How to fix EMS

[pa132399]

i didnt have the ambition to read through everything in here way too late still cant fall asleep but everything began to blur as i read it so if it was said in here im sorry...

ELIMINATE NREMT it is nothing but a money making gimmic and at 130 a pop for the medic test and basic i think in the 70's they sure make a killing on it.

Make states create there test to accomodate their approved protocols and meet the NHSTA guidline or better yet make the standards nationwide and then we could keep the godforsaken NREMT and actually use the drugs and protocols we are taught that in most cases are thrown out the window the day after you find out you passed the class. no havent taken the test but i think that it would either cut down on confusion or make it that we were a universal and wouldnt be governed by multiple redunant levels. my state PA has approved protocols then it kicks down to ems councils which cover different regions, and then different medical directors for each unit. If only it was universal it would be simple. but who would have thought of that.

Also if we were universal we might not be looked at as the very bottom of the totem pole by everyone else in the medical field. hey we might make a few extra bucks and be looked at as professionals.

Wow that was a mouthful must be my long lenghty post kind of night

 

[TheyCallMeNasty]

This thread is nothing but a pipe dream.....I lol'd when i read the AS degree for emt thats a good one, I think i've come across pieces of thin paper in the depths of LA County bathrooms that would be worth more than that degree....compared to others...

also I would be good with the jobs requiring degrees if they came with a salary to match it.

 

[Smash]

This thread is nothing but a pipe dream.....I lol'd when i read the AS degree for emt thats a good one, I think i've come across pieces of thin paper in the depths of LA County bathrooms that would be worth more than that degree....compared to others...

also I would be good with the jobs requiring degrees if they came with a salary to match it.

So which is it, the chicken or the egg?

Every other country in the world has come to grips with the requirement for a degree as an entry into EMS. Some places require a full degree as a minimum level, and that won't even let you operate at an "ALS" level. Mostly this education is done in the pre-employment sector, and paid for by the hopeful EMT. Funnily enough, this is exactly the same as every other profession, and lo and behold! EMS is seen as a profession as a result.

American EMS, however, seems mired in a lazy, self absorbed, anti-education, trade mentality that it seems unable (or unwilling) to change.

Now, before everyone climbs up me, yes I realise that there are exceptions, and most of those exceptions post here. However, the people who post here are arguably atypical of US EMS. So long as the above attitude prevails, unfortunately I believe that the poster is right, and this thread is a pipedream. If a few more people pulled their fingers out and stopped accepting that attitude, maybe things can change.

 

[FirstInTac'dOut]

"How to fix EMS"

I guess that depends on how you see EMS, and by extension, yourself.

To point, do you see yourself as a link in the chain of MD-PA-NP-RN-ERT-(EMS)? If you do, I suppose that you are of the mind that EMT-B certification should be done away with entirely, and that Paramedic certification (or, dare-i-say, licensure) require a Bachelors degree, and thus, I bet you think, more respect and higher pay.

Or... Do you see EMS as part of the Emergency Response system, ie Police, Fire. If you do, I bet you would prefer a high intensity, high-immersion, boot-camp style program for EMT/Paramedic training.

Full disclosure: I am a graduate of 4 year University, and I also fall into the latter model, or perhaps a hybrid of the two.

Ever wonder why in an ER, or a Nursing Home, paramedics, and to a lesser extent, EMTs, walk away muttering under their breath about the incompetence of the nurses? In my observation, it's because nursing TRAINING is non-tactical, it is care based; or, if they are more advanced, and this includes MDs, it is diagnostically based.

EMS, however, is different. EMS is based on differential treatment algorithms, and a tactical approach to medicine. The role of EMS, in its purest form, is to identify life threats, treat and stabilize them, and get the patient to a hospital. EMS is, in my eyes, a Emergency Medical Corps, if you will. You are the soldier of medicine, on the front lines. Police get called for Crime. Fire Dept gets called for Fire. EMS gets called for Medical Emergencies. Simply put, unless you are going to turn the ambulance into a rolling OR, you are not a doctor; unless you are going to manage a pt's condition for 12 hours at a time, you are not a nurse. You are something else.

