Is anyone afraid that Evidence-Based Medicine will kill EMS?

[JPINFV]

I am fairly certain that if moved to a rural area that has extensive transport times (ie like the area I service it is 2 hours via ground L/S to reach definitive care) .

How long does it take you to return from definitive care without lights and sirens? The studies on L/S are pretty consistent that they save time. The problem is that the time saved is generally not enough to even begin to hope to be clinically significant. Similarly, in those 2 hours how much impassible slow traffic (please don't get me started on the stupidity I saw in MA with ambulances going L/S on the freeway when going the speed of traffic) or red stop lights do you encounter? Alternatively, are lights and sirens used as a legal justification for speeding (I'm from California, so it would be wrong of me to judge someone else on speeding, so don't take it like that)?

 

[fire_911medic]

Those are valid points JP -

As far as traffic - we are straight interstate after we reach certain areas, but due to distance, yes the average cruising speed is around 80 with L/S - around 65 -70 (65 speed limit) without. Though caution is exercised at all times. Going through town, into university or one of the other areas, it's not unusual to experience traffic so badly you cannot get through and frankly people just don't give a care. I think common sense should be applied, and if not neccessary, L/S should not be utilized. however, protocol dictates that if exceeding the speed limit by more than 5 (which is general flow of traffic) then they must have L/S activated - even on interstate, or if going through heavy traffic and attempting to maneuver around it. With the exception of a few miles, there is little extreme back up as we are not even remotely close to a densely populated urban area. Even university is not located within a major metropolitan area and is a far cry from larger cities such as Chicago and Houston.

 

[JPINFV]

In otherwords, it's not lights and sirens that saves time. It's speeding (I'm from an area where the speed of normal traffic is 80, even though the speed limit is 65), and yes, 20 mph over that distance will save time, but it's not the L/S that's allowing you to do that. The one thing I can see rural areas needing L/S for is for going around slow moving farm traffic or getting them to yield sooner, which was what I was going after for impasible traffic.

 

[fire_911medic]

In otherwords, it's not lights and sirens that saves time. It's speeding (I'm from an area where the speed of normal traffic is 80, even though the speed limit is 65), and yes, 20 mph over that distance will save time, but it's not the L/S that's allowing you to do that. The one thing I can see rural areas needing L/S for is for going around slow moving farm traffic or getting them to yield sooner, which was what I was going after for impasible traffic.

Yes, it speeding that saves the time. However, it is department policy which permits them to speed only utilizing L/S. Without that justification, they would not be permitted to speed and if caught going excessive speed (or heaven forbid ticketed) without patient requiring that level of transport or on a return leg they will receive strict disciplinary action from both the service and the state. It is so rural in many of these areas that it could safely be passed without the use of L/S. But point is understood. Thanks for clarifying though. I misunderstood where you were going with the comment.

 

[DrParasite]

Will education solve all the problems of EMS? Probably not. But why is it that the only people who argue against education are the uneducated?

Point of information: Do you have a bachelor's degree? masters? maybe even a doctorate?

I have my bachelors. But I'm only an EMT. Does that make me uneducated? there is someone on these boards with the SN EMSLaw. I am pretty sure he has his Juris doctorate, but I don't think he is a medic. is he uneducated? There is a guy from Syracuse NY named Brad Pinsky. He's a volunteer EMT and volunteer firefighter. and he has JD after his name. is he uneducated?

There are quite a few paramedics in this country that used to be medics, who are now supervisors, and are now simply EMT basics because they don't need to do all the recert stuff as a medic to do their supervisory job. are they uneducated simply because they are only EMTs?

BTW, I hope Jeffrey_169 realizes that the point that he described as outstanding was stated by an "uneducated" EMT. But thing again, what does an uneducated person know

 

[JPINFV]

You don't get the entire "exception to the rule" thing, do you?

There are quite a few paramedics in this country that used to be medics, who are now supervisors, and are now simply EMT basics because they don't need to do all the recert stuff as a medic to do their supervisory job. are they uneducated simply because they are only EMTs?

