National Standards should all be the same across the Nation?

[medic417]

I dont want people here to get me wrong I believe in higher education lets make that really clear..... just because a medic doesnt have a "degree" as a paramedic or didnt get his from a "college" does not mean he/she does not have the skills set as the rest of you medics..... I am saying and please understand this while some of you have a degree for your paramedic or not, does that make you better than the ones that dont....but they are medics and fine ones at that,that dont have a degree. And when I made the statement that BACK IN THE DAY (PLEASE READ IT) I remember when you could get a medic certfication @ 410 hours and costed about $500.00 to get it. I was using as a reference as to back then compared to now is all that statement was. And I say again is 410 hours enough train NOW I say hell NO! Further more this thread turn into a nite mare how it got on this beyond me but it is here. I am sure everyone does a fine job at his or her skill set here on this forum you got what you got because you EARNED it and that is GREAT. What I am saying we have made it to where we cant recruit new MEDICS because of 1: cost 2: I have been told by some " if I spend that kind of money I should go be a RN" and that cool too... I am just also saying in my state West Virginia PEOPLE HERE DONT THINK LIKE the rest of us do.

Thanks to all thats commented on this.

Now I see the problem you are focusing on the skills not the education. Any monkey can be trained to do Paramedic skills but they can not be educated as to when and why they should be done. That is why so many services are mother may I or strictly algorithm services, never allowing the Paramedics to think for themselves.

 

[Sasha]

Thats what it is!

Then slow down! You turn a lot of people off your posts when they read like they were written by a 12 year old.

I do think degree medics are better because the required classes like College English and A&P, give the students a better foundation to be a better, well rounded medic.

 

[1badassEMT-I]

Now I see the problem you are focusing on the skills not the education. Any monkey can be trained to do Paramedic skills but they can not be educated as to when and why they should be done. That is why so many services are mother may I or strictly algorithm services, never allowing the Paramedics to think for themselves.

I refuse to go any further with this it is not worth it.... and for the record YOU GOT BE EDUCATED ON THE SKILLS SO YOU KNOW WHEN AND WHY AND WHERE TO DO THEM!!!!! DONE FINISHED!

 

[1badassEMT-I]

Then slow down! You turn a lot of people off your posts when they read like they were written by a 12 year old.

I do think degree medics are better because the required classes like College English and A&P, give the students a better foundation to be a better, well rounded medic.

And that maybe so!

 

[usalsfyre]

I refuse to go any further with this it is not worth it.... and for the record YOU GOT BE EDUCATED ON THE SKILLS SO YOU KNOW WHEN AND WHY AND WHERE TO DO THEM!!!!! DONE FINISHED!

Much better to be educated on physiology, pathophysiology, disease process, anatomy, chemistry, pharmacology ect, ect to know if a procedure or medication will be beneficial, useless or downright harmful in a paticular case. If you just learn to use a hammer, sooner or later everything looks like a nail.

You won't find the obsession with "skills" anywhere else in our healthcare system, and I think there's a reason for that.

 

[thegreypilgrim]

Well, looks like I joined this party a little late, but I'll chime in nevertheless.

I think the only way to truly unify EMS clinical and scope of practice standards to a national level is really to completely overhaul the system as it is. Just completely erase it and start over. All this DOT-Curriculum and NHTSA "Scope of Practice Model" and "Core Principles" stuff is really just kind of :censored::censored::censored::censored::censored:-footing around in my opinion.

What needs to happen is move the EMS regulation responsibilities at the federal level to the Department of Health and Human Services (HHS) rather than the DOT/NHTSA, and then stop trying to have the government control education standards and accreditation. That should be left to professional associations as it is with medical and nursing schools.

