EMS Education, Outdated Ideals and "Common Sense"

[Summit]

I was googling around and found these interesting tidbits: https://www.nremt.org/nremt/about/researchPresentations.asp

Fernandez AR, Studnek J (2006). Quantifying the Educational Background of EMS Educators.
Poster at the annual symposium of the National Association of EMS Educators.
As part of the biennial re-registration paperwork, Nationally Registered EMS professionals were asked to complete a survey reporting their highest level of education and their primary role in EMS. Those individuals who reported their primary role in EMS was that of an EMS educator reported the following was their highest level of education. 11.6% High School/GED, 38.5% Some College, 20.9% Associate Degree, 21.3% Bachelor’s Degree, 7.8% Graduate Degree. Overall, EMS instructors have similar educational credentials to the students that they are teaching.

Margolis GS, ****ison PD (2005). The Relationship Between Paramedic Instructor Qualifications and Student Performance on the National Certification Written Exam.
Poster presentation at the annual meeting of the National Association of EMS Physicians.
Candidates taking the National Registry of EMTs Paramedic exam were asked to identify the clinical credential and highest educational degree attained by their lead instructor which was correlated to the first time pass rate. Students who’s instructor was a nurse performed better than all other instructors (72.9% vs. 55.2%) and a linear relationship exists as the educational degree increases (from 62.7% at the Associates Degree level to 78.5% at the Doctoral level).

Gibson GC, Bentley MA (2011). Public Perceptions of EMS Provider Education: Are We All the Same?
Poster presentation at the annual symposium of the National Association of EMS Educators.
The objectives of this study were to determine what the general public knows about the education and training of EMS professionals, and to determine if respondents’ age produced significant effects. Findings indicate that the public has no concrete idea how much EMS education and training a paramedic has (Mean = 261.1, SD = 341.7). Additionally, the public thinks EMTS should have some college and paramedics should have Associates degrees. The public placed a high level of importance on educational requirements for license renewal and on graduation from a nationally accredited training program. Respondent’s age did produce significant correlations: the amount of education for EMTs and paramedics drops with respondents’ increasing age, while educational requirements for license renewal, and graduation from a nationally accredited program increases with respondents’ age. In sum, EMS can do a much better job of educating and informing the public about the training of paramedics.

Lerner B, Shah MN, Fernandez AR (2008). Do EMS Providers Think They Should Participate in Disease Prevention?
Poster presentation at 2008 annual meeting of the National Association of EMS Physicians.
The objective of this study is to determine EMS providers’ opinions regarding participation in disease prevention initiatives. Eighty-one percent (95% CI: 80.5 -81.6) of EMS providers re-registering in 2006 believed that they should participate in disease prevention programs and 28.8% (95% CI: 28.2-29.5) of respondents reported actually having provided prevention services. Those who had a graduate degree were the most likely to have provided prevention services (40%, p<0.001), as were those who had worked in EMS for more than 21 years (41%, p<0.001).

 

[VFlutter]

Overall, EMS instructors have similar educational credentials to the students that they are teaching. [/B]

Thanks for the info. As I pointed out earlier that is a really poor education model and the opposite of all other conventional education.

 

[Christopher]

Perhaps the time has come to retire the paramedic. It is a concept that seems to be along the lines of the steam engine and the airline stewardess.

That is actually one of the more profound suggestions I've seen regarding EMS. I had not thought of our problem like this before.

Would make for a very interesting introspection paper (although I'd use Tom Thumb vs Horse Drawn Carriage in the analogy).

 

[AtlasFlyer]

Are you referring to airline "stewardesses" as in the 60's/70's era model of "Fly Me", and the "Coffee, Tea or Me" thing or is the current profession of Flight Attendant being included in that too? As in, you really think airline flight attendants are unneeded? Many people are alive today because of the actions of flight attendants in evacuations. When the cabin is full of smoke, the FA's voice saying "COME THIS WAY" may be a person's ONLY means of finding an exit. Seconds count, flight attendants perform a [thankfully rarely needed but still extremely] vital role in commercial airline safety.

/rant

My apologies, back to your regularly scheduled thread.

 

[Veneficus]

Are you referring to airline "stewardesses" as in the 60's/70's era model of "Fly Me", and the "Coffee, Tea or Me" thing

If you think this is no longer the case, you should take a trip on Ryan Air.

It is only a matter of time before those poor flight attendants will be expected to prostitute themselves with a quota.

I actually felt sorry for them they had to do what was required of them.

 

[Rialaigh]

One thing I had not seen brought up yet (but I may have missed it in these 3 pages) is the joke of continuing ed requirements.

