I do find it interesting, though, that after suffering ad hominem attacks over the issue in a different thread [since cleaned by admins], no one seems to fully disagree that EMT-B is not long enough.
I do agree that EMT-B should be extended both in the diadatic part and the clinical part. Even if you don't remember every single minute detail from an anatomy and physiology courses, students should still leave the courses with an understanding and respect of the major themes. You can't consider different differential diagnosises [yes, we don't "diagnose," but we come as damn close to that line as possible, even as an EMT-B] if you don't know that they can even exist. Similarly, you can't really consider assessment tools if you don't understand what they're really measuring [this goes back to the mantra "treat the patient, not the monitor"]. It is this problem [lack of diadatic education] that will prevent our scope, and therefore our ability to provide care, from being increased.
Another reason is that, as long as the entry requirements are so low, anyone with two brain cells can pass. Sure, the providers that value their medical care will continue their education, be it in theory [A/P, pharm, etc. I'm talking about formal education] or practical [focused Con-Ed, higher cert level (moving from basic to paramedic)], but think about it for a minute. The person requesting a call for service doesn't get to pick and choose who their responder is going to be? Do you really want to roll the dice that the provider answering your 911 call is going to be someone who wants to learn?
Similarly, if you're 2 hours away from advanced life support and an hour away from the hospital, shouldn't that mean that you [generic "you", not directed at anyone] should be more educated since you don't have a paramedic safety net to fall back on?
The clinical part of the education should be increased as well. It's all fine and dandy to talk and teach about how to deal with the ideal situations, but as the cliché goes, patients don't read the manual/protocols. The clinical part is where the theory gets integrated into the practice of medicine. This is especially true since regional variances [my favorite example is DNR procedures] will always trump what the text book and teachers tell their students. My EMT-B course required 8 hours of ambulance ride alongs. That was a total of 2 calls [I even pulled a second ride along, at a different station and only got 2 calls on the second 8 hours as well. This was in the middle of Orange County, CA, not exactly your backwoods, low call volume area].
Finally, there is the issue of pay. This is, in the end, a chicken and the egg situation. Reimbursements won't go up as long as every 2 weeks to 3 months another batch of wide eyed providers graduate. First, as long as the procedures that can be done are low, the amount that can be requested and lobbied for reimbursement [BLS vs ALS 1 vs ALS 2, Medicare payments, for example], the pay will remain low. Second, as long as there are vastly more EMT-B providers then there are jobs, then pay will remain low. there's a reason that a certain 911 provider in my old area payed $3 less per hour than the local IFT companies [$2/hr less than one of the local waterparks]. The answer is simple supply and demand. This is the same reason that the mean hourly wage for garbage men is about 50 cents higher than EMTs [B, P, or otherwise] [
http://www.bls.gov/oes/current/oes_nat.htm#b00-0000 Emergency Medical Technicians and Paramedics vs Refuse and Recyclable Material Collectors]. Simply put, even though there is vastly less at risk with your garbage man, less people want to do it, so the wage is higher.
On the other hand, providers will complain about the pay vs education problem until a higher wage is offered for more education [example: paramedic students deciding against an associate degree, or even a BS [not wanting to go into education or management at that time] because everyone, in the end, will be payed the same in a lot of systems]. The problem is that it is easier to raise education standards and THEN request a higher wage, then ask for a higher wage to get a higher education.
Therefore, before anything changes at the BLS level, and by connection, the rest of the profession, education must first be increased. Most, if not all, of the problems facing EMS would be solved by requiring more education.