Paramedic education, then, should be shifted to the university system and the coursework should lead to a Bachelor of Science degree with a much longer internship phase. This would weed out all the Ricky Rescue types who want to spend the least amount of time in a classroom possible, and go right into "running code" (i.e. driving the ambulance real fast) and using all their Hollywood medic skills. Also, it would attract a different sort of person - someone who might have otherwise gone into research or nursing or perhaps even PA or medical school - with a more academic mindset and a mature enough mentality to grasp the gravity of what they'll be doing in their clinical practice as a medic. It will also make paramedics more valuable commodities and able to earn a decent salary because they would actually now have an educational foundation.

Finally, EMS needs to be removed from the auspices of fire departments and volunteer services and allowed to stand on its own. Just to show I'm not an "anti-fire" guy I also think private ambulance companies have no business doing it as long as they are a for-profit organization. EMS, therefore, should consist entirely of public 3rd Service agencies or NPOs. Once all that's done (not bloody likely to be any time soon) I think having nationwide clinical practice guidelines would be appropriate.

 

[1badassEMT-I]

Well, looks like I joined this party a little late, but I'll chime in nevertheless.

I think the only way to truly unify EMS clinical and scope of practice standards to a national level is really to completely overhaul the system as it is. Just completely erase it and start over. All this DOT-Curriculum and NHTSA "Scope of Practice Model" and "Core Principles" stuff is really just kind of :censored::censored::censored::censored::censored:-footing around in my opinion.

What needs to happen is move the EMS regulation responsibilities at the federal level to the Department of Health and Human Services (HHS) rather than the DOT/NHTSA, and then stop trying to have the government control education standards and accreditation. That should be left to professional associations as it is with medical and nursing schools.

Paramedic education, then, should be shifted to the university system and the coursework should lead to a Bachelor of Science degree with a much longer internship phase. This would weed out all the Ricky Rescue types who want to spend the least amount of time in a classroom possible, and go right into "running code" (i.e. driving the ambulance real fast) and using all their Hollywood medic skills. Also, it would attract a different sort of person - someone who might have otherwise gone into research or nursing or perhaps even PA or medical school - with a more academic mindset and a mature enough mentality to grasp the gravity of what they'll be doing in their clinical practice as a medic. It will also make paramedics more valuable commodities and able to earn a decent salary because they would actually now have an educational foundation.

Finally, EMS needs to be removed from the auspices of fire departments and volunteer services and allowed to stand on its own. Just to show I'm not an "anti-fire" guy I also think private ambulance companies have no business doing it as long as they are a for-profit organization. EMS, therefore, should consist entirely of public 3rd Service agencies or NPOs. Once all that's done (not bloody likely to be any time soon) I think having nationwide clinical practice guidelines would be appropriate.

It is a start and you have made the most sense out of all the the threads....Look I know I have no chance of the degree deal working out... I SURRENDER THAT BATTLE A FEW POST AGO! Whatever way it goes as far as education goes I am for it. But the system does need overhauled!!!! But how to get that started would take a act god for sure!

 

[John E]

John,

We do have a National Standard to become an EMT or Paramedic. Unfortunately it is a MINIMUM standard. A lot of states choose to stay at that minimum and that is the problem.

They will never be able to raise that Standard, because of the people that jump up whining about the higher education that would be needed.

I take your point but we don't really have national standards, we have a national registry which isn't recognized by all states. There will always be minimum levels of training and education, not everyone needs to be walking around with a PhD or a Masters degree. We just need to set the minimum level high enough that fewer idiots can work in the field. With that increased education should come better pay, more responsibility and more respect within the health care field.

I should have been clearer, what I'm suggesting is a nationally recognized level of training/education for EMT and for Paramedic which are agreed upon nationally. Not just a qualifying testing agency. For example, an EMT can perform procedures A,B, and C while the Paramedic can perform procedures A, B, C, as well as X, Y, and Z. The Paramedic level would be at the Associates Degree level at a minimum in my world by the way. EMTs would probably be at the 1 semester or 1 year of community college level of education. The specific details aren't that important as none of us are in a position to effect this sort of change anyway.

