healthcare AND education are quite exportable..and exploitable.
 
Hmmmm....now this one is a loaded statment. Have we ever measured the number of foreign students this country gives free/discounted educations to in total? The trades is why we give outsiders what we cannot (or refuse) to give our own. Not only is education up on the free trade market but the educations in healthcare are. People come here, get their freebie educations then go back home, very often. Colleges make a buck and we get the bill. So yes, healthcare AND education are quite exportable..and exploitable.
Ah yeah it's those free-loading immigrants that are the cause of all our problems! Certainly not the fact that the income tax brackets top out at something like $375K/year (so, Bill Gates and your neurologist pay the same in taxes), no national sales tax, tax breaks to the wealthiest 1% at a time while involved in 2 protracted wars, and defense expenditures that exceed that of the rest of the developed world combined. That has nothing to do with it.
 
Ah yeah it's those free-loading immigrants that are the cause of all our problems! Certainly not the fact that the income tax brackets top out at something like $375K/year (so, Bill Gates and your neurologist pay the same in taxes), no national sales tax, tax breaks to the wealthiest 1% at a time while involved in 2 protracted wars, and defense expenditures that exceed that of the rest of the developed world combined. That has nothing to do with it.

I did not say it was any nations' fault....I simply said, education and healthcare are both exportable and exploitable.
 
Hmmmm....now this one is a loaded statment. Have we ever measured the number of foreign students this country gives free/discounted educations to in total?

Since most universities in the US expect to make money, I would think like all other businesses, they make investments in people they feel will bring money to the university.

The fact they have to look overseas for talent demonstrates either the lack of talent in the US or more probably, the lack of developed talent from the extremely underfunded and ineffective celebration of mediocrity that is primary and secondary education, because US residents seem to think investing in education is not a priority and everyone is equal when it comes to ability.

The trades is why we give outsiders what we cannot (or refuse) to give our own.

I don't understand this statement?

Not only is education up on the free trade market but the educations in healthcare are.

This may come as a surprise, but the healthcare education overseas is equal or better than the US.(but the propaganda says the US is always the best, just like Iran says the same about themselves) However, the institutions abroad cannot afford to "invest" in talent like the US can, because they is less free money. So the spots are much more limited.

There are whole countries without medical schools, who pay for their students to go to schools in other nations. How many attend US schools? Only a handful at best. The limited opportunity and price are removing themselves from the global market.

People come here, get their freebie educations then go back home, very often.

Lol, that made my night. I don't think you understand how education makes a person marketable and portable.

Colleges that offer free education to people hope those people will stay at the college and make money for them. However, once you have a recognized education that is in demand, people compete for your talents. Like sports figures, most want to play for winning teams or those that offer the most.

It is not that American's aren't offered the same opportunities, it is they fail to capitalize on them, becase they don't understand the value. For the last 70 years they haven't had to. They could extort outrageous prices for labor for a lifestyle that is unsustainable without an educated society. The time to pay the piper has come, and the US cannot afford it. So a lot of "middle class" and "well off" who exist beyond there means are being forced to live with what they can sustain. It is not the American dream by any length.

It is not the fault of foreigners that they value education more than who they are going to the prom with, what snookey is doing on TV tonight, etc.

Students in Europe compete to get into the best high schools. How many US students worry about going to the best high school? Do they define the best as who has the best football record?

I won't get started on elected school boards. The uneducated idiots deciding what needs to be taught, like intelligent design or rewriting conservative history to further a politcal agenda.

Fear, misinformation, and wonder, the best population control ever.

Colleges make a buck and we get the bill.

You know of course one of the reasons tuition is so high is because the government support of education is flawed?

Rather than giving money to colleges and forcing them to take students for it, they give it to them and demand almost nothing in return. Then to top it off, the give the students loans (which have to be repaid with interest. That is an investment) to cover the tuition which is more money for the institution only passed onto the student. So they often have to take the best deal after completion, which today likely may mean overseas.

The effort of privatizing state education was successful. For the private investors, not for the public or the nation. Do you know in almost every country outside the US, state schools are considered far superior to private, which are often looked at as diploma mills, since if you pay you pass? Why are US state schools lesser than its private ones?

So yes, healthcare AND education are quite exportable..and exploitable.

Do you get this stuff off the TV?