In a hospital setting nurses are required to keep up with the latest and greatest study, research, equipment, procedure, etc, because it is what is required by hospital administrators and doctors. The reason this is required in hospitals is because people have a choice of what hospital they go to, even if they are brought in by EMS to one hospital they may transfer if they choose. Therefore the hospital with the best surgeons and procedures and recovery times..etc...gets the most business.

EMS however does not keep up with the latest and greatest anything (by and large) and really doesn't care because in the short term it does not affect business. The patient generally does not have the option to call 911, wait on an ambulance, and then refuse your service and request a different 911 ambulance. Therefore (from a dollar standpoint) you will get the transport and you will get paid regardless of how outdated the standards are or how poor your equipment and skills are.

There is very little monetary incentive to keep EMS "up to date" in the short term. Now long term your contract can be revoked and your county/city can go with another service, however if most of the EMS services are not keeping up with medical industry standards, then the county has little incentive to fire one mediocre EMS service for another.

Until either our medical directors start caring more, the administration who runs the bottom line start pushing the medical directors a little more. Or a national standard for continuing education is pushed through to law requiring every EMS provider to attend X continuing ed EMS course every 3-5 years which would be developed by a few progressive front-line systems (and yes, this means your medical director would be require to attend the course as well) then I don't see things changing.

Unless - In P-school X number of hours (or a percentage of the course) are required by your accrediting body to be taught by a PA, Nurse Practitioner, MD, DO, or current practicing critical care nurse with 10+ years experience. Topics taught by these people could be body systems, lab interpretation, pharmacokinetics and pharmacodynamics, Etc.


And I would be all for having a minimum amount of the course taught by higher level medical providers.

 

[Veneficus]

And I would be all for having a minimum amount of the course taught by higher level medical providers.

In order to do this all they have to do is pay said provider's fee.

As for the rest, there are actually incentives not to advance care.

A majority of the US population is covered by fire based EMS. It costs lots of money to advance people's education. In the areas they serve they have a state monopoly on EMS. They cannot be fired or replaced. Why spend money you don't have to?

Emergency Medicine specialized medical directors often work in the EDs EMS transports to. They get paid based on how many patients they see. Why on earth would they require education for providers that could reduce transports and take money out of their own pockets?

Reimbursement rates are fixed, why pay to have the latest and greatest people and equipment when you get paid the same as those with the minimum?

On the same note, how do you afford to pay for the latest/greatest on that?

Educational institutions have an economic incentive to keep requirements low.

1st. If you need highly educated instructors, you need to pay them. You can pay Joe paramedic to put on a con-ed class for $20 an hour. You would pay me $200 plus expenses for the same hour. (granted it is likely to be much higher quality)

2nd. as long as Harvard on the Hill Community College or Dewy, Cheatum, and Howe's 6 week paramedic mill can charge a couple thousand bucks and have full classes of fire/EMS hopefuls paying part time instructors without benefits a pityful wage, you make more money. If you charge more, there are less hopefuls. That means less money.

Finally, there are not a lot of highly qualified professionals. Which means if you can't afford to pay their price, which has to be more than they can make picking up regular or OT in a clinical environment, then you won't have a program.

 

[AtlasFlyer]

If you think this is no longer the case, you should take a trip on Ryan Air.

It is only a matter of time before those poor flight attendants will be expected to prostitute themselves with a quota.

I actually felt sorry for them they had to do what was required of them.

European Ryan Air or the Ryan International Airlines based out of RFD that recently ceased operations?

European Ryan Air is a scourge on the entire industry world-wide, and a hideous example of an airline. I don't care if they offered me a free ticket, I wouldn't fly on them for anything. And yes, I completely agree with your assessment of their FAs!

Thankfully we live in an era of extremely safe commercial aviation. We have those who died in the past to thank for the advancements in safety that we take for granted today. Evacuations are rare, ones where people die even more so, and I'm incredibly glad for that. I used to teach new-hire and recurrent FAs at American Eagle, and I taught people things I hoped they would never, ever have to use. But at the times they're needed, they're NEEDED, and they DO save lives.

 

[EpiEMS]

Educational institutions have an economic incentive to keep requirements low.

Regarding the incentives, I think this is plausible. However, I would hesitate to generalize this to all educational institutions -- it would be less true of not-for-profit institutions, given that they have more latitude to provide those goods which are socially optimal.

I'd wager that if activists within EMS, medicine, and public health were to work together, it'd be very possible to raise requirements and institute an associates' level for EMTs with a bachelors' level preparation for medics. Of course, that might require the shuttering of some institutions...