Once you've gotten your education you can be hired only at the level that you're trained at, no extra IV certs or whatever, if you wish to be allowed to perform more advanced procedures you have to continue your education to the Paramedic level. Then communities can decide what the health of their citizens is worth. If the public wants their EMS providers to be able to push drugs, read 12 lead EKGs, etc, then they'll have to pony up, if they're satisfied with advanced first aid providers with fewer treatments available to them, so be it. Since we're dreaming, I'd like to see even the basic EMT be trained/educated to a higher minimum level than is now the norm. Not just allowed to perform more skills. If it means that it's a 2 semester class or several classes all taken in one semester, so be it.

What we have now are states, counties and sometimes cities determining what level of training and what sort of procedures the various EMS providers will be performing, it's counter intuitive, it's wasteful and it's silly. A person living in a rural county should be treated by someone with the same level of training/education as the person living in the large urban city. The procedures allowed should be broad enough to deal with the wide range of available hospital care. It needn't be artificially dumbed down to suit the needs of a particular area or region or city.

I'd also get EMS out of the fire dept. I mean, since we're talking a fantasy world and all...

JohnE

 

[John E]

John it is not about what we get paid for.....it is about pt care.....

I have no idea what you mean by that. What is "about pt. care"?

EMS is job, a career for most of us who work in it. I don't work for free and I don't advocate anyone do either. Patient care is part of the entire EMS system, as are things like salaries, working conditions, equipment, vehicles, training, etc., etc. Obviously patient care rates very highly on the scale of importance, that's so obvious it needn't be stated.

John E

 

[reaper]

John,

What you think is fantasy is what should happen. It can happen when it is pushed in that direction. Nurses used to think it would never change and they made it happen. It takes time and small steps.

We do have a National training standard all ready. It is controlled by the DOT and it is a joke. What you are proposing is a national protocol. That will never happen until the education level is raised and mandated.

I am the first to hate Federal government running things. But, this is something that they need to control. We need a national standard and take control away from the states. Then we will not have this fractured system. Every state will work under the same standards and policies. We need two levels and no more. EMT would be entry level and Paramedic would be advanced level. No intermediate, no add on certs.

This would force the hold outs to come up to the standards. They would have no more excuses. Like you stated, the counties can decide if they want minimum care or advanced care. That would be the only choice they get to make.

All it takes is the professionals to fight for it.

 

[ExpatMedic0]

What we have now are states, counties and sometimes cities determining what level of training and what sort of procedures the various EMS providers will be performing, it's counter intuitive, it's wasteful and it's silly. A person living in a rural county should be treated by someone with the same level of training/education as the person living in the large urban city. The procedures allowed should be broad enough to deal with the wide range of available hospital care. It needn't be artificially dumbed down to suit the needs of a particular area or region or city.

I'd also get EMS out of the fire dept. I mean, since we're talking a fantasy world and all...

JohnE

Thats exactly what I was saying earlier in the post. I do not think anyone addressed my point(forgive me if I missed a post)

Do Nurses and RTT's face problems this big? They may have small scope of practice laws that vary from state to state, but nothing like we face that I am aware of.
For example are there any states that do not accept the NCLEX test from the NCSBN? Are there also any states, counties, city's or rural areas that have registered nurses that did not take the NCLEX or nursing program that did not need to meet the NCSBN OR NCLEX requirements? Does any licenced Registered Nurse from any state's training vary from 12 weeks in one state and 3 years in another state like our Paramedics?

 

[jjesusfreak01]

The idea that the DHHS would do a better job than any organization at anything amuses me...

 

[emt_irl]

Exactly, just like it is in many countries. Paramedics in Dublin vs Paramedics in rural areas, do they have any training or scope of practice differences?

A huge problem in the U.S. is you have firemen getting trained on a fire department in 12 weeks to be state certified Paramedics in Texas, and then you have Paramedics in Oregon taking almost 3 years of school with a minimum mandatory AAS or the option of bachelors in various subjects.