Yes, healthcare is exportable, but not by the US. Only the wealthy can afford it. It is why medical tourism is becomming so popular. Take your money out of the US to buy medicine you cannot buy in it. Failure on the US part if it ever existed.

Education is exportable too. I pay 1/3 what I would in the US for a superior education.(most in the US never see what is going on elsewhere, the TV god tells them all they need) That money could be employing all kinds of professors and support services in the US. But the schools there cannot compete economically. While they claim they can academically, my experience doesn't support that. I can work in any system, not just the one I was trained in. Oh, the power went out! How am I supposed to work without an automated lab and CT scan?

I was reading a blog yesterday about US medical students who want less science that they find useless and more business education as part of the medical curriculum.

How very short sighted, "how can we make more money" instead of "how can we provide care people will pay more for."

Should the US keep its mindless emotional politics of the masses, it will marginalize itself further in the world.

I've studied this somewhere before... Oh Yea, Egypt, Rome, France, Britian, Spain, Greece, Persia, the list goes on.

Best of luck with wherever you keep getting your "information" from.
 
All I have to say is pwned...actually I think we might be in qwn, rwn...perhaps even zwn status?
 
I did not say it was any nations' fault....I simply said, education and healthcare are both exportable and exploitable.

You said we give away too many freebies and get nothing in return (a curious mixture of FOX News mythology and some degree of truth...but whatever truth there is in this is certainly due to the US's own fault).

Healthcare certainly is exploitable, it has been exploited for decades by the wealthy and the corporate world.
 
This thread has gotten totally off topic, so sorry for adding to it.

A lot of hospitals appear to be doing quite well at making money, why can't EMS?

IMHO, one option may be to make EMS part of the County Public Health Department.

One city here local requires their PD to have BS degrees, why can't EMS?


Also, here in Texas, within the next few years, in order to teach EMS, you have to have a BS degree, and I believe that degree, is in EMS. It's a beginning.
 
OK guys, I'm sure this has been done before (in fact I remember doing something similar a while ago) but put those concerns aside and indulge me.

Say you've been charged with developing a curriculum for a Bachelor of Science degree in Paramedicine in a university context. What should the prerequisites be? What are the core upper division courses? Have at thee!

I actually have been charged with this task, but for an associates level. However, I will show you what I think would be a good Bachelors program, that meets gen ed requirements of course.


Lower Division - Paramedicine
----------------------------------------------------------

Freshman Year

Semester I

General Biology I (4)
English Composition I (3)
College Algebra (3)
US History I (3)
General Chemistry I (4)

Semester II

General Biology II (4)
English Composition II (3)
US History II (3)
Dosage Calculation (1)
General Chemistry II (4)



Sophomore Year

Semester I

Anatomy & Physiology I (4)
Fundamentals of Prof Communication (3)
Medical Terminology (3)
General principles of pathophysiology and disease (3)

Semester II

Anatomy & Physiology II (4)
Drugs & Solutions (1)
General Microbiology (4)
American, British, or World Literature (3)
One of the three (Required for a bachelors degree regardless of field):

Art Appreciation (3), Music Appreciation(3), Theatre appreciation(3)



Upper Division - Paramedicine
---------------------------------------------------------------------
Junior Year

Semester I

Paramedic Theories I (4)
Pathophysiology for the paramedic (2)
Physical Assessment and Evaluation (2)
Advanced Cardiac Life Support (2)
Paramedicine Clinicals (4)


Semester II

Paramedic Theories II (4)
Pediatric / OB GYN Emergencies (2)
Gerontology, Community Health, and Home care (2)
Advanced Principles of Pharmacology (2)
Paramedicine Clinicals (4)


Senior Year

Semester I

Paramedic Theories III (4)
Research in Paramedicine (1)
Trauma & Critical Care (2)
Critical Care Clinicals (4)
EMS Management and grant writing

Semester II

Field Internship
Medical director's summative review
 
Not reading the EMS Vs Education posts. :deadhorse:

On the OPs topic of curriculum design...(because the topic is of particular interest to me).

At a symposium (makes it sound a bit more fancy than it actually was) on education in EMS, one of the presenters asked the question, "Who should Ambulance (EMS) most closely align itself with in terms of education?" The answers (conveyed via electronic clicky thingies) were in order of popularity, 1) No one. Do it our own way, 2) Medicine, 3) Nursing, 4) Mainstream academia.

