How to evolve EMS

[NysEms2117]

Be more than 21 and less than 35 years of age at time of appointment

meaning from 18-20 your doing what exactly

Possess a minimum of 60 College Credits towards a degree in police science or a related field.

"Related field" is stretched in policing and i am willing to admit that. But still some kind of credit minimum

Plus an added extra- I'd venture to guess that the police departments that have HS diploma as the requirement, also have a very lengthy FTO timeframe, as opposed to those that have a higher minimum requirement.

 

[DrParasite]

meaning from 18-20 your doing what exactly

IDK, maybe working as an EMT on an ambulance?

Plus an added extra- I'd venture to guess that the police departments that have HS diploma as the requirement, also have a very lengthy FTO timeframe, as opposed to those that have a higher minimum requirement.

Forgive my ignorance here, but if the office can perform the job, why do they need a lengthy FTO timeframe? Is there any studies that show a positive coloration between academic education prior to academy and length of FTO time? Whether they have a HS diploma or a PhD, if they are doing the job as expected, they should be able to be a fully released LEO

 

[NysEms2117]

1. Honest answer if you live in the tri-state area: POLITICS, people don't want to hear the person protecting them goes to an academy after high school, for 28 weeks, gets handed a gun and goes off. They want to know, or at least THINK THAT THEY KNOW, he/she has been properly trained, and acclimated.
2. I don't have time to look for said studies, so no I don't, but logic dictates if you learn first hand from somebody that's been doing it long enough to be a FTO, it will teach the brand new rookie officer not to do stupid ****. The academy teaches off of a checklist: Can they fire a gun to a "competent" proficiency. When your life depends on it, competency gets a whole new meaning. I learned a ton during my FTO period, those certain "tips/tricks of the trade". *I am not saying all FTO's do that*

 

[EpiEMS]

not that i'm disagreeing with statistics, however as of recent(past 5 years) police departments, sheriffs departments, and state police have all pushed for more education.

I've seen/heard this as well, especially given that higher levels of LEO education have positive relationships to performance (and reduce incidences of unauthorized use of force).

EpiEMS found the actual stats.. I didn't know the DOJ even kept track of stuff like that

Me either! I'm glad I found it!

I used to think that county wide EMS was the way to go..... now that I have worked in a county wide system, my opinion has shifted, because I have seen the coverage holes that are created.

On the bright side (or maybe not), when you've seen one EMS system, you've, well, seen one system, as the aphorism goes. I like the idea of county-wide EMS for rural areas, as I've said - spreads the costs.

1. Honest answer if you live in the tri-state area: POLITICS, people don't want to hear the person protecting them goes to an academy after high school, for 28 weeks, gets handed a gun and goes off. They want to know, or at least THINK THAT THEY KNOW, he/she has been properly trained, and acclimated.

Not to mention, if you're paying your personnel well, you can be much more selective!

 

[DrParasite]

@DrParasite, do you think it'd be sufficient to have such a low barrier to entry? This might undermine us with respect to other healthcare fields. For example, I don't know of any nursing programs that have such minimal requirements.

Since you asked for my opinion, 20 years ago you didn't need a degree to become an RN. 10 years ago (and I might be dating myself here a bit), you didn't need a degree to come an RN; there were still diploma programs out there. Now to work in a hospital you need a BSN as a new grad, but most existing RNs aren't getting their BSN unless they want to move into management, or their employer is forcing them to get it. But here is the real question related to this process: has the mortality level increased or decreased with the increased education? Has the skill set increased? Can a BSN nurse do anything less than diploma nurse RN to warrant that increased salary? What does the thousands of dollars and a piece of paper do to benefit the individual nurse, and the healthcare system as a whole? Or was it just a marketing scam to raise the salaries of nurses, while not giving any benefit to the patient.

