ET Intubation

[Ridryder911]

I agree with you vent. In the 70's most medics were starving for any education and would had jumped at the chance to improve themselves. I remember medics working twice as many hours as most of the ones now, but would had gladly took any courses all in the name of improvement.

As you identified, a lot of the problem may be in the bias attitude of not thinking one has to continuously improve and prove one self. Many believe because they received a year of training or less they are automatically knowledgeable in emergency medicine and the skill that lies within.

I do believe that is where many of the differences in between those that are trained and educated is separated. Education demonstrates the need of continuous improvement and monitoring of proficiency. Unfortunately, many EMS is now being placed into areas that much rather have numbers of employees that are "certified" to be able to deliver care, rather than to able to deliver competent care. We could blame it upon economics and politics, but again EMS and EMT's much rather take the easy way out, only to pay for it later.

Intubation is only the beginning of examining of our competencies. Yes, technology is wonderful and has definitely improved patient outcomes when used appropriately. Unfortunately, many providers are placing money and interest of using such equipment to make diagnosis and treatment regimes, instead of requiring medics to have a thorough knowledge and proficiency in assessment and diagnostics. EMT's and medics relying upon equipment to determine what treatment and how in-depth should occur. A good example is the use of pulse oximetry. Most EMS personal are very lacking in understanding of the use, the restrictions, and inaccuracies of such.

I do personally believe we have came to a fork in the road of prehospital care philosophies. One side is to produce mass numbers, with just the minimum number of hours to follow lengthy and detailed protocols, thus providing systems from litigation and at the same time provide "patient care".. and the other fork is having more educated medics with a in-depth and knowledge, with liberal protocols adapting care, what is best for the patient to stabilize and treat. The problem is the latter is more costly and takes more time, which many services do not want to invest in.

Again, as you have pointed out apathy is one of EMS biggest enemies.

R/r 911

 

[Medic's Wife]

Until the entry level education levels are increased and there is some national unity with standards among paramedics, the 1970s will remain

I agree wholeheartedly, but wouldn't an increase in pay scale have to go hand in hand with this? Where my husband works is one of the highest paid counties in the state, but they are still hurting badly for medics. They're having trouble filling the slots with warm bodies, much less highly competent bodies. I can only imagine that with higher educational standards and continuing education standards' minimums being raised, there would be an even greater shortage than there is right now. Is everyone experiencing this problem, or is it just regional? I'm definitely for more intensified training and education, but I'm afraid I see pay being one of the things getting in the way of that happening.

 

[Ridryder911]

It is a hand in hand situation. You pay more, more would be attracted upon entering the profession that is serious about it. Shortages, are there for a reason.. Filling the slots with warm bodies and a pulse, will not correct the problem only aggravate it.

Far as those that complain they cannot afford to go to school, that is a lame excuse. Just like any other profession one could get a student loan, work extra, etc.. If one wants to enter a profession bad enough, one will find a way to afford it.

Far as shortages, I believe it is a myth. There are plenty of medics out there, but the problem is multicomplex. The pay sucks so bad, generally most civilized persons prefer not to work > 40 hrs a week, and have 2-3 jobs to pay for rent. I know we have plenty of NREMT/P that work at Wal-Mart, K-Mart and used car dealers, yet most are not the type most of the administrators prefer to have representing them, even if their standards are poor.

Every 16 weeks we crank out about 100 Paramedics for a demand of about 20 so we are overloaded with the numbers, but still a shortage in supply. So, again it is the type of individual that we produce as well.

I see many that exit medic programs that never enter the workforce, or even challenge the registry test. This is even in all levels of EMS. If medic school was that hard, costly, and really challenging, then one would make sure that they took advantage of doing what they were educated and trained to do. You do not see many professionals not entering a profession after spending years of study and thousands of dollars on studies, not to go into that profession.

Again, I still contend it is too easy to become a medic. No entry requirements, very reasonable costs of medic schools (<$2000 -10,000), < 5 months to 2 years. So it is really not that difficult to "waste" the time, to see if it is for them. Some will say the pay off is poor, that is the reason why Compare this with even beautician school (>1 yr, $9,000) or even truck driving school in costs and return investment.

There are no easy answers, but we need to compare our profession with other health careers and see how they were able to meet the needs and as well succeed. Physical therapists, nursing, even physicians maintain a supply and demand, only allowing a selected number into programs and thus allowing quality and serious students and for those students to have a position and competing salaries. Compare this where we have a over abundance of EMT's and have flooded the market.

There are many out there, that would never want us to perform such due to increased costs for salaries, (which would dip into administration budgets) as well as professionals will demand such things such as benefits and career ladder movements. Many much rather for us to be a "trade" and keep status quo with description of shortages as an excuse to "get what they can"..

The whole system need to be revised. It is poor designed from the top to the poor EMT in the street, working at poverty level. With increasing call volumes, poor financial reimbursements, and many EMS closings, it is time for EMT and medics to become very concerned with their profession.

R/r 911

 

[VentMedic]

I'm with Rid totally on the education issue. AND, where there's a desire to learn, there's a way.

Many have wondered why the paramedic is not fully utilized in hospitals and clinics. They are not recognized in Washington, D.C. as a profession. Since there are no standards or consistency in education, Medicare and other re-imbursement agencies will only pay for a "service" and not the professional. Insurance will reimburse for the "ambulance service" and not for the service provided individually for that health care professional. When working in the ER, paramedics will go under nursing services and be counted in cost as aides. Thus the ability to use a paramedic in the ER will be determined by the budget for extra staff that provides no reimbursement quality. Intubation will be provided by the health care professionals that can be reimbursed for it; MD, NP, RT.

Each profession must think of itself as a business that must market itself to exist. The other healthcare professions have increased their value and through their powerful national organizations, have lobbied on Capitol Hill for a piece of the pie. There is money to be had.

Even Massage Therapists are now recognized healthcare professionals. In many states, their initial training hours has surpassed that of a paramedic. They are also now established in state community colleges with a 2 year degree of their own in the School of Health Sciences. Once they pass their national exam they now have a state LICENSE to practice in many states. They have a strong national lobbying organization to get more benefits and reimbursement. MTs are now widely accepted in hospitals due to their professional status and reimbursement potential. This has all occurred over the last 20 years.

 

[chico.medic]

During one mandated refresher class (40 Paramedics-active on City or county rescue), I asked how many intubations each performed during the past 2 years. A couple had 10, majority had 6 or less and about 5 medics had 0.

What are the demographics of your area? I work in a county of 210,500 people, and my company provides services to approximately 3/4 of them. I've had 7 tubes since January 1st.:excl: (It might just be the fact that I'm averaging 80 hours a week.)

 

[Guardian]

there's some great stuff on here, thanks, couldn't agree more with rid and vent.

 

[jeepmedic]

Here at the BOP we Paramedics are a cross of what you on the street think of a paramedic, ER nurse, and a MLP. I have done a lot of other things that I never thought I would be allowed to do on the street.

As far a the education part. I have seen in my 20+ years how the people have changed. It used to be " lets see how many classes we can get to this year" to " lets see how many classes we can skip this year" this has been on the Fire and EMS side. People want the certs. but don't want to put the work in.

As far as Firemen in EMT-B classes I have taught classes and ask "Why are you taking this class?" and always get the "because I have to have it to get a job with X Fire Dept.