EMS Remediation: How can EMS Improve?

[disassociative]

After reading some of the replies in the "Progression of EMS" thread, I decided to post a thread of my own. Let's pretend that the US Government has approached you in regards to the current EMS System, I mean the ENTIRE SYSTEM: Education, Credentialing, Policy, Scope of Practice, EMT Levels, Federal Representation, Communications planning, disaster response, and even salary, what changes would you make and why?

For those of you who are unsure where to start, here are some hot topics
going on at the moment:

Degrees in EMS
Salary
Consolidation of EMT Levels
Federal Representation
Formal Licensing
Private Services vs 911
EMS Personell working in the hospital

Bureau of Labor & Statistics on EMS
http://www.bls.gov/oco/ocos101.htm

 

[Ridryder911]

In the words of Dr. Phil... "apparently, what we are doing, is not working"... So why should we continue what we know that is not working?

R/r 911

 

[BBFDMedic28]

We should do away with the national regisrty. A test that is formulated to make poeple fail is rediculous.

 

[bstone]

We should do away with the national regisrty. A test that is formulated to make poeple fail is rediculous.

While I do agree that the NREMT really, really needs to rewriter their test to be more realistic (and not nearly as many ambiguous questions..."which is the MOST correct" stuff), it's the closest thing we have to true portability of licensure/certification.

I believe we should have a not-for-profit educational organization in place of the NREMT. Not a for-profit group with closed standards who self appoint and self identify.

 

[Ridryder911]

We should do away with the national regisrty. A test that is formulated to make poeple fail is rediculous.

Fail? It actually has one of the highest pass rates for any medical certification level. As well, it has been known to be one of the easiest medical examinations around...thus the high pass rate. Also one of the cheapest... compare this with nursing, electricians, P.A.C., Respiratory Therapist, etc..

It does not matter if it is for profit or not. Actually non-profit status does not impress me. Such organizations as AHA, ARC, etc.. has one the highest income.. non-profit just means the money is placed back into the company.
Most test administrators is usually a private profit corporations, that contracts out to certain organizations.

As well, NREMT has no impact on policy implications on EMS standards. They are just simply test administrators. It would not matter what corporation that would be contracted to perform the test. They have to be objective and test of what the current curriculum and standards are.

R/r 911

 

[triemal04]

That's funny, I was going to say make the written test harder and cover more of the curriculum, and completely revamp the practical portion; continue to test the skills, but make the oral and medical/trauma assessment stations MUCH more in depth than they are, and add a couple more of those.

 

[Canoeman]

EMS --- Improve?

dis-- as an EMS service manager I wish we could revamp all Medicare , Medicaid and Third Party billing - it is unfair for all parties - - I should not get screwed when other are reimbursed more for the very same thing area to area. Certainly we need a fair system and the problem is systemic to all health care right now but it is soooooo hard to pay great wages and benefits then have the best equipment and working conditions for my paramedics in this current system. If we COULD fix the system some of your list might be able to disappear - pay scale - equal pay/ comparable pay etc

Degree Program - Yes I want this for all my guys/girls - the cream will rise to the top - the system will be better because of this.

NREMT - Keep it the way it is (althought as a non-profit they have many other alternatives for funding) sure I hated the testing -- I was scared s---itless when I was thrown out on the street as a green paramedic - but I worked with great fellow paramedics who taught me to be one of the best as well.

tri - make it more difficult -- na -- but can we work on the after paramedic driving school --- yes we can grow this.

Licencing - Yes if we can always include CEU's

Federal Rep - YES NOW

Private vs 911

dis - 911 -assuming you are meaning public - muinicipal paid by tax dollars
This is where I have totally changed my perspective after working Private - then Municipal Fire Based and now a Non-Profit service. Give me NFP now by far ---- because ----- I can get funding from every scourse available --- tax-subsity - contracts - grants -- donations - bequests - physical gifts -all forms of billing (Medicare, Medicaid, Third Party) - subscription programs ya da ya da --- and the other can't - it WILL be the new wave -- and my service is beginning to ride it.

Canoeman

 

[Ridryder911]

Canoeman,

What are some suggestions you have to improve reimbursement rates? I agree, until there are some fairness in providers nothing will change. What does in... can not go out... no bucks-no trucks!

R/r 911

 

[BEorP]

Degrees in EMS: 2 year college diploma as the minimum with BSc/BS highly reccomded
Salary: will fix itself
Consolidation of EMT Levels: two levels only
Private Services vs 911: no private services

 

[skyemt]

i agree with tremal04 (did i just say that?)... make the written test much longer, to really test the comprehensive knowledge...

also, change the assessment criteria on the practical exam... the way it is now, you can memorize the list of steps, pass the exam, and have no real understanding of what it is you are doing...

considering that almost the entire quality of a call is determined by the quality of the patient assessment, this seems to be an obvious deficiency in the testing process...