A thought on Paramedic education:
A four year degree requires approximately 1200 hours of classroom time (15hr/wk x 10 wk semester x 2 semesters/yr x 4 yrs = 1200hrs). You could do boot camp-style training (5day/week x 12 hr day = 60/hr wk) in 20 weeks, or less than 6 months, and acheive the same goal. I know there are some out there who will say that the information load would be too intense in such a short time, and certainly that is an argument, but some studies show that intensive learning can not only encourage retention, but can also force dramatic change in the WAY you think; which, I believe, is most important when you are training someone in a new field; or, for example, turning someone from a civilian into a type of soldier. A Tactical Medical Responder. Para-medicine necessitates para-military style training.

Sorry if this got rant-y; it has been a long week. I'm sure there will be more who disagree than agree, so please, let me know what you think. Here we go...

Oh, and look: Most people I've come across who'd rather see themselves on the same level as a nurse, or other hospital staff, seem to regret their career path more than anything. If you want to be an RN, be an RN. If you want to play doctor, you should've gone to medical school. Treat the life threats, treat the symptoms, gather the information and the evidence for the Doc. Don't try to BE the doc. Let them all do their jobs, and understand what yours is, and what it could be.

 

[usalsfyre]

Yeah...no....

Medicine. That's what we do. We don't ensure the safety of large groups of people, we don't protect property, we treat the individual patient, one at a time.

 

[thegreypilgrim]

This thread is nothing but a pipe dream.....I lol'd when i read the AS degree for emt thats a good one, I think i've come across pieces of thin paper in the depths of LA County bathrooms that would be worth more than that degree....compared to others...

also I would be good with the jobs requiring degrees if they came with a salary to match it.

This is precious. Like the august Smash asked, what comes first? How is the proportionate salary increase supposed to unfold? Do you expect someone else to just magically force employers to start paying their providers more if they have a degree? It doesn't work that way, unfortunately. It requires self-initiation, organization en masse, and sacrifice to rise to the professional level.

 

[thegreypilgrim]

Or... Do you see EMS as part of the Emergency Response system, ie Police, Fire. If you do, I bet you would prefer a high intensity, high-immersion, boot-camp style program for EMT/Paramedic training.

This is what EMS has been for years. It has not succeeded transitioning EMS into an actual profession.

Ever wonder why in an ER, or a Nursing Home, paramedics, and to a lesser extent, EMTs, walk away muttering under their breath about the incompetence of the nurses? In my observation, it's because nursing TRAINING is non-tactical, it is care based; or, if they are more advanced, and this includes MDs, it is diagnostically based.

This is an incredibly arrogant statement to make, based on flawed thinking and hasty generalizations. Sure, there are incompetent nurses but I would be loath to apply that descriptor to nurses as a whole. And I have no idea what you mean by "non-tactical" or "care-based" or "diagnosticlly-based" training. You're going to have to explicitly define those concepts and explain why the the complexities of nurse or physician training can be distilled down to these single concepts.

EMS is, in my eyes, a Emergency Medical Corps, if you will. You are the soldier of medicine, on the front lines. Police get called for Crime. Fire Dept gets called for Fire. EMS gets called for Medical Emergencies. Simply put, unless you are going to turn the ambulance into a rolling OR, you are not a doctor; unless you are going to manage a pt's condition for 12 hours at a time, you are not a nurse. You are something else.

I am not a soldier. I am not some Public Safety guru. I am a health care professional who practices medicine of a defined scope. I like to think that paramedicine is more than some adaptation of combat-style first aid and rescue. No, that isn't what I do.

A thought on Paramedic education:
A four year degree requires approximately 1200 hours of classroom time (15hr/wk x 10 wk semester x 2 semesters/yr x 4 yrs = 1200hrs). You could do boot camp-style training (5day/week x 12 hr day = 60/hr wk) in 20 weeks, or less than 6 months, and acheive the same goal.

This is by all known evidence a terrible educational model. Time spent at your desk in the classroom is not at all where the magic of learning happens. Many additional hours outside the classroom are necessary to augment and solidify what was gleaned from the lecture material which is why the pace of the course needs to account for that (and you ought to know that 10 week quarters go by rather quickly). Furthermore you have access to an excellent faculty that is dedicated to learning (not the espousal of war stories) and the resources of a university in this setting which can be invaluable. This 6 month "boot-camp style" model is a great way to ensure students have a flawed understanding that is basically just rote-learning and higher-order naturalistic understanding is absent.

If you want to be an RN, be an RN. If you want to play doctor, you should've gone to medical school. Treat the life threats, treat the symptoms, gather the information and the evidence for the Doc. Don't try to BE the doc. Let them all do their jobs, and understand what yours is, and what it could be.