Responding to the atmosphere of independence and hope in the room, I answered "No one". I still agree with that to an extent, but I think we need to look to the medical model of education to do away with the methods and knowledge progressively piled on top of a frame work intended for first aiders many years ago. The nursing model, at least as it is taught in this country, is useless in ambulance and most people here seem to recognize that.

One of the education gurus at uni is trying to introduce the DENT (Define, Explore, Narrow, Test) mnemonic into the clinical decision making process. I like the attempt at moving away from the pick-a-protocol-and-transport mindset, but DENT was never for me.

Officially speaking, our vitals/hx/physical exam is still just an expanded version of the old ambulance/advanced first aid structure. Although most paramedics superimpose more complex practice on top, I think everyone would benefit from ditching a framework that has been cobbled together over the years. Start fresh with something the reflects the education we have and the environment we now work in. How you practically achieve that, though, is beyond me.

@ Americans- Whats the deal with this "college level algebra" rubbish? I did a bunch of algebra in high school and I have no particular fondness for the idea of returning to it. Why on earth would any health care professional need any understanding beyond that of highschool mathematics? EDIT: I mean before they do epi and research methods etc.
 
Last edited by a moderator:
English Composition I (3) What does this actually involve?

Dosage Calculation (1)
How stupid are these people that they actually need an entire subject devoted to this? We had formulas posted online and were expected to know them come class time.

Medical Terminology (3)
Pretty much dito to above. Half a lecture on the basics of medical term formation then expected to learn them in our own time. This is university we're talking about right? Cover the basics in a lecture and expect a substantial amount of personal study to cover the bulk of the material?


Advanced Cardiac Life Support (2)
Does it really need its own class? Its basically a one page chart with some foot notes.

Gerontology, Community Health, and Home care (2)
S**t yes. Then advanced gerontology, then a PhD in oldness. I don't think you can know too much about old people in EMS :P


Medical director's summative review
We have a process called "Pannels" after our grad year that involves interviews with talked out scenarios then grand rounds style explanations and questions on patho, risk factors, relevant pharm etc + some actual scenarios on dummies or pretend patients. I think its a good idea.

10char
 
First, yes insurance companies would love to pay us more and yes the average salary would double to triple for Paramedics IF we would actually become health professionals!

The reason the pay sucks is simple; It's just too damn easy to become a Paramedic! Seriously, I have sat in CMS meetings and listened to EMS Administrators attempting to justify raising costs. It's laughable and embarassing.
....Hmmm .. "So Mr. EMS Provider, your major overhead is equipment and salaries?"... For a 500 clock hour trained individual, that within six months, you will have the ability to have four times the number of applicants than positions?..... "What is so special... and unique that we should increase the payment, so that you share the offset?".... Why are the costs of EMS equipment in particular, so expensive.. Is is that they can't be responsible for upkeep and not being rough on it?....

Seriously, it does not matter the exact format for a four year?... Use the general education model that everyone else has within almost every professional health care curriculum. Yeah, that's right every other true health profession requires their programs to be credentialed and have a degree before entering the workforce! It's a wonder EMS gets paid for what it does! Pretty expensive taxi ride .... Rather EMS should be getting paid for what they know, rather than what we do. Yes, this means eliminating the old .."We're only for Emergencies"... stigma crap and truly becoming a member of the health field.

Increase the entry requirements alike every other professional program, allowing about only 1/8 of those able to enter and exit. Produce true professional applicants that have the knowledge of medical science, the exposure of clnical settings and then have a year of residency with a acredited EMS service. Those exiting will be few, the demand would be high, their ability to actually save insurance companies trillions daily would be there (yes, they would love to save money!), as well as reducing needless numbers of patients being transported to ED's that should never be there.

We should have to be able to justify everything we do...
 
Last edited by a moderator:
Yeah, that's right every other true health profession requires their programs to be credentialed and have a degree before entering the workforce! It's a wonder EMS gets paid for what it does! Pretty expensive taxi ride .... Rather EMS should be getting paid for what they know, rather than what we do. Yes, this means eliminating the old .."We're only for Emergencies"... stigma crap and truly becoming a member of the health field.

