National EMS Scope of Practice Model Revision

[Medic27]

Normally basic airway management is included in the EMR class.

Oh, I was unaware. That's good to know, is o2 administration included or do they defer that to the EMT?

 

[EpiEMS]

Oh, I was unaware. That's good to know, is o2 administration included or do they defer that to the EMT?

By NRB & NC, definitely.

 

[Medic27]

By NRB & NC, definitely.

Great to know! I was unaware.

 

[VentMonkey]

@VentMonkey Including practical skills time, I don't think 80 hours is so crazy - but maybe it's more like 40-60? The educational guidelines for EMR go beyond a basic first aid class, at least, based on my experience with the AHA & Red Cross.

Right, but how proficient does an LEO, or even big city firefighter have to be in order to perform said skills in the few minutes it will take to wait for the medics and EMT's to arrive?

Why push for EMR, but not AEMT? To me, the only levels of certified prehospital providers needed are EMT and paramedic as it would appear all other providers (i.e., EMR, and AEMT) have become befuddled with no real applicable efficacy.

Most of what's been proven to prolong life is the very basics. Why else could one's life be prolonged by their own relative if said relative was taught proper CPR? None of this needs to be taught correctly, but then certified to death.

I am well aware of the educational advancements needed in our industry, and many of you know which side of this debate I am on. But, if we can't even figure out how or why we should be focusing on practical, and logical matters when talking specific certifications what's it matter?

EMR is like a pseudo-EMT. Hmmm, what's an AEMT to a paramedic??...

 

[Medic27]

Right, but how proficient does an LEO, or even big city firefighter have to be in order to perform said skills in the few minutes it will take to wait for the medics and EMT's to arrive?

Why push for EMR, but not AEMT? To me, the only levels of certified prehospital providers needed are EMT and paramedic as it would appear all other providers (i.e., EMR, and AEMT) have become befuddled with no real applicable efficacy.

Most of what's been proven to prolong life is the very basics. Why else could one's life be prolonged by their own relative if said relative was taught proper CPR? None of this needs to be taught correctly, but then certified to death.

I am well aware of the educational advancements needed in our industry, and many of you know which side of this debate I am on. But, if we can't even figure out how or why we should be focusing on practical, and logical matters when talking specific certifications what's it matter?

EMR is like a pseudo-EMT. Hmmm, what's an AEMT to a paramedic??...

The answer to your first question there are very rural sections in my state where it can take 40 minutes code 3 for ALS to arrive with only two EMR's in that city. That would depend on the need for population and EMTs/LE available. Where do you draw the line? It's hard. I don't think anyone can give a definitive answer.

 

[VentMonkey]

There are very rural sections in my state where it can take 40 minutes code 3 for ALS to arrive with only two EMR's in that city.

And there are some very strong opinions on this board about people living in very rural America. Use the search button, this is hardly a new topic.

 

[Medic27]

And there are some very strong opinions on this board about people living in very rural America. Use the search button, this is hardly a new topic.

I will sometime I am a little newer to the forum.

 

[DrParasite]

I understand this but I think the EMR cirriculum is an important role in terms of police officers or other civilians that don't want to take the next step into diving deeper. I think of police officers and city officials when I think of EMR. Do you disagree?

Until you get people like this https://emtlife.com/threads/emergency-medical-responder.46117/ who think EMR should be a certification that you should get paid to do....

 

[Medic27]

Until you get people like this https://emtlife.com/threads/emergency-medical-responder.46117/ who think EMR should be a certification that you should get paid to do....

That is so much BS I don't even wanna go into it... I think EMT basics hardly have a place, but they do in some areas. It is ridiculous to think an EMR would be paid, I don't know where that person found that idea but no... EMT/EMR for a baby sitter job to make them more prepared? Great idea, for a job as an "EMR", in itself? I don't think so. Like said it's literally a 40 hour course, EMT for me was 140. Take 4 weeks out of your life to take an EMT course and then go jump on a rig after passing the NREMT if you want to make a career out of EMS.

 

[VentMonkey]

That is so much BS I don't even wanna go into it... I think EMT basics hardly have a place, but they do in some areas. It is ridiculous to think an EMR would be paid, I don't know where that person found that idea but no... EMT/EMR for a baby sitter job to make them more prepared? Great idea, for a job as an "EMR", in itself? I don't think so. Like said it's literally a 40 hour course, EMT for me was 140. Take 4 weeks out of your life to take an EMT course and then go jump on a rig after passing the NREMT if you want to make a career out of EMS.

But you were just advocating for EMR?

Also, once our eldest daughter hits babysitting age I hardly find the need for her to have to become an EMR in order for my wife and I to feel safe leaving her alone with other little gremlins.

Common sense goes so much farther in life than any nifty rescue course, or cool patch. It is your reaction to life's curveballs that will show your "heroic worth", not a cert.

 

[Medic27]

But you were just advocating for EMR?

Also, once our eldest daughter hits babysitting age I hardly find the need for her to have to become an EMR in order for my wife and I to feel safe leaving her alone with other little gremlins.

Common sense goes so much farther in life than any nifty rescue course, or cool patch. It is your reaction to life's curveballs that show your "heroic worth", not a cert.

I think EMR's can serve a purpose alongside another speciality (police, wildland fire, swat, e.g.) , I definitely don't advocate for them getting paid for that alone. I absolutely agree with your last statement but if you are someone wanting to make a career owning your own daycare or watching children it would help install confidence in the parents. I don't know why would ever put EMR's on trucks they wouldn't know what to do with themselves. EMR is a separate entity from an EMT, the only real difference in 100 hours - 120 hours. If you want to be an EMT become one, move to Baton Rouge or anywhere basics are on hot demand and you will get a job. An EMR will not.