I'm having a tremendously difficult time understanding why so many people have equated the suggestion for something as meager as a baccalaureate degree with wanting to turn medics into doctors. I really think that is absurd. What I want is for paramedics to become professionals who can exercise critical thinking, be autonomous, accept responsibility, and play a greater role on the health care continuum than a manual laborer who brings people to the hospital after minimal intervention.

 

[DrParasite]

This is by all known evidence a terrible educational model. Time spent at your desk in the classroom is not at all where the magic of learning happens. Many additional hours outside the classroom are necessary to augment and solidify what was gleaned from the lecture material which is why the pace of the course needs to account for that (and you ought to know that 10 week quarters go by rather quickly). Furthermore you have access to an excellent faculty that is dedicated to learning (not the espousal of war stories) and the resources of a university in this setting which can be invaluable. This 6 month "boot-camp style" model is a great way to ensure students have a flawed understanding that is basically just rote-learning and higher-order naturalistic understanding is absent.

I respectfully disagree. While I don't discount the value of the work done outside of the classroom, I do think that classroom time is time for learning, and when you leave classroom, you should be permitted to be off the clock.

Speaking for myself only, I hate homework. in high school, I hate homework. in grammer, I hated homeworking. in college, I hated homework. I did stuff outside of school, and while I gave 100% while I was in class, outside of class I did have other priorities.

I've also taken 4 and 5 credit classes over the summer, cramming 9 credits of schooling into a 8 week time frame. plus working full time. it sucked. We did the same work as a a regular 4 month just super condensed. but the work was the same.

It can be done, and I do think that a good instructor/professor can teach what is needed during the time frame, and if you can't, than it's either time to restructure the course or utilize the time better. Outside of some outside reading, you should be able to teach what you need to within the timeframes give. and yes, I did have many upper level course that were able to do just that.

Class is for learning. let people have lives outside of class, as well as time to unwind from a mentally difficult day

I'm having a tremendously difficult time understanding why so many people have equated the suggestion for something as meager as a baccalaureate degree with wanting to turn medics into doctors. I really think that is absurd. What I want is for paramedics to become professionals who can exercise critical thinking, be autonomous, accept responsibility, and play a greater role on the health care continuum than a manual laborer who brings people to the hospital after minimal intervention.

because more of your baccalaureate degrees are crap. no wait, that's not accurate; most of your baccalaureate degree are diverse, and are not focused on a single area.

I have said it before, and I will say it again: you show me a baccalaureate degree that is completely 100% focused on paramedicine, and prehospital emergency care, and I will support it 100%. no electives, no side focus on health services management, no side focus on emergency management, no courses that are designed to give you a "well rounded education", everything is about become a good paramedic.

when you go to a trade school, or a current paramedic or EMT program, everything is 100% focused on the skill. grad schools are like this too, where everything is focused on the overall goal. I can't tell you how many courses in college I took were a huge waste of time, some because I learned nothing from them, others because they weren't at all applicable to my area of study.

I think Australia actually does something like this. Sadly, I haven't seen anything in the US like this, nor do I forsee it happening anytime soon.

 

[JPINFV]

Damn, I wish I wouldn't have needed to study outside of class.

 

[usalsfyre]

The expectation of any higher education program that I've ever been aware of is that you study outside of class.

 

[medicswag]

Why doesn't nursing take over EMS? They have done remarkably well advancing their profession.

 

[Handsome Robb]

Why doesn't nursing take over EMS? They have done remarkably well advancing their profession.

Go back under your bridge.

 

[JPINFV]

Why doesn't nursing take over EMS? They have done remarkably well advancing their profession.

...because it's not nursing. Why doesn't medicine take over nursing? After all, advanced practice nurses are just wanna-be physicians that couldn't hack medical school.

/See, I can play this game too!

 

[medicswag]

...because it's not nursing. Why doesn't medicine take over nursing? After all, advanced practice nurses are just wanna-be physicians that couldn't hack medical school.

/See, I can play this game too!

Are you implying that " [paramedics] are just just wanna-be [nurses] that couldn't hack [nursing] school."?