They are, 100% without a doubt, undereducated if they didn't keep up with CMEs and maintain their paramedic certification if they are involved with clinical oversight of paramedics.

 

[Veneficus]

Point of information: Do you have a bachelor's degree? masters? maybe even a doctorate?

I have my bachelors. But I'm only an EMT. Does that make me uneducated? there is someone on these boards with the SN EMSLaw. I am pretty sure he has his Juris doctorate, but I don't think he is a medic. is he uneducated? There is a guy from Syracuse NY named Brad Pinsky. He's a volunteer EMT and volunteer firefighter. and he has JD after his name. is he uneducated?

There are quite a few paramedics in this country that used to be medics, who are now supervisors, and are now simply EMT basics because they don't need to do all the recert stuff as a medic to do their supervisory job. are they uneducated simply because they are only EMTs?

BTW, I hope Jeffrey_169 realizes that the point that he described as outstanding was stated by an "uneducated" EMT. But thing again, what does an uneducated person know

Do you argue against education?

 

[Outbac1]

I don't believe that EBM (Evidence Based Medicine), will end EMS. Quite the contrary, I believe it will change EMS. EMS will change as we take the lessons learned and apply them to our patients. We can affect our pts by what we do before they get to the hosp.

How far from a hospital shouldn't be part of the equation. Why should a pt have to wait to be admitted to an ER to have nitrates or CPAP administered when they have CHF? Why should they wait for tx when the 10 min. drive with little traffic turns into 40 mins or more because of heavy traffic or obstruction. It is because of the evidence that CPAP and nitrates work that we can do these things prehospital.

We have the opportunity to have a positive effect on the lives of many of our pts. We can do this because of the education in medicine we receive and the progression of medicine in general.

Education in medicine needs to be ongoing. A family Dr. does not do heart surgery. They need substantially more education to do that. But they have way more education than a paramedic.

They say there is a Dr. shortage and people don't have family Drs. There are about as many Drs. now as about 20 years ago. They are not working as many long hours and thus are not seeing as many pts. They actually want a life. Imagine that! This opens the door of opportunity for us. With more education and the progression of medicine there will be more things we can do for pts without bringing them to the hospital. Evidence based medicine will be a part of this and we need to be involved. Especially if we want trials and experiments to benifit us.

The comments about education need to be focused to the subject at hand. A person with a Doctorate in history may be considered "educated" but not in medicine.

Here in Canada (most places), an EMT-B isn't qualified to drive an ambulance letalone attend pts in the back. If the US wants to move forward in EMS you need to get on the bandwagon with the rest of the world. Increase your standards and education.

 

[Jeffrey_169]

you tried to connect your thoughts with the subject at hand.

Since you yourself have pretty much decided what you've decided and since this isn't the place to do so I won't get into it with you other than to point out that it would be hard for you to have been having these discussions here for decades give that you've only been posting here for less than 2 years.

If you're claiming that you've had discussions with people about the state of education in EMS outside of this forum for decades now, well only you know how long you've been in the EMS field.

Did the thought ever occur to you that maybe the folks who have advocating for fewer ALS interventions done in the field may have had a point after all?

I certainly hope that you're including any studies that support increasing ALS interventions when you bring up studies that can't be reproduced or have biased methodologies

To try and bring this back to the original topic, any system of health care that is as you say, "extremely resilient" to change even when faced with scientific proof is one that perhaps needs to go away. Science did away with the barbers and the leeches, for the most part anyway, maybe the idea that a Paramedic in an ambulance really isn't a substitute for a hospital and a team of health care providers is correct. I don't know where the truth lies, but I do know this, there isn't any magic "education" button that is gonna improve patient survival when it comes to EMS. Unless that includes studying whether the whole premise of what EMS means needs to change.

As for the assertion about my antagonism, you brought it, I only replied to your vitriol.