You do not have Registered Nurses and Respiratory Therapist getting trained in 12 weeks in Texas and having other states require a degree, while some offer a year of vocational training. There is a standard for them across the board.....
The NREMT is still a huge work in progress to help with these issues and the problem go's beyond them.

from coast to coast both north-south and east-west you will have the same level of training and professionalism. We all work under the 3rd edition clinical practice guidelines where are our protocols/guidelines to practice with our licence. the only different may be a younger paramedic may be able to lift the stretcher easier or do cpr longer then an old guy lol, also all our ambulances are the exact same also they are all cen compliant so everything is in the same place in the back(admitidly there are some older models still about and used as back up trucks when the main rig is gettin repaired)

 

[thegreypilgrim]

The idea that the DHHS would do a better job than any organization at anything amuses me...

That's nice. At least in that case, however, we'd have a healthcare service (which is what EMS is right? Or do you agree that we're just DOT materials handlers?) overseen and represented by a healthcare agency. Which would make sense right? What if instead of law enforcement being regulated at the federal level by the DOJ or Homeland Security (whatever it is) it wad regulated by the Department of Interior? That wouldn't make a whole lot of sense would it? I'm sure if that happened a bunch of odd and borderline nonsensical changes to how law enforcement is conducted across the country.

 

[jjesusfreak01]

The idea of DHS having control of state law enforcement is equally terrifying. It's the job of the states to mandate the level of care within that state. I'm all for national suggested guidelines, but in the end, every state also has the right to reject the out of state training for anyone if they don't think it's up to par.

Sure national would = a higher standard of care, but EMS is just not something that the Feds have jurisdiction over.

The DOT looked at a bad situation in our country gave a massive suggestion on how to fix it, which the states followed. I trust the DOT over other government agencies.

 

[reaper]

A majority of states have proved that they cannot handle the job. So yes, Federal over site and mandated training standards would be one thing that is needed.

No more state certs. Have a national cert that is good in all 50 states. Only two levels and required education!

 

[1badassEMT-I]

I have no idea what you mean by that. What is "about pt. care"?

EMS is job, a career for most of us who work in it. I don't work for free and I don't advocate anyone do either. Patient care is part of the entire EMS system, as are things like salaries, working conditions, equipment, vehicles, training, etc., etc. Obviously patient care rates very highly on the scale of importance, that's so obvious it needn't be stated.

John E

Patient Care

 

[Ridryder911]

Wow! What ignorance! One comes on here questioning why there is not this or that, then when appropriately stated the only way to correct is by doing the proven old fashion way : by proper education defends the old bull sh*t line of .."can't afford it"... or let's also place the old .. ".. don't have time".. crap. Really how bad do you want it and how dedicated are you? Can't afford it, do like every other professional has done.. get a student loan or part time job... Why do we think those in EMS should be exempt, really why are we so damn special?

Can't do it right then get the h*ll out! Really, not the top of your profession after 10 years then really how interested are you really in the profession? There are always excuses for not going forward, the main one is lack of persistence. Like your position, fine then don't gripe about it and on how to lower it to meet your standards instead of going forward as one should.

There are already National Standards set in place. Have been since the development of EMS. Again, research some history of EMS. However; protocols are a different thing. Protocols should be only used as guidelines. Cookbook medicine is dangerous, unethical and just provide poor care! Usually utilized due lack of education, liability for the service and economic reasons.The only reason most services utilizes them is due to the education level of their medics. Again, one of the reason medics are not respected as health care professionals is because they want to play the game without the responsibility of obtaining a proper education and formal clinical training. EMS is one of the only so called health profession that does not require academic higher level to enter the profession, and it shows.

Don't believe me? Look at the so called text book (yes book not books) that are written at a high school reading level... really? Our profession is taught with a textbook (single) ? Health care professional? Geez....