 

[46Young]

It's this mentality right here that totally takes the wind out of the sails of any movement to turn EMS into some semblance of a profession. I have difficulty understanding the notion that any suggestion of increasing education standards is fruitless because even after that "we're still not doctors". I do not understand this objection. Are you suggesting that in order to increase our autonomy and/or functions to a meaningful degree we'd have to attain an education level equivalent to physicians and anything less than that would be redundant? Surely, there are many options between where we currently are and that of doctors that are worth pursuing.

Also, the ED is not definitive. The ED physician doesn't make a "definitive diagnosis", so by the same logic we shouldn't require such a thing as an Emergency Physician. The point is "See A, do B, transport" is not a sustainable model from neither a medical or economic standpoint, and policymakers will eventually come to understand this. The system will be changed in a way which can be beneficial to EMS providers or not as much.

(1) An undergraduate degree is the standard for any professional career, let alone one in healthcare. If a BA/BS is required to be an HR Representative, CPA, engineer, etc. than why shouldn't it be necessary for something as critical as emergency care?

(2) It is precisely because 90% of our patients are not only not time-sensitive, but not even acutely ill that our education needs to provide us with the tools to handle this. EMS literally has nothing to offer the vast majority of people who access it beyond a cardiac monitor, a line of saline, and a ride to the hospital. That is not worth the ambulance fee. We should adapt our capabilities and services to the public, not try to adapt the public to what we think we should limit ourselves to.

(3) Our decisions need to be justified, and if options such as provider-initiated non-transport, alternative clinical pathways, treat-and-release, etc. are going to be incorporated into EMS the providers must have the cognitive abilities to justifiably apply them. If we're going to make such demands on paramedics then they have to be provided the tools to properly and safely fulfill those demands. It isn't prudent from a logistical standpoint to think that an 18 month AS degree is sufficient education to achieve that level of performance. Especially when Nursing, Respiratory Therapy, Occupational Therapy, etc. have all long ago determined a BS degree is required for their functions.

This is myopic thinking. Sure, it will require short-term sacrifice, but will result in long-term gains. Raising the bar for entry into the field will significantly limit the number of employable candidates and desaturate the market. Demand for paramedics will increase, and with that a better negotiating position for said paramedics. Career development will also open up once it is understood by the rest of society that a "Paramedic" is an educated person. I don't see why, following this, paramedics won't be able to move into management/administration, academia, or other clinical roles (e.g. CCT, primary care, etc.).

1 - An RN and an RRT treat patients without a 4 year degree. The progression to BSN doesn't really include any further medical education. I suspect that the same holds true for respiratory therapy. In EMS, it's the same thing. Going to school for two more years won't make me a better paramedic; it's for career development, Rather, it would be if there was a career ladder to speak of. Those opportunities are few and far between in single role EMS.

2 - In the role of prehospital EMS, how much more can realistically be done? Our role is to assess, treat if necessary, and transport to a hospital. It would be nice if we could transport the pt to a more appropriate destination, or perform more treat and release functions, but we're not performing field surgery, field CT's and X-Rays, nor are we capable of performing blood work or diagnosing and writing a treatment plan based on any of the above results.

If you want to talk about expanded scope and functions outside of 911, then we're getting away from EMS, and transitioning into roles that PA's, BSN's, and NP's are better suited for.

3 - OLMD consult can address that. Many, if not most systems here will be too litigation phobic to enable provider initiated refusals and anthing past minor treat and release. We have urgent care facilities that can do treat and release.

In EMS, I suppose that an Attending Physician in Emergency Medicine would be the top level of the profession. We're at the bottom. What liberties and level of autonomy are you looking for, exactly? Without Medical Direction, I would say that we need a lot more than four years of medical education to pracitce independently. I don't know of any medical professions in the U.S. that can practice with true autonomy that have only four years of medical education.

CCT and specialty transport is done by nurses in many places. Good luck taking that over with our extent of disorganization.

 

[46Young]

This is precious. Like the august Smash asked, what comes first? How is the proportionate salary increase supposed to unfold? Do you expect someone else to just magically force employers to start paying their providers more if they have a degree? It doesn't work that way, unfortunately. It requires self-initiation, organization en masse, and sacrifice to rise to the professional level.

I agree with Callen. If I'm going to sacrifice my time, money, and opportunity cost by earning a degree, it is not unreasonable to expect to be compensated appropriately. I realize that this created a catch-22, but I am unwilling to wait things out for 10-20 years for an uncertain future at best/ I also have a family to support and a mortgage to pay. I'm not going to screw myself out of a gainfully employed lifestyle just to fight the good fight. Just the opportunity cost of the loss in retirement savings, the inability to save for a home, or even pay off student loans and other debt bears mentioning. I suspect that many others feel the same.