 

[VentMonkey]

If you are someone wanting to make a career owning your own daycare or watching children it would help install confidence in the parents.

It has had no bearing on which daycare my wife and I have chosen for our girls.

None of the daycares around us have EMR's working for them. I promise you none of the well-to-do parents I know care anything about this silly certification. The biggest word in any parents vocabulary with daycare is- trustworthiness.

 

[Summit]

First Responder (now called EMR) is a great level for those who don't provide patient care as their primary role. As I mentioned previously, most people take an AFA class because it is a faster or an EMT class so they can work in EMS.

What I tend to see is the Wildernest First Responder which is the FR content + wilderness care in about 80 hours. Some places do offer the WFR with the ability to sit for NR-EMR, but not many... there is just about no demand for the NREMT EMR cert. The certification granted by WFR education agencies (CMC, DMM, SOLO, WMI, WMA, etc) is considered good enough by agencies that utilize WFR.

Day care I expect to have first aid and CPR

 

[Medic27]

It has had no bearing on which daycare my wife and I have chosen for our girls.

None of the daycares around us have EMR's working for them. I promise you none of the well-to-do parents I know care anything about this silly certification. The biggest word in any parents vocabulary with daycare is- trustworthiness.

Alright well I guess we live on different sides of the Mississippi or something because I know several people with EMR's who are in child care or work in a school.

 

[EpiEMS]

Right, but how proficient does an LEO, or even big city firefighter have to be in order to perform said skills in the few minutes it will take to wait for the medics and EMT's to arrive?

As far as the basic skills, I would say they need to be fairly proficient. Think about BVM use - that's not an easy skill to master, but it is awfully helpful if you're ventilating an overdose. Having a certified level of proficiency helps HR departments, for one, but it also helps to ensure a baseline level of competence.

Why push for EMR, but not AEMT? To me, the only levels of certified prehospital providers needed are EMT and paramedic as it would appear all other providers (i.e., EMR, and AEMT) have become befuddled with no real applicable efficacy.

I'm actually a big fan of the AEMT concept - I think it ought to be our entry level transporting EMS provider, and also should be pushed for rural area services (career, volunteer, or hybrid). EMR is kind of like AEMT insofar as that it tries to bridge the gap (skill gap, availability gap, etc.).

Most of what's been proven to prolong life is the very basics. Why else could one's life be prolonged by their own relative if said relative was taught proper CPR? None of this needs to be taught correctly, but then certified to death.

I'm all for training people, but without an independent certification process, it's hard to verify competency.

 

[VentMonkey]

I'm all for training people, but without an independent certification process, it's hard to verify competency.

Because clearly we have done a stellar job eliminating incompetence from this field thus far?

 

[Medic27]

Because clearly we have done a stellar job eliminating incompetence from this field thus far?

I think we all know an EMT who shouldn't be an EMT, I know I have.

 

[VentMonkey]

I think we all know an EMT who shouldn't be an EMT, I know I have.

Right, or an EMR, medic, etc., etc., etc.

Verifying skills competency in a climate controlled environment from a sequentially drawn up sheet on a mannequin works just fine...until it doesn't.

If we, as a group, want to advocate AEMT being the minimum, then basics should go the way of the dinosaur, yes? Not have a revised set of national protocols.

All that's fine, but there really is no need for more than two prehospital provider levels, so long as they're truly designed to compliment one another and not stifle each other with overlapping skill sets, and knowledge.

Then again, illogically defining our profession based soley on the skills that each certificate possesses is also not a new concept to American prehospital providers.

It's hardly medicine in this sense, and predominantly ego.

 

[Medic27]

Right, or an EMR, medic, etc., etc., etc.

Verifying skills competency in a climate controlled environment from a sequentially drawn up sheet on a mannequin works just fine...until it doesn't.

If we, as a group, want to advocate AEMT being the minimum, then basics should go the way of the dinosaur, yes? Not have a revised set of national protocols.

All that's fine, but there really is no need for more than two prehospital provider levels, so long as they're truly designed to compliment one another and not stifle each other with overlapping skill sets, and knowledge.

Then again, illogically defining our profession based soley on the skills that each certificate possesses is also not a new concept to American prehospital providers.

It's hardly medicine in this sense, and predominantly ego.

Absolutely, I agree I just hope as an EMT I would be eligible to to advance to an AEMT with no cost.

 

[EpiEMS]

Because clearly we have done a stellar job eliminating incompetence from this field thus far?

Fair enough. Initial certification is a minimum level of competence, and competence has to be carefully evaluated in different contexts (agency FTOs, chart reviews, etc.). I don't think we can ever fully eliminate incompetent people in any field - but we certainly need to reduce the ability of our testing to monitor for incompetence.

If we, as a group, want to advocate AEMT being the minimum, then basics should go the way of the dinosaur, yes? Not have a revised set of national protocols.

Not necessarily -- it could just be used to raise the floor, as it were, if we ratchet up the standards. For example, we could say "Ok, now the baseline for first responders has to be the EMT level."

All that's fine, but there really is no need for more than two prehospital provider levels, so long as they're truly designed to compliment one another and not stifle each other with overlapping skill sets, and knowledge.

I don't disagree - but as our levels are designed now, EMT & paramedic are fundamentally different jobs, so I'm not sure that EMT & paramedic are the levels to keep, unless EMT is the first response (non-transport) level & paramedic is the only transporting level. (Perhaps keeping EMTs for IFT.)