I am all for education, but not education just for the same of education. I am 100% against requiring a bachelors degree to be a paramedic. But I would be 100% in favor of requiring a bachelors degree in Emergency Medical Sciences, where every course was directly relevant to the field of paramedicine. The reason I support non-degree paramedic programs is because every minute you are in class you are learning stuff that is directly related to being a paramedic. There are no electives, no other courses to make you "well rounded," everything you do in class is designed to make you a good paramedic. Show me a degree program that is 100% designed to make you a paramedic, and demonstrate to me why it's better than a non-credit program, or rather, the non-credit one isn't as good as it is, and I will support it too.

It is my opinion (and speaking as someone who got their original EMT at 17), if they can do the job, let them. If your requirements are 6 college credits of A&P, awesome. if they need to read and write at a 14th grade level (equivalent to an associates or 2nd year undergrad), test them and see how they do. If they can't use a computer, can't speak properly, don't use proper grammar, can't show up on time, can't pass the exams, or whatever criteria you want to use, they don't graduate. But what does a HS diploma mean, other than they passed HS? are there smart people who dropped out of HS for one reason or another (take care of a sick family member, was sick themselves, insert any other reason for not graduation?

My current EMT program is 244 hours. We are one of the longest programs in the state and exceed the minimum by quite a bit. and if I had my way, I would double it, adding 244 hours of clinical time on an ambulance with a minimum of 75 patient contacts. But that's not my decision.

You mentioned how other healthcare fields don't respect us. How do you define respect? how do you quantify it? Can one bad apple ruin the respect that has been built up over years? How do you know when we have the respect of others?

At the last 3 full time EMS jobs I have held, I can tell you the ER staff respected me as an individual. They listened to what I said, we were friendly and social both inside and out of work, and I may have slept with one or two ER staffers. And when I worked on the street at a EMS agency ran by a Level 1 trauma canter, I knew many of the attending MDs on a first name basis, and they knew who I was. And I had an issue with someone, it was handled appropriately. There was accountability both ways, and we all respected one another (and called each other by name). So I was respected, even if my profession wasn't. But they also knew me, saw me 3-4 time a week, often several times a day. It's very hard to respect someone you only see once or twice a month, regardless of what their profession is.

On the bright side (or maybe not), when you've seen one EMS system, you've, well, seen one system, as the aphorism goes. I like the idea of county-wide EMS for rural areas, as I've said - spreads the costs.

I've been in over a dozen EMS systems, urban, suburban and rural, in three states, and in various levels of employment (mostly part time or per diem, with 3 FT ones over the years, plus looked into others. We can discuss county wide EMS in another thread.... it does spread out the cost, but there are several drawbacks.

 

[akflightmedic]

Yes, but even 15 years ago Florida was doing that...... they still seem to be the only state where they want all your fire and medical training completed before you get hired, and they still have 1000 applicants for every 1 position. and when i was looking they only accepted florida training, out of state stuff didn't cross over.

Out of state did cross over IF it met the same high standards as FL set for itself (speaking of Fire Rescue here).

I have completed TWO separate fire academies, one in SC and one in FL. I was pissed I had to redo the one in FL...but after doing it, I realized how inadequate my SC training had been. Just saying, from my perspective there is value in the way they do this particular thing.

 

[Summit]

@DrParasite
Those Hospital Diploma RN programs were typically 2.5-3 years in length.
ADN/ASN RN programs are typically 3 years if you include prereqs (there are a few AAS programs where it is more like 2-2.5, but these are not common).
BSN programs have 4 years of content.

Your stats are off.

If you go back 30 years, 50% of RNs had a Diploma as their highest qualification, 25% had an associates degree, and 25% had a bachelors degree.

30 years ago, RNs had higher requirements and education rates than paramedics do today. Today, most new RNs are entering practice with a BSN.

Most Paramedics enter practice after a 6-12 month vocational program comprising about 1000 hours of training including clinicals.

If you look at other non-graduate level allied health professions, almost all of which earn more than EMS, almost all of them have educational pathways that resemble nursing somewhere between 30 years ago and today, that is to say, have higher requirements than ALS EMS.

 

[SpecialK]

Here's what I have seen work really well:

1. Reprioritisation: Moving from the old Priority 1, 2, 3 system to our new five colour coded dispatch framework. This has reduced immediate responses from 92% to somewhere closer to 65% and lights and siren responses from 64% to under 50%.

