Future Paramedic Scope?

[Melclin]

I think I may have been misunderstood when I said streamline (and perhaps it was not the best word to use).

Still, what a sad indictment it is on your poor systems that you think I meant 20-30 hours of a&p as it pertains to EMS, when I said streamlined. You always think the worst Venty, you must have been disappointed many times to so quickly assume the worst.

Maybe I don't quite understand what you mean when you guys talk about your a&p prereqs, and its interesting that you says its what all the other allied pros do, because that is what I meant - doing it as part of your degree. Do nurses not go to uni for the entirety of their education over there? Do they do separate pre reqs and then go off to nursing school?

In any case, what I was refering to when I said streamlined for a focus on clinically relevant features was the kind of a&p I did as part of my degree. We shared the same classes with the physios and the nurses, OT, midwives etc. We all had very similar first years. However, because we were already doing our respective degrees, our assignments and learning focuses were different. While being part of the same subject and all having the same curriculum and exams, we might have different assignments (the medics doing one on ..say fluid compartments, and the OTs on perhaps... a musculoskeletal issue. In tutes, our tutors would often emphasize certain points like: "Oh and you medics pay special attention to this slide on adrenergic receptors. Or "this will be of special interest to the midwives, you'll need to know this for MID2011 next year" ect. It was nice to have things pointed out that were the kinds of things we couldn't really just forget after the finals (Now I just no you are going to leap on me for that but honestly, if I forget the difference between an osteocysts and an osteoblasts on the road, its not the end of the world. Whats the difference if I thought early morula becomes advanced morula a day earlier than maybe it actually does, but changes in oncotic pressure in pregnant women? Thats a keeper. Factors affecting the irritability of muscle cells? I'll hang onto that one. Concentrations of different adreneric receptors on different organs? You betcha. Where as the midwives/nurses/physios will want to take slightly different things out of the same semesters).

It also meant that the paramedic faculty could have a say in the curriculum its medics were undertaking, and have a better understanding of what they'd done when they came into 2nd and 3rd years because while the a&p was taught by a different faculty, it was all at the same university and part of the same degree structure. Which meant a better continuity of knowledge and a better all round understanding of our educative needs.

 

[Melclin]

Oh good god. I just read that article you posted Vent....That is truly a shocker.

I thought this was a particular gem:

"Advanced airway management can be covered in 3 hours of didactic training and 6 to 10 hours of practical training (on a manikin and then real patients). Intravenous access should require no more than 6 hours (including the physiology of tonicity of body fluids, fluids and electrolytes etc.), and another 6 hours or so of practical training and experience. Cardiac monitoring with rhythm recognition, interpretation and treatment requires the majority of training time, around 100 hours.

"

That really is a travesty. I'm sorry you guys have to put up with that BS.

 

[VentMedic]

I think I may have been misunderstood when I said streamline (and perhaps it was not the best word to use).

Still, what a sad indictment it is on your poor systems that you think I meant 20-30 hours of a&p as it pertains to EMS, when I said streamlined. You always think the worst Venty, you must have been disappointed many times to so quickly assume the worst.

Maybe I don't quite understand what you mean when you guys talk about your a&p prereqs, and its interesting that you says its what all the other allied pros do, because that is what I meant - doing it as part of your degree. Do nurses not go to uni for the entirety of their education over there? Do they do separate pre reqs and then go off to nursing school?

In any case, what I was refering to when I said streamlined for a focus on clinically relevant features was the kind of a&p I did as part of my degree. We shared the same classes with the physios and the nurses, OT, midwives etc. We all had very similar first years. However, because we were already doing our respective degrees, our assignments and learning focuses were different. While being part of the same subject and all having the same curriculum and exams, we might have different assignments (the medics doing one on ..say fluid compartments, and the OTs on perhaps... a musculoskeletal issue. In tutes, our tutors would often emphasize certain points like: "Oh and you medics pay special attention to this slide on adrenergic receptors. Or "this will be of special interest to the midwives, you'll need to know this for MID2011 next year" ect. It was nice to have things pointed out that were the kinds of things we couldn't really just forget after the finals (Now I just no you are going to leap on me for that but honestly, if I forget the difference between an osteocysts and an osteoblasts on the road, its not the end of the world. Whats the difference if I thought early morula becomes advanced morula a day earlier than maybe it actually does, but changes in oncotic pressure in pregnant women? Thats a keeper. Factors affecting the irritability of muscle cells? I'll hang onto that one. Concentrations of different adreneric receptors on different organs? You betcha. Where as the midwives/nurses/physios will want to take slightly different things out of the same semesters).

