"Is Prehospital EMS (PHEMS) a Profession?"

mycrofft

mycrofft

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Taken from a definition of a profession by sociologists:

1. Professional association
2. Cognitive base
3. Institutionalized training
4. Licensing
5. Work autonomy
6. Colleague control... (and) code of ethics
7. High standards of professional and intellectual excellence
8. Occupation with special power and prestige
9. An exclusive elite group
10. Quality of detachment
11. Autonomy
12. Group allegiance
13. High degree of systematic knowledge
14. Strong community orientation and loyalty
15. Self-regulation
16. System of rewards defined and administered by the community of workers.
"The Rise of Professionalism: A Sociological Analysis" (Larson, et al). http://www.amazon.com/Rise-Professionalism-Sociological-Analysis/dp/0520039505

So how does PHEMS meet this checklist? IS it met in every state and county and EMSA?
 
1. Met by NAEMT
2. Yes
3. Yes.
4. Yes (even if it's called "certification" in some places).
5. Some places.
6. Depends. Some places the oversight agencies are run by EMS providers, and some places they're run by nurses.
7. No.
8. Yes.
9. No, but I don't think this one is relevant.
10. Huh?
11. Some places yes, but not in enough places. Even some places that seem to allow autonomy go on to provide cookbook protocols.
12. Somewhat.
13. I don't know if I would call it a "high degree" yet.
14. Yes.
15. See 6.
16. No.
 
No.

(perhaps the shortest reply I ever typed)
 
9. Exclusive elite group: regarded as more than a skill set and you can't become one just by passing a test or by decree (elite) and has concerns, dirty laundry and points all the members of the group can be proud of as a grow; and denied to others. ("Secret handshake", that stuff).

10. Quality of detachment: for PHEMS: practice and standards based upon research about and/or by PHEMS, and if someone else lodges a complaint or compliment, the group will decide if it is relevant, not a knee-jerk reaction. (i.e., if I complain about the counter person at Burger King she is likely to be fired; if I complain about an EMT, it will not result in a knee-jerk firing, have to be considered and weighed).

I think about nursing. Despite claims to be a "profession", and in some ares it is treated as such, it does not truly meet all these standards. Like the "Pirates' Law", it is more of a guideline than a hard and fast rule.
large_pirate.jpg
...yaaar.
 
mycrofft said:
9. Exclusive elite group: regarded as more than a skill set and you can't become one just by passing a test or by decree (elite) and has concerns, dirty laundry and points all the members of the group can be proud of as a grow; and denied to others. ("Secret handshake", that stuff).

10. Quality of detachment: for PHEMS: practice and standards based upon research about and/or by PHEMS, and if someone else lodges a complaint or compliment, the group will decide if it is relevant, not a knee-jerk reaction. (i.e., if I complain about the counter person at Burger King she is likely to be fired; if I complain about an EMT, it will not result in a knee-jerk firing, have to be considered and weighed).

I think about nursing. Despite claims to be a "profession", and in some ares it is treated as such, it does not truly meet all these standards. Like the "Pirates' Law", it is more of a guideline than a hard and fast rule.
large_pirate.jpg
...yaaar.
Click to expand...

Just out of curiosity which ones?
 
Nurses depend upon MD's for their protocols and have to have their work approved and signed off by physicians. For one. Or two.
 
mycrofft said:
Nurses depend upon MD's for their protocols and have to have their work approved and signed off by physicians. For one. Or two.
Click to expand...

You mean the medical treatment? However, all of their nursing care and theory has been developed by nurses.

edit: besides who is to say that Larson, et al is correct?
 
All nurse care is subject to medical control by a MD. If I screw up a vital sign or bandage change a MD can ream me out, or yell at my nursing boss, who then calls me in to pas it on. Can you see a nurse reaming out a surgeon for sending pt to his/her floor with a badly placed drain or a haemostat sticking out of their ear or whatnot?

Nursing protocols are required at least in Calif to be approved if not written by a MD. And "nursing care", as defined by nurses (and management), is less and less about bedside nursing.

Follow the money and follow the reamings.
 