John E

I believe the post in question is on point if you read it in the proper context. He is saying there would not as many ALS transports to analyze if we had the education to treat and release on scene. He is referring to those who do not need transport to a trauma or advanced facility, but rather a simple fix such as basic suturing, prescription and administration of basic antibiotics, etc. I believe he is also referring to the patients who do not require ALS interventions, but get it becasue they called 911. If we could treat on scene we could eliminate unnecessary transports, which would in turn reduce the statistics which say we are useless in the field in ALS care. There are too many transports which are not needed, and so when we intervene via protocol we are giving interventions which are not needed which provides the illusion we are ineffective.

He is also stating these interventions are not in our scope of practice, education, or protocols, but if we are to improvbe our ALS transport ratios we need to diversify to a capacity where we are able to.

He has a valid point if the point expressed is out into context. I agree no magic wand or cure all soiolution will fix the issues we face, but we do need to consider more education as a means of repairing our image to both the practitioners and Joe Public.

 

[Jeffrey_169]

you tried to connect your thoughts with the subject at hand.

Since you yourself have pretty much decided what you've decided and since this isn't the place to do so I won't get into it with you other than to point out that it would be hard for you to have been having these discussions here for decades give that you've only been posting here for less than 2 years.

If you're claiming that you've had discussions with people about the state of education in EMS outside of this forum for decades now, well only you know how long you've been in the EMS field.

Did the thought ever occur to you that maybe the folks who have advocating for fewer ALS interventions done in the field may have had a point after all?

I certainly hope that you're including any studies that support increasing ALS interventions when you bring up studies that can't be reproduced or have biased methodologies

To try and bring this back to the original topic, any system of health care that is as you say, "extremely resilient" to change even when faced with scientific proof is one that perhaps needs to go away. Science did away with the barbers and the leeches, for the most part anyway, maybe the idea that a Paramedic in an ambulance really isn't a substitute for a hospital and a team of health care providers is correct. I don't know where the truth lies, but I do know this, there isn't any magic "education" button that is gonna improve patient survival when it comes to EMS. Unless that includes studying whether the whole premise of what EMS means needs to change.

As for the assertion about my antagonism, you brought it, I only replied to your vitriol.

John E

I believe the post in question is on point if you read it in the proper context. He is saying there would not be as many ALS transports to analyze if we had the education to treat and release on scene. He is referring to those who do not need transport to a trauma or advanced facility, but rather a simple fix such as basic suturing, prescription and administration of basic antibiotics, etc. I believe he is also referring to the patients who do not require ALS interventions, but get it becasue they called 911. If we could treat on scene we could eliminate unnecessary transports, which would in turn reduce the statistics which say we are useless in the field in ALS care. There are too many transports which are not needed, and so when we intervene via protocol we are giving interventions which are not needed which provides the illusion we are ineffective.

He is also stating these interventions are not in our scope of practice, education, or protocols, but if we are to improve our ALS transport ratios we need to diversify to a capacity where we are able to.

He has a valid point if the point expressed is out into context. I agree no magic wand or cure all solution will fix the issues we face, but we do need to consider more education as a means of repairing our image to both the practitioners and Joe Public.

 

[alphatrauma]

Point of Imformation: do you have a degree? masters? maybe even a doctorate?

I have my bachelors. But I'm only an EMT. Does that make me uneducated?

Generally speaking, no. Then again, I don't think this discussion is about generalities... it's about medical science and the practical application/advancement of prehospital medicine as a profession.

If I may inquire... Bachelor of _____?

there is someone on these boards with the SN EMSLaw. I am pretty sure he has his Juris doctorate, but I don't think he is a medic. is he uneducated? There is a guy from Syracuse NY named Brad Pinsky. He's a volunteer EMT and volunteer firefighter. and he has JD after his name. is he uneducated?

Do any of these degrees/disciplines have concentrations in chemistry, biology, physics? Are they educated... by all means yes, but they are at a considerable disadvantage when it comes to the practical application/understanding of emergency medicine (prehospital), as opposed to someone with an advanced degree in the health/medical related area of study.

There are quite a few paramedics in this country that used to be medics, who are now supervisors, and are now simply EMT basics because they don't need to do all the recert stuff as a medic to do their supervisory job. are they uneducated simply because they are only EMTs?

