Education Standards Gap Analysis Documents

[Summit]

It all looks very good. The *ONLY* skill qualm I have is why remove needle decomp from the AEMT?

 

[timmy84]

I think they are really considering I/99 and Paramedic too close to distinguish the difference. I/85 and AEMT seem to be very similar. EMT-B and EMT except the removal of activated charcoal, and NG/OG which is not in Indiana's scope anyway. Of course all of this needs to be adopted by every state, and I am not sure if I have confidence in that happening. I HOPE IT ALL DOES. I think I would like to see EMS advance itself to a bonafide profession by the time I retire (approx 2040), LOL.

 

[Summit]

I think they are really considering I/99 and Paramedic too close to distinguish the difference.

Certainly so by looking at skillset alone, thus the choice. With the elimination of the I-99 on the horizon, enrolling in an I-99 class would be stupid. Paramedic school is the way.

 

[timmy84]

Certainly so by looking at skillset alone, thus the choice. With the elimination of the I-99 on the horizon, enrolling in an I-99 class would be stupid. Paramedic school is the way.

I would hope that no school even offer I/99 at this point. We should all want to become paramedics anyway. Why would one not want to learn everything they can to help people out of the hospital. I do not really understand why one would go to I/99 school instead of paramedic school anyway.

 

[Aidey]

I've only looked at part of this so far, but I've got a few questions on it.

1. With the increase in education for A&P, why remove pressure points and elevation from the AEMT and Paramedic level for bleeding control? Did I miss some big finding in trauma resuscitation stating these aren't effective? Are they recommending that when direct pressure fails we go straight to a tourniquet?

2. How is this going to affect states that don't use NREMT for their EMT levels?

3. Why no umbilical vein access? Are they thinking that we go straight to IO if a IV access is unable to be obtained through a peripheral vein?

4. Why remove urinary caths? I understand that for most urban areas they aren't necessary, but for rural areas they can be.

Also, will these changes affect an agency's or medical director's ability to increase the scope? For example, a rural area could still keep urinary caths if their medical director/protocols called for it. Or will it still be handled the same that it is now?

 

[triemal04]

I've only looked at part of this so far, but I've got a few questions on it.

1. With the increase in education for A&P, why remove pressure points and elevation from the AEMT and Paramedic level for bleeding control? Did I miss some big finding in trauma resuscitation stating these aren't effective? Are they recommending that when direct pressure fails we go straight to a tourniquet? Actually, yes. It's now generally more recommended to move to the use of a tourniquet if bandaging/direct pressure isn't effective. Been a lot of new info on how to control bleeding found in the last couple of years...

2. How is this going to affect states that don't use NREMT for their EMT levels? More than likely not at all. Which, while this is good, and a good step in the right direction makes it infuriating as well. Any state that has their own certs can keep them, and any state that wants to add extra skills/procedures/whatever to each level can. Right now there are no consequences to not adopting this.

3. Why no umbilical vein access? Are they thinking that we go straight to IO if a IV access is unable to be obtained through a peripheral vein? Yes. And for the average paramedic that's probably best; the newer IO's are a bit better than the old Illinois needle/jamsheedis and honestly, would you do that enough to be confident/competent at doing it?

4. Why remove urinary caths? I understand that for most urban areas they aren't necessary, but for rural areas they can be. Not a clue. Personally I think it's stupid to remove it. But hey, nobody has to follow these new levels and is free to add what they choose, so...

Also, will these changes affect an agency's or medical director's ability to increase the scope? For example, a rural area could still keep urinary caths if their medical director/protocols called for it. Or will it still be handled the same that it is now?
Again, there is nothing that mandates that states follow these right now.

I like the path that this is going down, but it doesn't go far enough. Unless medicare starts to only pay bills for services/states that follow these levels, this won't have an impact nationwide. As well, the anyalsis doesn't really give out a lot of information as to what the paramedic level needs to add in certain areas, (A&P being one), just that it needs to improve. Someone correct me if I'm wrong, but I can't recall anywhere in the new standards that defines that, just that a "comprehesive" understanding is needed...which could vary from area to area unless it get's more specific.

 

[Aidey]

Thanks for the reply. I understand that in severe bleeding definitive control needs to be obtained, and providers shouldn't be worried about "going through the steps" before attempting a tourniquet. It just seemed strange to me that they would remove it, rather than emphasizing the tourniquet. I knew pressure points had fallen out of favor, but I guess I hadn't realized elevation had too. Granted, elevation is really only helpful in isolated bleeding injuries with no structural issues.

 

[Shishkabob]

The army found that in bleeds, pressure points and elevation were worse then useless. If pressure alone didn't stop the bleed, you don't waste time doing anything else but putting on a TQ.

The NR changed their standards back in January.

 

[Aidey]

I guess I'm just used to doing both elevation and pressure at the same time in the cases where you can safely elevate without risking aggravating an underlying injury. The most common ones I can think of are self-injurious/suicide attempt lacerations to the wrist.

 

[Summit]

Colorado will apparently be keeping the I-99 level.