If we could get nationally organized, truly nationally organized, then we could talk about everything else you're advocating. I expect a decent ROI for any education I choose to complete.

Me, the only reason that I'm completing the EMS-AAS is so that I have the best chance of promoting to Lieutenant. After that, it's going to be a degree in Emergency Management. A few people at my old hospital based EMS job did the Emergency Management thing, and they all left that department to work in other areas of the Health System for much more money, and a real career track. I prefer to use education in a way that is profitable. After all, that time invested is time away from my family, and also time that I could spend building my business or working OT.

Until employers require degrees for employment, or at least heavily incentivize them, an EMS degree is going to be only a "joke degree" for purposes of compensation and career advancement (they have automotive Assosciates degrees now), unless you parlay that into another degree program.

 

[46Young]

Why doesn't nursing take over EMS? They have done remarkably well advancing their profession.

EMS should partner with their organization and seek to benefit from their strength and influence. What's the alternative, the IAFF?

 

[JPINFV]

Are you implying that " [paramedics] are just just wanna-be [nurses] that couldn't hack [nursing] school."?

No, because EMS is not nursing no more than RT or AAs, or perfusionists are wanna-be nurses. On the other hand, the NPs are fighting to be called "doctor" (because "doctor" doesn't have a specific connotation in US health care) and have unrestricted practice rights.

 

[46Young]

I respectfully disagree. While I don't discount the value of the work done outside of the classroom, I do think that classroom time is time for learning, and when you leave classroom, you should be permitted to be off the clock.

Speaking for myself only, I hate homework. in high school, I hate homework. in grammer, I hated homeworking. in college, I hated homework. I did stuff outside of school, and while I gave 100% while I was in class, outside of class I did have other priorities.

I've also taken 4 and 5 credit classes over the summer, cramming 9 credits of schooling into a 8 week time frame. plus working full time. it sucked. We did the same work as a a regular 4 month just super condensed. but the work was the same.

It can be done, and I do think that a good instructor/professor can teach what is needed during the time frame, and if you can't, than it's either time to restructure the course or utilize the time better. Outside of some outside reading, you should be able to teach what you need to within the timeframes give. and yes, I did have many upper level course that were able to do just that.

Class is for learning. let people have lives outside of class, as well as time to unwind from a mentally difficult day
because more of your baccalaureate degrees are crap. no wait, that's not accurate; most of your baccalaureate degree are diverse, and are not focused on a single area.

I have said it before, and I will say it again: you show me a baccalaureate degree that is completely 100% focused on paramedicine, and prehospital emergency care, and I will support it 100%. no electives, no side focus on health services management, no side focus on emergency management, no courses that are designed to give you a "well rounded education", everything is about become a good paramedic.

when you go to a trade school, or a current paramedic or EMT program, everything is 100% focused on the skill. grad schools are like this too, where everything is focused on the overall goal. I can't tell you how many courses in college I took were a huge waste of time, some because I learned nothing from them, others because they weren't at all applicable to my area of study.

I think Australia actually does something like this. Sadly, I haven't seen anything in the US like this, nor do I forsee it happening anytime soon.

We're seeing this problem in the fire service. Weight is given to those holding degrees for promotions, which is fine, but it's too much weight. Those with practical experience are being left behind while we now have officers that had the education points, regurgitated the operations manuals and did well on the written, but are a train wreck on the fireground. These are usually the EMS people who went up the EMS career ladder then made a lateral move to All-Hazards officer (medic/fire officer). Practical skills and knowledge are being de-emphasized in favor of education points in sometimes loosely related fields and the ability to memorize a manual.

In my personal experience, I can advocate for a mandatory pre-req of college level A&P and pharm prior to admission to a non degree paramedic program. A general aptitude test would also be wise. Other than that, I've seen nothing in the college curriculum that would have made me a better medic than the program I went through previously (NY Methodist Paramedic Program, accredited). The time spent with the fluff classes could have been better used on field rotations, or perhaps additional education on any number of subjects within the core curriculum.

 

[usalsfyre]

I've seen several post implying specific field diagnosis is impossible because we lack diagnostic imaging. Do we suck that bad at H&PE? Can we not assess and if the findings are ambiguous transport for further diagnostics?