Unfortunately, as we (myself included) are becoming painfully aware of, being a "medic" does not automatically equate to being adequately educated. Semantics not-withstanding, we can split hairs all day about what being "educated" actually means... but I think we all know what the bottom line is.

 

[DrParasite]

Do you argue against education?

in general? no. I think education is a good thing and you can never have too much education.

however, I don't think it's right to raise standards unnecessarily. The paramedic program, as it stands now, requires strict oversight, a medical director who approves every protocol, and a lot of cookbook medicine. The paramedic's job is to stabilize the patient as best as they can so they can be transported to definitive medical care, which is a physician.

Also remember, that a paramedics education, the entire year or two they spend in school, is DIRECTLY related to paramedicine. no electives, no making you a well rounded person, no courses just to give you a good background on things that are useful to know. the entire paramedic program is entirely devoted to what you need to know to be a paramedic.

As a side note, there is an Assoc Physician Asst Program, a Bachelors Physician Asst Program, and a Masters Physician Asst program, depending on what school you go to. After you complete all the programs (which ever one you get into), you still take the same PA-C test, and clinically you are considered a PA, regardless of the degree you have. just saying.

Back to your original question: am I against education? no. would I be against every medic needing a masters degree with the current system? yes. if the field changes, would the educational requirements need to change as well? absolutely.

Now, do I think that 120 hours is enough for an EMT class? yeah, I do. It's your baseline, the bare bones. you still should be taking PTHLS, ICS, PEPP, CBRNE, HazMat, and CPR, as well as refreshers, con ed on burns, psychs, strokes and other various topics to expand your knowledge. Plus, your agency should have their own in house training program so you can learn how they do things, and so you can gain experience. Remember, experience, especially when you do screw up, can be one of the most valuable tools in the medical field. and it's the EXACT same way in hospitals (why do you think they have big meetings where seasoned doc critique the actions of younger docs?).

Will it prepare you for everything? absolutely not. it s doctor who finishes med school, which culminates with 8 years of college education, ready for everything? absolutely not.

So am I against education? no. am I against artificially inflating the educational requirements when it won't benefit the patient? yep.

 

[Jeffrey_169]

Generally speaking, no. Then again, I don't think this discussion is about generalities... it's about medical science and the practical application/advancement of prehospital medicine as a profession.

If I may inquire... Bachelor of _____?



Do any of these degrees/disciplines have concentrations in chemistry, biology, physics? Are they educated... by all means yes, but they are at a considerable disadvantage when it comes to the practical application/understanding of emergency medicine (prehospital), as opposed to someone with an advanced degree in the health/medical related area of study.



Unfortunately, as we (myself included) are becoming painfully aware of, being a "medic" does not automatically equate to being adequately educated. Semantics not-withstanding, we can split hairs all day about what being "educated" actually means... but I think we all know what the bottom line is.

This is absolutely true. Level of education is important, and the relevance to the field being studied is also important. there are, however, other aspects to be considered as well. Just becasue someone is educated doesn't mean they are qualified of creditable. A pharmaceutical company conducted research into the effects of certain drugs on pediatric patients. The results were quickly contradicted by several studies which were instigated by the obvious conflict of interest. My point is when a study in conducted it must be scrutinized to gain creditability, the person(s) conducting the study must be educated in the field they are studying, and the results must be able to be repeated. Using one study to base all conclusions on is not only presumptuous, but dangerous.

One a separate note, just becasue someone is educated does not mean they have common sense or creditability. In such cases all you have is an educated dummy.

 

[DrParasite]

oh, and Veneficus, I am still waiting to hear what your formal education level is.

Alphatrauma, my degree is a Bachelor's of Science. coursework (including ones I have taken after I graduated) includes biology, chemistry, psychology, organic chemistry, some chaos theory, calculus, and most history courses than I care to admit.

Oh, and for the record, you can major in basket weaving and be premed, so what your degree is might not be the best line of thinking when determining what someone's science background is.