We could really use a Flexner report for EMS.

 

[Brandon O]

Emergency Medicine specialized medical directors often work in the EDs EMS transports to. They get paid based on how many patients they see. Why on earth would they require education for providers that could reduce transports and take money out of their own pockets?

My understanding was that EM physicians are usually paid for time, not per patient. Or do you just mean that salary is linked to the volume of their ED?

 

[Veneficus]

Or do you just mean that salary is linked to the volume of their ED?

This

Though some do bill fee for service.

 

[Brandon O]

This

Though some do bill fee for service.

Pretty much every ED in this country, except perhaps some rural and community hospitals (that may be closing soon), is hugely over-busy. Do you really think the average EP wouldn't be willing to trade a few dollars for a functioning system, more time for each patient, less BS, and less running around?

 

[Veneficus]

Pretty much every ED in this country, except perhaps some rural and community hospitals (that may be closing soon), is hugely over-busy. Do you really think the average EP wouldn't be willing to trade a few dollars for a functioning system, more time for each patient, less BS, and less running around?

I think the busier ED docs in the major facilities would happily trade a few bucks for a functioning system. I know several of my friends would.

But those major facilities are not the only EDs out there and I know of at least 2 suburban facilities that would fight tooth and nail to make sure patients stop at their ED.

 

[Brandon O]

I think the busier ED docs in the major facilities would happily trade a few bucks for a functioning system. I know several of my friends would.

But those major facilities are not the only EDs out there and I know of at least 2 suburban facilities that would fight tooth and nail to make sure patients stop at their ED.

Well, I agree with that -- on an institutional level. These are the same places that don't want you bypassing them toward trauma or STEMI centers, because they want those dollars.

Not sure about the individual providers, though. In any case, I imagine there's a way to integrate community EMS practices with the local hospitals, tying them in with the system as it progresses.

Heck, the personnel in question could be hospital employees. Actually, that might be more plausible than trying to make this happen via existing ambulance services.

 

[Veneficus]

Well, I agree with that -- on an institutional level. These are the same places that don't want you bypassing them toward trauma or STEMI centers, because they want those dollars.

Not sure about the individual providers, though. In any case, I imagine there's a way to integrate community EMS practices with the local hospitals, tying them in with the system as it progresses.

Heck, the personnel in question could be hospital employees. Actually, that might be more plausible than trying to make this happen via existing ambulance services.

Considering reduced reimbursement for bounce backs I think at the very least the hospital should contribute some money.

 

[JPINFV]

My understanding was that EM physicians are usually paid for time, not per patient. Or do you just mean that salary is linked to the volume of their ED?

Depends on the contract and depends on the practice group. Some will be a "keep what you kill" system while others will put all of the money in a pot and pay out by hours worked. That doesn't count that if no one wants to work the crud hours then the group might offer higher pay for those times (like over night, weekends, etc).

 

[EpiEMS]

Curious to see if hospitals move towards hiring EM physicians as employees rather than contracting to practice groups. Or is that a thing already?

 

[JPINFV]

Curious to see if hospitals move towards hiring EM physicians as employees rather than contracting to practice groups. Or is that a thing already?

That might not be as easy as it sounds. In California, the Medical Board has interpreted state laws as such to ban the corporate practice of medicine. In essence, since corporations do not have rights or privileges, and you have to be licensed to practice medicine (hence a privilege), therefore only physicians can practice medicine and a non-physician cannot supervise a physician's practice of medicine... including things like billing.

That's why even mega groups like Kaiser end up contracting out to a practice group (Permanente Medical Group).

http://www.mbc.ca.gov/licensee/corporate_practice.html

 

[EpiEMS]

That might not be as easy as it sounds. In California, the Medical Board has interpreted state laws as such to ban the corporate practice of medicine. In essence, since corporations do not have rights or privileges, and you have to be licensed to practice medicine (hence a privilege), therefore only physicians can practice medicine and a non-physician cannot supervise a physician's practice of medicine... including things like billing.

That's why even mega groups like Kaiser end up contracting out to a practice group (Permanente Medical Group).

http://www.mbc.ca.gov/licensee/corporate_practice.html

Silly interpretation...
It'd be much more efficient to insource (basically, to vertically integrate, almost), I would think.

 

[JPINFV]

Silly interpretation...
It'd be much more efficient to insource (basically, to vertically integrate, almost), I would think.

So if Jim, the MBA with no medical training bought your ambulance company and decided that... since he's the owner he can tell you, the licensed provider, how to practice paramedicine, you'd be fine with that?