EMS, thread on a dutch perspective

[SayCet]

Hello,

My name is JW, I'm from Holland.
To make my point I need to wright some background information, some of you will be familiar with, some of you won't.
So in advance, my apologies for the long story.

Let me start off introducing the dutch EMS-educational system.
Holland does not have paramedic's, as the paramedic's in the EMS-system. It trains specialized nurses to be able to work on a ambulance.
There are no difference's in degrees, between the paramedics. There are no technicians (if you rule out the drivers that is), just the Paramedic degree and every ambulance has a paramedic.

If you want to become a paramedic, you will have to start by getting a Nursing bachelor degree. After that you will be a basic nurse. You will have to work on a normal surgery or medical unit for a few years, and experience a thing or two.
After that you can specialize, for example; IC-nursing, ER-nursing, Anesthetic nurse or Cardiac Care nurse.
These educations vary from 1 year (CCU) to 3 years (anesthesia) of length.
After the training the nurse will have to work for a few years before he or she can apply for paramedic training. If accepted, the paramedic training will take 1.5 years.
All and about, it will take the average nurse about 10 years to become a paramedic.

On a dutch-EMS forum there currently is a discussion on a new Bachelor degree, that will allow student's to (after finishing the 4-year bachelor) work on a ambulance as an EM-Paramedic.
Many dutch paramedics are against this development, for the student will miss a lot of experience.

The EMS system provides many possibillity's to become a paramedic (I'm only talking about paramedics, because technicians can not be compared with dutch paramedics). The most 'interesting' is the bachelor degree for paramedics. This will allow very young paramedics to be able to work in the field.

The question:
What are the pro's and con's on your (EMS professionals) current educational system for EM-P's?
Where I am specially interested in the bachelor-paramedic degree.

Do you find that young EM-P's are less competent, compared to the EM-P's who worked they're way up, from technician to paramedic?

Thanks in advance!

 

[MrBrown]

Education for Paramedics (general term) in Australia and New Zealand has undergone radical, groundbreaking change since the Year 2000.

Both nations use civilian Paramedics who are not nurses, doctors or anything else but a civilian Paramedic.

Prior to 2000 in Australia and up until very recently in New Zealand all Ambulance education was vocational ie on the job post employment, there was no University course, you had to work on an ambulance to get the training. It was about 60% practical and 40% theory for example one might learn about the K/Na pump and cardiac action potential as it relates to emergent cardiology but never learn about the sliding filament theory of muscle contraction because it was not necessary in the sense of practice as a Paramedic.

There were two prime levels in both countries; Ambulance Officer and Paramedic, the latter being the person with the invasive procedures and pharmacology and the former having a varying scope of practice but generally limited to the fundamentals of care eg GTN, salbutamol. There was provision in New Zealand for an intermediary level called Intermediate Care Officer who was permitted to start a drip and do basic cardiac monitoring and manual defibrillation/cardiovert.

Over the past ten years we have pushed Ambulance education out of the vocational apprentiship model and to the Universities. Now you must complete a Bachelors Degree at minimum in Australia and here in New Zealand for access to any invasive procedures eg cannulation. It is expected anecdotally that the Degree will become required for paid employment here within the next few years. The education required for Intensive Care Paramedic (ALS) in both nations is a Post Graduate Certificate which is above a Bachelors; they exist in Australia and are being bought in here within the next few years.

The Degree offers a much broader base of clinical knowledge and general awareness of healthcare in general over the "emergent" piecemail focus of the vocational programs. Research is a big part of the Degree.

Yes, we have problems with young immature students straight out of school with no life experience but they quickly wash out or adjust. It remains a major gripe with the vocational Paramedics about young students.

Personally Brown finds those who are older make better Ambulance Paramedics because they are more mature and have some life experience to draw on but Brown also knows several outstanding Paramedics who are younger than Brown. Its like comparing apples to oranges.

 

[thegreypilgrim]

I'm a big fan of the Dutch approach to most things in life, including their EMS.

Heb je geen paard, gebruik dan een ezel.

The question:
What are the pro's and con's on your (EMS professionals) current educational system for EM-P's?
Where I am specially interested in the bachelor-paramedic degree.

I suppose the only "pro" of the educational system we have in place for EMS personnel in the US is that it allows you to be done quickly...which, of course, assumes a rather broad definition of "pro".

EMS education in America is incredibly variable, but typically follows one of two models (neither of which are really adequate). The first sort are the Paramedic Programs offered through local community colleges (like the one I attended) or through major academic teaching hospitals (although these are much less common). Usually they're about 12-18 months in length, and typically will provide enough college credits to confer an Associate's degree (AS/AA) which is about half the credits required for a Bachelor's degree. Then there are what are affectionately referred to as "medic mills". These are private, vocational schools that are essentially designed to churn out as many paramedics as possible per academic year. They often contract with fire departments or ambulance companies (some of them actually own and operate their own paramedic schools, however) to provide paramedic training for their EMT-level employees.

These types of schools are especially problematic because they're a shining example of the celebration of mediocrity and minimal standards that has become commonplace in American education in general, but is particularly endemic to EMS. Some of these schools crank out new medics in as little as 12 weeks and offer such intellectually stimulating courses such as "Everything You Need to Know about Anatomy & Physiology in One Easy Week."

As has been recounted ad nauseam on this board, the education of paramedics in the US is abysmally inadequate. Even the community college or hospital-based AS programs are insufficient and often based on the vocational "clock hours" model of education rather than standard college credit hours. The level of "hours" required for paramedic programs is minimal as well - often around 1200 total hours. It literally takes longer to be a cosmetologist here than a paramedic.

There are about 13 four-year university level programs that confer a Bachelor's Degree in EMS, but as far as I know, all of them are "post-professional" degrees. Meaning, none of them are actually recognized by state EMS administrations for certification (the state will not grant you a license to practice as a paramedic based on completion of one of these degrees).

Do you find that young EM-P's are less competent, compared to the EM-P's who worked they're way up, from technician to paramedic?

I'm not entirely comfortable with the idea of 18 year old kids administering vasoactive medications or performing other invasive procedures. It's not a question of competency (certainly they're just as capable of anyone else) but more one of maturity. Doing something just because they can versus doing something because it is needed/appropriate from a clinical standpoint.

 

[SayCet]

Thank you both for you clear point of view on the current EMS system.

Greypilgrim:

The dutch system is changing, slowly, also providing a similar bachelor training. Besides that, the current ambulance educational program may be changed from a consistent national program to a individual program (designed by hospitals or EMServices). Therefore I am interested in the EMS-education.

From what I hear, the current EMS educational system seems to be a bit of a mess... (no mean to disrespect ofc.) Please correct me if I am wrong, but you say it is because of a lack of consistency in the offered education?

You say the current educational program is insufficient, in what way is this?

These EMS-bachelor programmes, if you've graduated and got the degree you will not find any work as a paramedic? Why isn't the bachelor program accepted?

In reply on your last paragraph, you really seem to catch the essence of what makes it dangerous to have very young paramedics on the job.
In Holland we also have a discussion about what age is appropriate for people to join the EMS. It's a though discussion for not every adolescent is incompetent...