 

[Ridryder911]

Degrees in EMS: 2 year college diploma as the minimum with BSc/BS highly reccomded
Salary: will fix itself
Consolidation of EMT Levels: two levels only
Private Services vs 911: no private services

I will add no Fire Service EMS as well. Third party public utility, just as strong as FD, PD with higher salary, and same if not better benefits. Since the requirements would require a degree for entry level (which FD, PD) does not.

R/r 911

 

[triemal04]

I will add no Fire Service EMS as well. Third party public utility, just as strong as FD, PD with higher salary, and same if not better benefits. Since the requirements would require a degree for entry level (which FD, PD) does not.

R/r 911

Again...if the requirement in the state (or nation preferably) is that a degree is required to be a paramedic, then local departments will have no say over that. Increase education requirements for EMS=a win/win situation.

 

[jakobsmommy2004]

We should do away with the national regisrty. A test that is formulated to make poeple fail is rediculous.

The intent is not to make people fail! The intent is to have a national standard for ems.

 

[BossyCow]

I believe that the national registry is only formulated to make those insecure in their knowledge base and skill set fail. As far as the educational requirements, we have to make sure that the educational level includes an end salary that will allow us to repay the student loans.

The kind of debt that the education level suggested here would bring, can't be repaid at $8 an hour.

So many ambulance companies see EMS as a cash cow. Pay the newly certified, stars in their eyes EMTs, work them until they burn out and then have a new crop standing by to take their place.

EMS is a relatively new field. It will change, it will evolve, it has to.

 

[disassociative]

The proper way to study for the NREMT is to pick the areas that you have the most trouble with. The ones that you hate going over; then study them over and over.

To understand the test methods of exams such as the NREMT, NCLEX, etc,
one must first understand the testing method:

Areas of Measurement: Judgment, Critical Thinking & Problem Solving, Competency, Ability to Analyze information.

There are 4 levels at which a test can be administered:

1. Recall/Recognition

example question:

An acute myocardial infarction (AMI) is a classic heart attack. Infarction can be defined best as:

a. death of a tissue
b. irregular heartbeat
c. insufficient oxygen mixing with the blood
d. collapse of blood vessels in and around the heart.

With recall/recognition, the test-taker is merely recalling data from definition, simply remembering the text that he/she has read and memorized. This is the test method alot of you may be familiar with. NREMT does not use this method.

2. Understanding
The understanding level of testing requires the test-taker to speculate on
Why he/she does something rather than quoting from memory. This form
of testing offers insight into the critical thinking ability of the test-taker;
being able to take the provided information and create a dynamic care
plan based on: Clinical Judgement, Knowledge, and implementation.

The reason most person(s) have trouble with the NREMT is because they
are studying at the recognition/recall--giving no regard to "Why" and
"How" something is done. The questions are worded in such a way as to
almost eliminate completely, the ability of the student to locate a
a keyword or context clue.

3. Application
The application method of testing words questions in such a way that
the test taker can no longer rely on memorization alone(much like the
understanding level). He/she must take what they know and apply it.
This is just like when the paramedic goes into the field to find a
patient in a domino effect. Most of the time, the medic knows what is
going to happen next as far as the physiology and has already
prepared for it.

Usually on the NREMT, there are several interventions listed that
would work just fine. Your job is to choose the most complete
intervention as it relates to continuation of care.

4. Analysis
Analysis type questions are asked in such a way that the test-taker
must analyze the effects of provided data and render the appropriate
care, taking into consideration the various "X" factors. You must be
able to apply what you know on all levels.


Cramming will not work on the NREMT. YOU MUST have understanding as to
why you render a process and what physiological mechanisms are responsible.

You must have a clear understanding as to why you are doing something, as well as what physiological mechanisms are responsible for the underlying conditions while taking into account both the overall physiology of what is to come based on both: The disease/trauma process as a whole and the effect your interventions are going to have on the patient; be them positive or negative.

The NREMT pays researchers almost $1000 per question. Everything is planned, there isn't a single part in any of the questions is accidental. These questions are shaped around the aforementioned test model.

What kind of test taker are you?

There are two types of test takers, those who think predominately in images
and those who thing predominately in words(NCLEX-RN Prep. Kaplan; 2003. pg 31).