We require a kindergarten teacher to have a four year degree to teach Tommy to color within the lines and to learn ABC's ... but for someone to perform differential diagnosis, interpret ECG's, perform intubation and administer medications.. only require a GED and a one year vo-tech course? Do we not see some problems here? Really, one goes to school longer to become a beautician than a Paramedic in most states.

One of the acknowledged problems in EMS is that we already have too many titles and levels. That is why many states have abandon the Intermediate level and will continue do so. As the title inflicts: half-way... implying the ability to provide the "almost a Paramedic" but not quite the real thing when needed. Administrators love the economics of using such as cheap way to have ALS charges without the pay structure
Unfortunately, those that do not have a formal education do not understand skills are only that. They should only reflect the action(s) of the knowledge in intervention. A monkey could perform most the EMT's skills... understanding and interpreting the risks, involvement and potentials is another story. Treating patients is never black and white. If one thinks so, then they lack the knowledge of quality medical care. Each case is unique, each case should be treated accordingly and have latitude of what is best for that patient in the given circumstance. Is there generalized care? You bet! .... But alike treating headaches not all are treated with Tylenol nor should be. Treat patients not protocols.

Really want to do proper care, then do it properly. Suck it up, go to an accredited program that has high academia ratings and provide good clinical settings. Let's beef up our educational programs that require one to be able to read, write and have critical thinking skills before allowing entrance to them. Have a National Standard Test that actually can evaluate one's knowledge level based upon academia and as well practical testing based on critical thinking skills that demonstrate one's ability to think "outside" the box or standard protocols, as patients present in the real world.

When and IF we ever do this, then we will be able to have nationalized EMS standards..

R/r 911

 

[ExpatMedic0]

I get the overall point your trying to make but I am going to have to say that 2 of your statements are at least somewhat wrong

medics are not respected as health care professionals

I have to disagree with the above line. Majority of the public, registered nurses and docs that I encounter appear to respect myself and other Paramedics. I guess you cant win them all over though.

Don't believe me? Look at the so called text book (yes book not books) that are written at a high school reading level... really? Our profession is taught with a textbook (single) ? Health care professional? Geez....

Many schools are using the brady set for text now, which are several text books. Most schools also require additional text books like the duben, 12 lead the art of interpretation, and others. I had a huge stack of books.....

I can not speak for schools all over the U.S. just the ones in my area.

 

[thegreypilgrim]

I have to disagree with the above line. Majority of the public, registered nurses and docs that I encounter appear to respect myself and other Paramedics. I guess you cant win them all over though.

It's good to hear that at least in your area, paramedics enjoy some measure of respect among healthcare professionals. I wish I could say my experience was the same, but unfortunately it lines up more with what Rid was saying. Especially since I don't work for a fire department, but a private ambulance company there's even less respect in that I'm not perceived as a "real" paramedic. Nurses are the healthcare professionals we most commonly interact with, and they tend to save what little respect they have for EMS to the firefighter/paramedics they interact with (it must be those yellow pants). We hardly ever speak to physicians or have any sort of extended interaction with them.

Many schools are using the brady set for text now, which are several text books. Most schools also require additional text books like the duben, 12 lead the art of interpretation, and others. I had a huge stack of books.....

I can not speak for schools all over the U.S. just the ones in my area.

Mine was the same way. I had to use one of those wheeled luggage carriers to carry all the books we had to have. I'm sure some of the better schools in my area were similar, but we do have some notorious medic mill programs here (this is SoCal after all) which I would be very surprised if used any sort of standard, recognized textbook from a reputable publisher at all.

One of the local medic factories is known for having almost entire classes of firefighters intentionally fail out, so as to not have to become a medic. The students there are also rumored to circulate a something known as the "book of love" amongst themselves which is supposed to be a bound book full of captured exams with the correct answers filled in that the students all study from. What's incredibly frustrating is this is one of the primary training centers utilized by fire departments to cross-train their firefighters to paramedics. It's really no wonder then why the LA EMS system is broken beyond repair.