2. Clinical hub: This, coupled with reprioritisation, has been a life-saver. For the first ever time, the metropolitan workload dropped while the number of patients increased. It has taken some time to "bed-in" and the Ministry of Health has agreed to fund it nationwide. The triage nurses are amazing at getting people to self-care or facilitating referral with self-transport. People call for medical help because they do not know what to do, not because they need an ambulance. The Nurses are great at doing more assessment and getting people where they need to go.

3. Sierra: This is a single Paramedic or ICP in a car targeting non-urgent work. They can spend more time with the patient and figure out what they need rather than sending a traditional ambulance. If the patient needs to go somewhere and needs transport then Sierra can take them. This has reduced traditional ambulance workload the equivalent of having one additional ambulance on the road during the day. It only works well if you have volume to support it though I think otherwise they get tied doing first-response work or providing clinical backup.

4. Primary care options: Most every section in the new CPGs has guidance on referral and transport, and this enhances the existing ability of ambulance personnel to treat and refer. It has always happened but now it's being enhanced. Historically only about 70% of patients were transported and this is set to reduce to about 50% by 2020.

 

[DrParasite]

2. Clinical hub: This, coupled with reprioritisation, has been a life-saver. For the first ever time, the metropolitan workload dropped while the number of patients increased. It has taken some time to "bed-in" and the Ministry of Health has agreed to fund it nationwide. The triage nurses are amazing at getting people to self-care or facilitating referral with self-transport. People call for medical help because they do not know what to do, not because they need an ambulance. The Nurses are great at doing more assessment and getting people where they need to go.

Point of information: are you talking about sending a nurse instead of a paramedic to evaluate the patient?

or having the person call 911 (or the equivalent), request an ambulance, be transferred to the nurse, explain what is happening, and then having the nurse tell the person to stay in bed and see their GP in the AM?

 

[DrParasite]

You know, I might need need to apologize, because there is a study Analyzing the Relationship Between Nursing Education and Patient Outcomes

http://www.journalofnursingregulation.com/article/S2155-8256(15)30212-X/abstract

Here is the interesting part from the abstract:

Results revealed that, although at the individual and work group levels no significant association existed between BSN education and empowerment or communication, on units with higher proportions of BSNs, care providers reported work environments more supportive of their work and patient care.

The percentage of BSNs had no significant direct effect on care quality or safety, although work environment, equally weighted for each occupational group, had a significant, positive relationship with interactions with nurses, care quality, and safety.

Maybe simply having the Bachelors will make employers be more supportive of what we do?

 

[EpiEMS]

Maybe simply having the Bachelors will make employers be more supportive of what we do?

At the least, it raises the barriers to entry - should raise compensation....

 

[SpecialK]

Point of information: are you talking about sending a nurse instead of a paramedic to evaluate the patient? or having the person call 911 (or the equivalent), request an ambulance, be transferred to the nurse, explain what is happening, and then having the nurse tell the person to stay in bed and see their GP in the AM?

We have both. The clinical hub are acute care nurses (ED, ICU. A&M) in Ambulance Control who call back grey and most green callers (i.e. the not medically urgent work) to see if they can direct them somewhere else other than sending an ambulance. This will be nationwide in a year or two.

The sending of a single paramedic or ICP in a car instead of a traditional ambulance is called Sierra (that is their radio callsign). It only works if you have a large enough volume of patients to support it I think or so the evidence seems to show. If I attend a patient who is OK to remain at home but needs a follow up welfare check I can ask Control to book Sierra to go visit them at a scheduled time (or as close to as possible). Sierra can be used for first response to purple (cardiac arrest) if they are just up the road or whatever and can be used for clinical backup but are about third in line for preference because the idea is to keep them free for non medically urgent work to reduce pressure on the ambulances. A bit like how many managers have an authority to practice and can respond but are not the first choice because their job is to run the ambulance service.

Sierra is only in Auckland, Wellington and Christchurch.