"Is Prehospital EMS (PHEMS) a Profession?"

[NomadicMedic]

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.

Eh, I think I'd disagree with this. Most firefighters I know consider themselves more along the line of tradesmen. Like carpenters or masons, they are well skilled in a complex task, but singular in function. I'd consider them to be classed between a laborer and a professional.

 

[46Young]

Is prehospital EMS a profession? That depends largely on the employer.

It's no wonder many who get into EMS thinking it's a profession come to the realization that it's not in most cases. It's not hard to see why when the employers require the bare minimum in education, offer low pay, poor working conditions, poor retirement, suspect job security, not much of a career ladder, "pulse and a patch" hiring standards, etc.

For every King Co. Medic One there's numerous undesireable employers. When looking at EMS globally as a profession, that's really poor odds.

Is prehospital EMS a profession? The high rate of turnover suggests not. I believe 7-10 years in the field before leaving is average, although I suspect it may be even lower.

 

[systemet]

No.

I have seen individuals act in a professional manner, but I've seen at least as many act unprofessionally, and sadly, perhaps more.

I think EMS has the potential to become a profession, but it's got a long way to go.

 

[St George]

Paramedics are considered healthcare professionals in the UK, however our equivilent EMT grades are not.

 

[downunderwunda]

Yes. Yes. Yes.

 

[RocketMedic]

Paramedics are considered healthcare professionals in the UK, however our equivilent EMT grades are not.

I've always wondered- what is the difference between an American paramedic and a UK paramedic? I met and spoke extensively with a friend of my instructor's who is a Scottish paramedic and he was very negative about the NHS and the UK way. He was really impressed with our pay here (apparently, after taxes, his wages are a pittance at best) and our scopes of practice. Apparently, although he is technically a "provider", his actual authorized scope is really, really limited.

 

[St George]

I've always wondered- what is the difference between an American paramedic and a UK paramedic? .

Im still learning exactly what an American paramedic actually is (and isnt). In the UK all paramedics must be state registered in a similar manner to an MD or RN. As such they can struck off for misconduct, and using the title "paramedic" without holding state registration is a crinimal offence. I wouldnt say their scope is limited - certainely medical direction does not exist in any shape or form over here, thus making our paramedics completely autonomous practitioners. The pay is extremely poor though, and this is a sad consequence of there being an excess of supply vs demand.

 

[Medic Tim]

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?

according to this . Yes EMS in NB is a profession.

 

[systemet]

I wouldnt say their scope is limited - certainely medical direction does not exist in any shape or form over here, thus making our paramedics completely autonomous practitioners.

You have guys in the UK running around giving tenecteplase, and there's no medical oversight at all? They don't send the 12-lead to a physician, and consult for risk stratification before pushing thrombolytics?

 

[St George]

You have guys in the UK running around giving tenecteplase, and there's no medical oversight at all? They don't send the 12-lead to a physician, and consult for risk stratification before pushing thrombolytics?

No there is no legal requirement to do this at all. In some areas, they can transmit ECG recordings to a local CCU for advice. But this will be at the discretion of the paramedic. In fact paramedics can give any drug listed here, without the need to discuss with an MD:
https://www.collegeofparamedics.co....n_medicines_pre-registered_student_paramedics

 

[systemet]

No there is no legal requirement to do this at all. In some areas, they can transmit ECG recordings to a local CCU for advice. But this will be at the discretion of the paramedic. In fact paramedics can give any drug listed here, without the need to discuss with an MD:
https://www.collegeofparamedics.co....n_medicines_pre-registered_student_paramedics

Interesting. This is one of the few things we always had to patch for.

Although that list suggests you might not be able to give plavix or enoxaparin?

 

[St George]

Enoxaparin = Heparin Sodium and that is on the list. Plavix (clopidogrel) is not widely used in the UK and its use in pre-hospital care not established. One thing though, we could never ever EVER use the word "Plavix"!!! Using brand names is a big no no in the UK.

 

[JPINFV]

Enoxaparin is a low molecular weight heparin, but it isn't heparin proper. There's more than a slight difference between the two.

 

[systemet]

Enoxaparin is a low molecular weight heparin, but it isn't heparin proper. There's more than a slight difference between the two.

It's nice from an EMS perspective as it's usually a single dose, and not an infusion.

(I'm know JPINFV is aware of this, but just for anyone's who's wondering. Sorry for the thread derail).

 

[JPINFV]

You also don't have to monitor labs with LMW heparin.

 

[R99]

No there is no legal requirement to do this at all. In some areas, they can transmit ECG recordings to a local CCU for advice. But this will be at the discretion of the paramedic. In fact paramedics can give any drug listed here, without the need to discuss with an MD:
https://www.collegeofparamedics.co....n_medicines_pre-registered_student_paramedics

That list is quite limited, we have some UK Paramedics here who say back in old country they could not pace, RSI, cardiovert, give IV adrenaline other than for cardiac arrest or sedate and are amazed at what we can do (shameless plug)

Our levels (for comparison)

Paramedic (UK Technician grade equivalent requires a Bachelors Degree)
LMA
Entonox
Paracetamol
Ondansetron
Adrenaline
Aspirin
GTN
Salbutamol
Ipatropium
Glucagon
IV glucose
Ceftriaxone
Midazolam
Morphine
Fentanyl
Normal saline
Loratadine
Amiodarone
Tourniquet
12 lead ECG interpretation
Cardioversion

Intensive Care Paramedic (UK Paramedic equivalent, requires a graduate degree ontop of bachelors)
Paramedic plus,
Intubation/RSI
Pacing
Ketamine
Adenosine
Atropine
IO access

 

[St George]

Hi. The list I posted is in addition to Schedule 7 emergency drugs (which includes many on your list above) and non-injectable drugs (such as entonox/GTN/salbutamol) are not restricted under UK law. Very interesting though - pacing and cardioversion are certainely not permitted, this is probably due to ambulance trusts introducing AEDs in place of manual defibs!

 

[RocketMedic]

An AED won't fix a problem that needs pacing or synchronized cardioversion...

 

[Veneficus]

An AED won't fix a problem that needs pacing or synchronized cardioversion...

An AED, not yet...

But I am sure somebody somewhere is working on an EMS model for basics or austere environments that will.

If the 12 lead can tell you the rhthym and that same monitor has a BF cuff and saturation monitor, it is not a large step in the software to pace and cardiovert.

Or even a device that can be put on by a basic that once the appropriate devices are connected is automated from there.

There are already implantable pacer/defibrillators, certainly an external model is possible.

 

[RocketMedic]

An AED, not yet...

But I am sure somebody somewhere is working on an EMS model for basics or austere environments that will.

If the 12 lead can tell you the rhthym and that same monitor has a BF cuff and saturation monitor, it is not a large step in the software to pace and cardiovert.

Or even a device that can be put on by a basic that once the appropriate devices are connected is automated from there.

There are already implantable pacer/defibrillators, certainly an external model is possible.

I have no doubts that the technology will rapidly advance, I was commenting more on the UK ambulance trusts not currently equipping them.