 

[emtbill]

Colorado will apparently be keeping the I-99 level.

Virginia as well. It is evidently a state's prerogative to keep their current levels and virginia choose to keep the Intermediate level (scope of practice is NREMT-I/99). My protocols are literally identical to the paramedic level except for RSI and crichothyrotomies. I believe Virginia is keeping the intermediate level because many ALS providers in rural areas would be unable to commit to bridging to paramedic when the scope of practices are essentially the same. Taking away Intermediate would mean less ALS availability in rural areas where patients need it the most.

 

[MrBrown]

A positive step, allbeit limited and on the whole dissapointing .... the scopes of practice for EMT and A-EMT are still very limited, much below what is allowed here. I know it's like comparing bananas to rocks but still I hardly think salbutamol, glucagon, entonox and GTN should be "advanced" procedures (they are basic skills I can perform here)

 

[ResTech]

I personally find this move in EMS to be exciting. I hope this plan for education over training is not optional for States and that the Federal Government forces compliance.

I been only remotely following the National Agenda and Scope over the years but it seems like a great deal of time and research has led up to this point. As EMS professionals we need to embrace this progression.

 

[Dominion]

In my opinion no more letting states decide their own protocols and skill levels. All states use the same national protocols and EMT, AEMT, and Paramedic are taught everything on that protocol. Then let medical directors (who are approved by this same nationwide governing board) decide what is and what isn't valid for their area. For example some protocols might be more for rural EMS while urban EMS doesn't really need that specific skill.

This would be the most logical step in the right direction I believe but the complications would be how do you enforce such a policy and would the government be willing to front the budget to form such a national committee. How do you decide who's on it and determines the protocols? Like above also how can you perfectly balance the many many different situations out there. For example some services don't do CPAP because of a cost issue (I know of 3 in the area that won't do CPAP because they can't afford it in the budget as well as other useful but 'considered' non-essential items.

Edit: Reading over the proposal I also find the new standards exciting and taking steps towards a proper solution. As far as I can remember Kentucky will be adopting the new standards. As of right now there is only one accredited program in Kentucky. (EKU AS Program)

 

[daedalus]

A positive step, allbeit limited and on the whole dissapointing .... the scopes of practice for EMT and A-EMT are still very limited, much below what is allowed here. I know it's like comparing bananas to rocks but still I hardly think salbutamol, glucagon, entonox and GTN should be "advanced" procedures (they are basic skills I can perform here)

At the educational status of these "providers" in the United States, any medication administration is an advanced procedure. The pharmacology section of the EMT book is 6 pages long, lol.

 

[daedalus]

Virginia as well. It is evidently a state's prerogative to keep their current levels and virginia choose to keep the Intermediate level (scope of practice is NREMT-I/99). My protocols are literally identical to the paramedic level except for RSI and crichothyrotomies. I believe Virginia is keeping the intermediate level because many ALS providers in rural areas would be unable to commit to bridging to paramedic when the scope of practices are essentially the same. Taking away Intermediate would mean less ALS availability in rural areas where patients need it the most.

Than Colorado and Virginia are choosing to keep EMS in the dumpster it is in now.

 

[46Young]

Do you see what I mean whan I speak repeatedly about organizing? Achieving educational reform on a national scale isn't likely without strong political influence.

Like emtbill said, some areas won't have any advanced care otherwise, so why would they agree to do away with what little they do have?

I've been told in VA that there will be no more new EMT-I classes, but current providers can re-cert. Fairfax is currently pushing their EMT-I's to upgrade to the P level.

 

[Ridryder911]

Do you see what I mean whan I speak repeatedly about organizing? Achieving educational reform on a national scale isn't likely without strong political influence.

Like emtbill said, some areas won't have any advanced care otherwise, so why would they agree to do away with what little they do have?

I've been told in VA that there will be no more new EMT-I classes, but current providers can re-cert. Fairfax is currently pushing their EMT-I's to upgrade to the P level.

As the EMT/I level is being abolished and transformed into the Advanced level. EMT-I 99's will be a thing of the past. Truthfully, the Intermediate level was never designed to allow advanced care forever. It was designed as a transitional period while obtaining your Paramedic and areas that could not immediately employ Paramedics; unfortunately employers and systems/cities found that they can bill as an ALS and never have to move forward.

One of the reason state's still want to maintain it is simple economics. Less pay to employees and increase revenue or being able to state they have ALS when in fact that is partially correct.

R/r 911

 

[46Young]

As the EMT/I level is being abolished and transformed into the Advanced level. EMT-I 99's will be a thing of the past. Truthfully, the Intermediate level was never designed to allow advanced care forever. It was designed as a transitional period while obtaining your Paramedic and areas that could not immediately employ Paramedics; unfortunately employers and systems/cities found that they can bill as an ALS and never have to move forward.

One of the reason state's still want to maintain it is simple economics. Less pay to employees and increase revenue or being able to state they have ALS when in fact that is partially correct.

R/r 911

Sounds about right. Fairfax is trying to get those who want to go ALS from in house to get their I while they still can, then upgrade all existing I's to P's.