The following question will help you identify what type of learner you are.
Read the following statement:

A nurse walks into a room and finds the patient lying on the floor.

As you read this, did you hear yourself reading the words, or did you see a nurse walking into a room as the patient lies upon the the floor?

If you heard yourself reading the sentence; you think in words. If you saw a mental image, you think in images.

Ok, now that I know this--how am I to apply it?

Formulate a study plan that meets both the test method required of the exam you intend to take as well as your learning type. For example, if you
think in images, you might want to take a hands on approach to a skill.

If you are unsure to the test method used on the exam--your best bet is the "Understanding Level" as this will provide the appropriate knowledge needed to answer a question modeled after any one of the four methodologies.

Who do you think is going to be more apt to ask the Chest Pain pt if they are taking Viagra?

1. The Paramedic student who relies on memorization to get by.
2. The Paramedic student who has seen first hand; hypotension
brought about by this drug interaction?

I am putting some thought into creating a thread entitled, "NREMT Test-Taking Strategies" in which these methods are covered as they apply to the NREMT exam offering evidentiary report from the NREMT research committee.

As for the ambiguity of questions on the NREMT:
If there are 2 good answers, you are expected to use your Judgment to choose the best answer.
The purpose of this ambiguity is to assess your ability to make judgments based on your overall knowledge.
It is more than appropriate.

 

[Chimpie]

I will add no Fire Service EMS as well.

Rid, can you expand on this more? You've peaked my interest.

 

[reaper]

Fire services only want EMS so they can justify themselves.

A fire only service might run 10 calls a day. If they have medical calls in there, then they might run 30-40 calls a day. As a taxpayer looking at call volume, I would be pissed that my tax money is paying 20 ff's to run 10 calls all day. Fire knows this and that is why they want EMS in their service, to justify their survival.

Now, as a citizen, do you want a medic treating you that wants to do EMS or has to do EMS?

Like Rid said, County Third service EMS is the way to go. Does not answer to fire and has complete medical control in the county. Has Medics working there that want to be medics, not playing medic to get that promotion in the fire service.

 

[Ridryder911]

I have a background of Fire Service Administration before I went more into the medical side. With this in mind, I have been monitoring FD responses for the past 25 yrs. Kinda like the dentist, they did such a great job.. they almost put themselves out of a job, with prevention (sprinkler systems, code enforcement, line firefighting techniques) etc.

The only and real reason there are paid Fire Departments is because of ISO ratings. If it was not for that, there would be drastically fewer FD's, if we were to base their continuance on the "what if" theory. Shame, EMS does not have some form of mandated codes for existence.

So what or where can a FD go from there? Run and call volume are down, there is no way to generate revenue on fires.. and yet manpower and FTE's need to be continued or even increased with all the other diversity and speciality programs. I agree, bless them for the great job!

The problem I have now seen, is EMS is the new "saviour" for the FD. The same FD's that 10 yrs ago, hated EMS, now loves it and wants to absorb it. Someone stated it was large metro areas.. far from it. Look at Paris, Tx (population 27,000) had a full time Paramedic level EMS, that was informed that they were to train the FD as Paramedics, and then their position was going to be dissolved. Why? To be able to keep the required F/F. No, this is not an isolated occurrence. FD management has to justify firefighters at the station if there is no fire, then what are they doing? The public has started demanding more responsibility for their tax money, and want some type of return.

FD sees EMS as the great PR as well, with some important bonus of being able to bill for their services as well. This not only off sets the cost, but actually pays for itself plus, if performed properly. Unfortunately, FD's are now beginning to feel the increase of EMS calls like others as the population age increases. Many did not expect the call volume to triple within the next 5-7 years.. this places a burden on the cross trained FF. No one wants to run 12 EMS calls, then fight fires as well, even if one is alternating.

The only professional way would to be third entity, like Fire, Police, and then EMS. Compare this with Austin/Travis County, TX. and many other thousands out there. I live in a frontier/rural state and it can be done. Third mill sales tax, bonds, consolidating; all to be repaid within a few years. It is all dependent upon how important EMS is to the community, most are beginning to realize for every FD response (fire) there are 10-15 EMS responses.

I am NOT a fire service basher, not by the least, rather they have their profession and job and we have ours. We are MEDICAL period. It makes about much sense to put a F/F in EMS as it would to put a nurse (actually, the nurse is medical).. both have similar interest, but not really specific for that job at the time.

We should all work together as a team, but care in the prehospital setting should be solely upon the EMS as a profession of itself. Really, we have became of age to be able to manage our profession and business, without any special interest that may be made.

R/r 911