Had a long post typed out in response and realized...some places meet this and some don't. Until all of us meet it we're probably not as "professional" as we like to potray.
 
silver said:
You mean the medical treatment? However, all of their nursing care and theory has been developed by nurses.
Click to expand...

Nursing theory and nursing diagnosis.

:rofl:
 
1. DBRD and Verdi
2. Yes
3. Yes
4. Yes
5. not everywhere
6. It is a question of how you look at it. When in doubt, the emergency physician decides everything for us.
7. Yes. We must learn very much for everything and get certificates. But despite all what we learn, are prohibited many measures, by the medical associations.
8. No
9. No, Rescue personnel has no lobby here
10. Many places working with a quality management system
11. No.
12. Group allegiance, there is here only in the fire brigade and volunteer civil protection/ EMS
13. Yes, I think.
14. No. Since everybody constantly fears for his job must have here is often bullying on the agenda.
15. Yes
16. No


* Offtopic *
The forum looks weird on my PC ...:unsure:
 
silver said:
At least they have there own academia, whereas EMS has "instructors."
Click to expand...

You don't see a legion of physician's assistant "academia", yet I don't see anyone arguing they're not a profession.

Nursing academia is what's responsible for such malarky as pneumonia being called "impaired respiratory gas exchange" and Jean Watson claiming "caring" is more important than the medical care delivered. Excuse me if I look at that part of nursing as a list of stuff we need to NOT do under any circumstances.
 
Last edited by a moderator:
usalsfyre said:
Had a long post typed out in response and realized...some places meet this and some don't. Until all of us meet it we're probably not as "professional" as we like to portray.
Click to expand...

This, pretty much says it all
 
Let me inject as we all know that some individuals conduct themselves as the epitome of professionals no matter what they are doing, while others ensconced in a "profession" are slugs. Hats off to the former.
 
Nursing theory and diagnoses...used more for teaching. If I were brought up for dismissal and cited one or the other versus hospital protocols, I'd be laughed all the way to my car with the cardboard box in my arms.

I bought my own copy of Marjory Gordon's Manual of Nursing Diagnosis (edition 1 if I recall) and used it to kerflubber my nursing clinical instructors who couldn't admit the real world trumped the school's philosophy.

NOW, that said, a bubble of nursing can form where an administrator who has a nursing background chooses to follow that philosophy in her span of control. However, that is pretty much a career killer if you want to advance. As I've commented a couple years ago, we need more people with backgrounds as EMT's (paramedic and basic etc etc) to go on, get educated, get promoted, then turn around and pay not back.
 
Being a fire medic is a profession, depending on where you work. As well as being a single role medic again depending on where you work.
 
It depends on the definition of a profession you use. Mycrofft has suggested one. But professions are characterized by a long period of formal learning, self-regulatory authority over the profession's members, and monopoly rights. So, for example, to be a lawyer you must attend law school, the Board of Bar Examiners and/or highest court of the state must license you, and practicing law without a license is a crime. Same for doctors - medical school, examination by the Board of Medical Examiners, and legal protection for their practice rights.

As a lawyer, I was taught by lawyers, tested by lawyers who reviewed both my subject matter knowledge and my moral character to practice. Lawyers determine my professional ethical responsibilities, and if I were to foul up, the discipline would be decided by lawyers. The law protects my monopoly as the holder of a plenary license to practice law - you can represent yourself, but you can't just go out and take clients on the courthouse steps. (Though that's a bad example, since I can't either, except in Washington D.C., and even there, it has to be across the street.)

EMS is not characterized by a length of training that would be equivalent to the three original learned professions (law, medicine, or the clergy). EMS credentialing is not necessarily in the hands of EMS practitioners. Only in the final point - legal protection and monopoly rights - is there some indicia of a profession. And while it's illegal to act as a paramedic without a license, it's also illegal to barber, or be an electrician or carpenter, without appropriate legal authority.

I'd say right now, EMS is more of a skilled trade. If it is to be more, it will require greater education, as well as EMS practitioners interested in becoming active in the political and regulatory aspects of their chosen career.
 
EMSLAW, I thought there was an older profession...
 
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