It also meant that the paramedic faculty could have a say in the curriculum its medics were undertaking, and have a better understanding of what they'd done when they came into 2nd and 3rd years because while the a&p was taught by a different faculty, it was all at the same university and part of the same degree structure. Which meant a better continuity of knowledge and a better all round understanding of our educative needs.

Obviously you know very little about the U.S. training of the paramedic.
You also contradict yourself. The fact that you do the same classes for A&P as other professions is essentially doing pre or corequisites.

In the U.S. system, that is NOT a requirement in most areas in the U.S. NO DEGREE required except in the state of Oregon and maybe one other. You may only need 300 hours of classroom and 300 hours of clinicals...Period. No college classroom work required. In many states, the majority of training is done in trade schools or in the backrooms of FDs and ambulance services.

Also did you not read my previous posts and that of Rid to see what is required of our instructors? They may also just need the equivalent of a high school diploma, a Paramedic cert (600 -1100 hours depending on the state) and maybe a few hours (not college credit hours) for an instructor cert.

Let me give you a very simple example of what equipment reps and instructors/educators are up against for a relatively simple device like CPAP. Yes, it is very simple in terms of not much assembly required but there is a medical concept behind it rather than just "indicated for".

While the terms preload and afterload are "touched on" in Paramedic school they are not explained as well as they should be because the information was "streamlined" as only what some thought Paramedics should know. Actually I find that rather insulting that Paramedics have only been thought of as "techs" who only need to know a few things and none of that stuff with the really big names as you also rattled off.

Anyway, for a CPAP inservice one is usually given maybe if lucky one hour. When you mention preload and afterload, PVR, SVR, CI and CO you might get someone say "oh yeah CO = SV x HR. For resistance you may end up using fire hoses as examples and then you might as well say "it pushes the lung water". For nitro, it causes peripheral dilation which is why people drop their BP and so on and so forth.

Nursing students, not even practicing RNs, can usually grasp these concepts quickly because they have had all the prerquisites.

Not all Paramedic schools are the same either. One school may want 20 live intubations and another may just need 5 good passes on a dummy head. Yet, the employer may treat both grads equally and put each of them on a truck as a lead Paramedic after a couple of shifts.

As well, if the systems you work in are allowing people who are not proficient in thsir skills on the road, that is a different issue.

We can take well educated RNs, RTs, PAs, NPs or whoever into any advanced skills program and teach them ETI, chest tubes, central lines insertion, A-line insertion or whatever very easily because they already understand the concepts or reasons why. Then, we just given them an opportunity to practice their skills. It is by far worst to try to have someone who has very little knowledge in A&P or meds trying to understand advanced concepts as they pertain to the skills.

 

[VentMedic]

"Advanced airway management can be covered in 3 hours of didactic training and 6 to 10 hours of practical training (on a manikin and then real patients). Intravenous access should require no more than 6 hours (including the physiology of tonicity of body fluids, fluids and electrolytes etc.), and another 6 hours or so of practical training and experience. Cardiac monitoring with rhythm recognition, interpretation and treatment requires the majority of training time, around 100 hours.

Why do you think some of us have been arguing against the EMT-Bs (120 hours of training) doing ETI and IVs? It is reduced to a handful of hours to do a "skill". Nothing more.

I only mention this article because it is still the national anthem for some FDs, Fire unions and private ambulance companies.

This is an example of one 3 month wonder program. Fortunately there are only a few of these.
http://www.pelhamtraining.com/Documents/ACCP%20090709_Application_Packet.pdf

However, there are several 5 - 8 month unaccredited programs. However, the 8 month program can be deceiving as it could mean a class meeting only 1 or 2 days per week.