The only reason i mention the lawyer people is because someone said EMTs were uneducated. For some, this is their second career. they have knowledge far surpassing that of a medic. might not be field related, but in their industry, they are the expert. they value education, have gone to college, often grad school, so to accuse someone of being uneducated because they chose not to go to medic school and become a medic, or because they think the current standards are adequate. I would take an active EMT in a busy system who has done the job for 10 to 10 years over a medic who has had their card for less than 2. experience plays a big factor in education

 

[Veneficus]

in general? no. I think education is a good thing and you can never have too much education.

however, I don't think it's right to raise standards unnecessarily. The paramedic program, as it stands now, requires strict oversight, a medical director who approves every protocol, and a lot of cookbook medicine. The paramedic's job is to stabilize the patient as best as they can so they can be transported to definitive medical care, which is a physician.

Also remember, that a paramedics education, the entire year or two they spend in school, is DIRECTLY related to paramedicine. no electives, no making you a well rounded person, no courses just to give you a good background on things that are useful to know. the entire paramedic program is entirely devoted to what you need to know to be a paramedic.

As a side note, there is an Assoc Physician Asst Program, a Bachelors Physician Asst Program, and a Masters Physician Asst program, depending on what school you go to. After you complete all the programs (which ever one you get into), you still take the same PA-C test, and clinically you are considered a PA, regardless of the degree you have. just saying.

Back to your original question: am I against education? no. would I be against every medic needing a masters degree with the current system? yes. if the field changes, would the educational requirements need to change as well? absolutely.

Now, do I think that 120 hours is enough for an EMT class? yeah, I do. It's your baseline, the bare bones. you still should be taking PTHLS, ICS, PEPP, CBRNE, HazMat, and CPR, as well as refreshers, con ed on burns, psychs, strokes and other various topics to expand your knowledge. Plus, your agency should have their own in house training program so you can learn how they do things, and so you can gain experience. Remember, experience, especially when you do screw up, can be one of the most valuable tools in the medical field. and it's the EXACT same way in hospitals (why do you think they have big meetings where seasoned doc critique the actions of younger docs?).

Will it prepare you for everything? absolutely not. it s doctor who finishes med school, which culminates with 8 years of college education, ready for everything? absolutely not.

So am I against education? no. am I against artificially inflating the educational requirements when it won't benefit the patient? yep.

Interesting perspective.

I would like to ask how you determine that increasing educational requirements would not benefit the patient?

Also, do you think the field should change prior to needing a degree or after? If prior, how do you treat all the people currently in the field? Suddenly raise their scope and change responsibility with "good luck, figure it out?"

What a lot of people do not understand is that jobs where you don't need an education are decreasing both in number and in value. That is a trend that will continue as it has in all modern nations. With near 10% unemployment, it is just as easy to replace union workers with new people who would demand less. I think Regan made that point quite clear in the 80s.

 

[Veneficus]

oh, and Veneficus, I am still waiting to hear what your formal education level is.

As posted on my profile: MSIV, as in medical student 4th year.

I really don't like posting my resume or titles, but i broke down on this forum because I got tired of certain people thinking because I am also a medic that that was the limit of my education.

 

[JPINFV]

The only reason i mention the lawyer people is because someone said EMTs were uneducated. For some, this is their second career. they have knowledge far surpassing that of a medic. might not be field related, but in their industry, they are the expert. they value education, have gone to college, often grad school, so to accuse someone of being uneducated because they chose not to go to medic school and become a medic, or because they think the current standards are adequate. I would take an active EMT in a busy system who has done the job for 10 to 10 years over a medic who has had their card for less than 2. experience plays a big factor in education

Prior education means little if it's not in that field. Even a PA or NP who enters medical school still has to take all of the medical school courses at most schools. Even the schools that offer students the ability to test out of a course still requires their students to take their tests. Just because someone already took gross anatomy elsewhere doesn't mean that they get a pass on GA.