+1

Community Based Emergency Health. A bachelors degree with students sharing many of the foundation classes with nurses, OTs, Physios, Midwives and health science majors. A graduate school directly involved in undergraduate education as well as its primary responsibilities too professional & clinical development and research. Paramedic schools with higher entry scores than nursing schools. Base wages fifteen thousand dollars per annum above the national average wage. Increasing professional and public respect as legitimate health-care professionals with a unique body of academic knowledge to be developed. This is what we enjoy here. Its not perfect but its coming along nicely and nobody disputes the value of education.
 
@Melclin

In the United States, individuals pursuing a bachelors of ANY subject are required to take specific general education courses, regardless of their major.

English composition 1 is one of those requirements, this class focuses on essay writing and communication in written form. This course allows the medics to not look dumb on reports by using, "Your" in place of "You're" or "Their" in place of "They're" or "There", and pretty much helps you get a little more respect from your peers, even if just a little bit. English Composition II focuses on argumentative essay writing as well as research writing all the while effectively using peer-reviewed sources and having to cite them in your work.

Of course Advanced Cardiac Life Support needs its own class because it is more than just a certification. A medic needs to understand the underlying pathophysiology associated with a patient's cardiac arrest or arrythmia instead of just playing cookbook medicine. I can think of no other topic that could use its own class.


As for dosage calculation, I feel that it needs its own class because nursing has its own class. We learn everything from simple dose / on hand * vehicle to chemo drips, not just a dopamine clock method calculation.. If paramedics are serious about wanting to be accepted in the medical community and want to truly become ready to transition to RN, they need a FULL dosage
calculation class, among the others I included.


The Gerontology and Home care is to address the current issue of Community health paramedics, which emphasizes skills such as the administration of vaccinations, catheter insertion, IV Pump training, IO Sheets, care of a port, as well as drawing from a port and flushing it as well as educates them about skin tears in the elderly and focuses on things such as the nutritional needs of these individuals.

The curriculum I posted above is based on the associate curriculum I am helping design currently for a local college who wishes to move from a certificate to a degree program in Paramedicine, choosing not to go the general technology route.
 
First, yes insurance companies would love to pay us more and yes the average salary would double to triple for Paramedics IF we would actually become health professionals!

The reason the pay sucks is simple; It's just too damn easy to become a Paramedic! Seriously, I have sat in CMS meetings and listened to EMS Administrators attempting to justify raising costs. It's laughable and embarassing.
....Hmmm .. "So Mr. EMS Provider, your major overhead is equipment and salaries?"... For a 500 clock hour trained individual, that within six months, you will have the ability to have four times the number of applicants than positions?..... "What is so special... and unique that we should increase the payment, so that you share the offset?".... Why are the costs of EMS equipment in particular, so expensive.. Is is that they can't be responsible for upkeep and not being rough on it?....

Seriously, it does not matter the exact format for a four year?... Use the general education model that everyone else has within almost every professional health care curriculum. Yeah, that's right every other true health profession requires their programs to be credentialed and have a degree before entering the workforce! It's a wonder EMS gets paid for what it does! Pretty expensive taxi ride .... Rather EMS should be getting paid for what they know, rather than what we do. Yes, this means eliminating the old .."We're only for Emergencies"... stigma crap and truly becoming a member of the health field.

Increase the entry requirements alike every other professional program, allowing about only 1/8 of those able to enter and exit. Produce true professional applicants that have the knowledge of medical science, the exposure of clnical settings and then have a year of residency with a acredited EMS service. Those exiting will be few, the demand would be high, their ability to actually save insurance companies trillions daily would be there (yes, they would love to save money!), as well as reducing needless numbers of patients being transported to ED's that should never be there.

We should have to be able to justify everything we do...

Good to see you still hanging around here.

As a point of discussion, we have both taken up this banner for a long time. I have seen no real progress in my career.

Could it be we have to let EMS providers fail on their own before they finally get the message?
 
Good to see you still hanging around here.

As a point of discussion, we have both taken up this banner for a long time. I have seen no real progress in my career.

Could it be we have to let EMS providers fail on their own before they finally get the message?

I believe you will see that occur. There has been over nearly 25 providers fail within my state the last couple years.. the shame is there is a law that requires the nearest community (EMS) to respond.. no matter what. The good thing there will be an EMS respond (maybe 50-60 miles away) but the bad thing is; communities are thinking.. why should we have an EMS when another community will have to furnish one?....

Maybe someday we see third party EMS develop?... Then again....

R/r 911
 
Back
Top