This is an example of one of FL's over priced medic mills.
http://www.amaedu.com/index.php

However, we do have good 2 year programs if someone wants to get a decent education.
http://www.mdc.edu/medical/AHT/EMS/ems_curriculum.asp

 

[JB42]

An example of the 2 year degree option here in NH. This type of program really needs to be the minimum especially with the new standards coming down the pipe. I think we should try for this before there should be any increased scope of practice.
http://www.nhti.edu/academics/academicprograms/degparamed.html

The article Vent posted blew my mind. I took my EMT-I class here and while the site tells you 140+ hours it was 176 hours of classroom time and 40 hours of clinicals. 16 more hours than that article advocates for a Paramedic. It really is disgusting that people want Paramedics to have less training than I do as an Intermediate. I actually think I could have done with another few classes worth of A&P as well.

 

[Melclin]

Obviously you know very little about the U.S. training of the paramedic.
You also contradict yourself. The fact that you do the same classes for A&P as other professions is essentially doing pre or corequisites.

Its hardly a contradiction. My point was that there are educative and logistical differences between the two. One is trotting off to one institution, taking a few classes in a broad subject matter, passing, then sometime down the track applying to a completely different institution that is unaware of the exact nature of your previous education. The other involves integrating the two as part of the same course structure, so that they flow in a more seamless fashion and you can focus more on the components important to your course.There's a difference. And seeing as we are talking about what we would like to see rather than what is currently the case, I was asking why you don't espouse an integrated degree at a college, with pharm experts teaching the pharm component, phys experts teaching the phys and medics teaching the nitty gritty etc. All of them knowing what the others are teaching and contributing to the content of each others curriculum. I meant that instead of the system you have now of backroom certificates.

In the U.S. system, that is NOT a requirement in most areas in the U.S. NO DEGREE required except in the state of Oregon and maybe one other. You may only need 300 hours of classroom and 300 hours of clinicals...Period. No college classroom work required. In many states, the majority of training is done in trade schools or in the backrooms of FDs and ambulance services.

I know this. What has it got to do with what I was saying about about hopes for the future course structures for paramedic education.

Also did you not read my previous posts and that of Rid to see what is required of our instructors? They may also just need the equivalent of a high school diploma, a Paramedic cert (600 -1100 hours depending on the state) and maybe a few hours (not college credit hours) for an instructor cert.

Again I'm not sure what this has to do with what I was saying. I wasn't suggesting that the a&p was to be taught as part of the programs you have now taught by bubba with his 15 minute cert. I was saying that it should be integrated with a paramedic program at the college level, and obviously if you are going to teach at university you need to be having MS/PhDs. I was saying that the whole thing should take place at the same excellent institution not moved to the same dodgy one.

Let me give you a very simple example...

Exactly why having an integrated system works better. Everybody knows what everybody else knows. If you separate whatever two bit local college that teaches a&p, from the paramedic schools then there's an education gap into which people are bound to fall and hurt themselves. A gap that closes when you integrate the two and move them to a higher class institution, like a good university that requires high standards of its students and teaching staff.

I get it, Vent, you medic schools are (often)rubbish, and I get the concept of teaching skills over the top of a firm educational foundation. I completely agree with you, and I fail to see at what point I suggested otherwise.

My original point was simply just to be cautious that the move towards academia doesn't go too far and forget that book learnin' doesn't teach you how to talk to a pt and perform very basic skills, because that happened here. I say this because when we moved to an academic 3 year degree from a vocationally based two year diploma, we had medics who could write 5000 word essays on fluid compartments and health care philosophies but couldn't take a blood pressure. But you all clearly have a lot of work to do on the system before such matters concern you so perhaps the warning somewhat premature.

 

[Melclin]

I think we should try for this before there should be any increased scope of practice.
/QUOTE]

I quite agree. To practice at what you would call the paramedic level here, you need to have spent a year at grad school, after 3-4 years on the road, after a three year bachelors degree.

It scares the crap out of me of me that someone in the US can walk of the street, write a check and literally, months later be practicing at the same level we have to spend a minimum of 7 (most often more) years achieving.