Then again, I guess I should be advocating myself to EMT-SB (EMT-Super Basic) since I'm a basic with a masters degree!

however, I don't think it's right to raise standards unnecessarily. The paramedic program, as it stands now, requires strict oversight, a medical director who approves every protocol, and a lot of cookbook medicine. The paramedic's job is to stabilize the patient as best as they can so they can be transported to definitive medical care, which is a physician.

If you want to change the system, you have to change the education requirements first, then the system. Otherwise it's like building a house first and then once the house is built, trying to build a foundation.

 

[Veneficus]

Just because someone already took gross anatomy elsewhere doesn't mean that they get a pass on GA.

Love your example, especially since I took it for undergrad and got to do it again in med school. But GA is much easier the second time around.

Then again, I guess I should be advocating myself to EMT-SB (EMT-Super Basic) since I'm a basic with a masters degree!

Especially if that is a biochemistry degree. People should get a special patch or something for that.

 

[fire_911medic]

I think education is a good thing and you can never have too much education.

Okay good, so glad we agree, now why are we having this debate?

however, I don't think it's right to raise standards unnecessarily. The paramedic program, as it stands now, requires strict oversight, a medical director who approves every protocol, and a lot of cookbook medicine. The paramedic's job is to stabilize the patient as best as they can so they can be transported to definitive medical care, which is a physician.

Yep, and a cookbook medic is worthless. Find a medic that can properly treat and assess a patient and then transfer that knowledge onto the receiving nurse or doctor and you've found one of quality. Also, not everybody functions as a cookbook fire medic. Some function quite independently in clinics with their own patient loads and things - I hardly find that to be cookbook medicine. And if it is - many of the patients forgot to read the instruction manual !

Also remember, that a paramedics education, the entire year or two they spend in school, is DIRECTLY related to paramedicine. no electives, no making you a well rounded person, no courses just to give you a good background on things that are useful to know. the entire paramedic program is entirely devoted to what you need to know to be a paramedic.

Darn, and here I thought my bachelors degree from a quality university in paramedic medicine was actually worth something. Guess I spent all that money for nothing - never mind it's left me with a nice job and I'm able to live off just one income. Wouldn't have had that opportunity without a degree.


So am I against education? no. am I against artificially inflating the educational requirements when it won't benefit the patient? yep.

Hmm, okay - so having a better understanding of how the body works, greater knowledge of diseases and how it affects the body along with more rounded people is going to negatively affect our profession? I'm sorry, but as painful as it was for other professions when they moved into requiring degrees, they saw great benefits. The problem is we are content with having less education than a mechanic ! Nothing is more complex than the human body and just like auto makers won't acknowledge backyard bob's mechanic work, doc's are going to acknowledge us as having the same standard until we step up and demand that respect. It's increased the pay and respect of other professions allowing for longevity in the careers. Saying that a basic doesn't need the indepth knowledge of how things function and 110-120 hours is adequate is like saying a PT - assistant (which is a two year degree) just needs to be taught how to do a few exercises and then turn them loose after all, they are functioning under a licensed physical therapist. You wouldn't think of doing that, but somehow we think that's adequate for basics.

I respectfully state I am forced to disagree for all the reasons highlighted above.

 

[rhan101277]

I think there are some terrible medics out there that make the good one's look bad to. It may not be their fault, maybe their educational program wasn't good. On a couple of my ambulance clinicals, the paramedic I rode with was very good. If he thought someone didn't need to go to the hospital, then he would say, I can take him if you want me to but he is breathing fine, vitals ok etc. That way we don't jam up the ER and its there for people that really need it. Some people call 911 out of loneliness or they forget to take their beta blockers and get worried when their BP goes to 228/90. You need to know enough to see past things that are non-emergent, do an accurate and detailed assessment and only transport people who really need it. Of course if they demand to go then so be it. Always make them sign a refusal though and give them good medical consultation.

Many paramedics I talk to say, "You don't want to be the paramedic that brings every call to the ER." Maybe sometime, when people obviously aren't in any need of emergency care, you develop rapport with the patient and explain you can take them if they want to go, but everything seems ok. I know its tough to do, but I guess only seasoned medics do this type stuff.