Nationalization or federalization of EMS

[JJR512]

Would or could EMS be better if there was a national body that defined, refined, maintained, and enforced education standards, curricula, ambulance standards, and, possibly to some extent, some basic protocols or standing orders? The goal being that an EMT-B is an EMT-B no matter where he or she went to school. All EMT-Bs from any state or jurisdiction would get the same training and take the same test and be able to perform all the functions of an EMT-B in any state or jurisdiction and be able to work with other EMT-Bs from other jurisdictions just as easily as if they went to the same class together. Same thing for EMT-Ps, of course.

Now, here's the next part of my overall question. If you agree that there does need to be some kind of national body as mentioned, or even if you disagree a bit on the details and have some other ideas but still feel that, in principle, there needs to be a national body that oversees and unifies EMS, should this national body be an agency or bureau of some department of the US Federal Government, or can or should it be a private national association? If you choose that it should be a private national association, please describe how it would have the authority to enforce itself to all EMS agencies, both public and private, across the country.

 

[akflightmedic]

There have been interesting discussions elsewhere on the net in regards to this.

Here is a snippet of a proposal from an ERDoc who is very proactive in EMS education, standards, etc.

How about this for a solution (of course this plan only applys to the US, sorry to all of our foreign friends). Start out by making a college like the rest of medicine has. Let's call it the American College of Prehospital Medicine (ACPM), similar to the American College of Emergency Physicians (ACEP). Initially, to gain any strength or legitimacy this college would have to fall under the auspicies of a stronger, more established organization such as ACEP. They will set the standards as to what it takes to become board certified. Let's establish the requirements as:
1. obtain a bachelors degree in prehospital medicine from an accredited college/university (not Joe's Online College).
2. pass a written and oral exam

The requirements for the bachelors degree would be established by ACPM/ACEP and would obviously encompass necessary courses but at the same time the student would be required to meet the college/university's general education requirements. Those who have been working in the field would be allowed to be grandfathered in by a process to be determined by ACPM/ACEP but would include the written and oral board exams. The grandfather clause would be closed at a predetermined point in time.

So, now we have a bunch of college educated, board certified paramedics running around. How do we get the ambulance companies to hire them? Seems simple enough. We have ACPM/ACEP lobby congress to change the billing/fee process (all that money that I donate to ACEP/EMPAC might as well go somewhere). Make it mandatory for full payment that a pt be cared for by a board certified paramedic. Those that are not will only recover, say, 25-33% of what the board certified medic would recover. Set the payment schedule up similar to what we have in the ER. There would be certain levels of billing depending on the severity of the pt. No company would want to collect up to 75% less so they would be forced to hire the board certified medics. With the small supply of board certified medics the salary would go up. Given the current economic climate in the US, congress would love to be able to cut costs.

Eventually as it aged, ACPM would become an independent entity in the American Board of Medical Specialities. I've only given the topic a little thought, but it might work. I'd love to hear some feedback.

 

[VentMedic]

Here is a snippet of a proposal from an ERDoc who is very proactive in EMS education, standards, etc.

I wonder if he got the idea from the January 2009 newsletter for NAEMSP.

http://www.naemsp.org/documents/NAEMSPNewsJanuary09Final.pdf

Page 2, President's Corner.

 

[Veneficus]

As much as I would like to see it, there would be an explosion of "state's rights" issues for federalized paramedics.

 

[akflightmedic]

I don't know Vent. He posted that on Jan 13th on a diff site, you know the one.

Is he one in the same? It would be odd and out of character for him to poach and not credit the true source.

 

[Dobby]

Im hoping that this might be of some assistance maby you have something similar in th U.S.A mabey this would give some ideas or helpful tips.

Here in South Africa each and every person in the medical sector needs to be registered with the Health Proffesions Council of South Africa (HPCSA), nursing staff have a different council.

For further reference www.hpcsa.co.za

 

[VentMedic]

I don't know Vent. He posted that on Jan 13th on a diff site, you know the one.

Is he one in the same? It would be odd and out of character for him to poach and not credit the true source.

This article was for a sub-specialty for doctors but the concepts could easily be applied to Paramedics.

 

[WiFi_Cowgirl]

I think they should just leave it alone. I do sincerely believe that they could do worse. It is possible.. I also believe, that no matter how much it's debated. Nobody knows the correct answer to "fixing" EMS. From my view, how it affects me and the people I serve, it's perfect. Maybe bigger sirens.

 

[BossyCow]

We can't even get the ER docs within our region to come to consensus on this, how are we going to set a national standard that meets all the needs of the different types of agencies?

But, the feds have done such a great job with retirement, taxes, the environment and in regulating such industries as airlines, banking, securities.. what the hey... lets give 'em a shot at EMS!

 

[TheMowingMonk]

Personally I think it is a great idea. I feel medic should at least have a bachelors, its one of the first steps towards getting better pay and more respect in the field. Plus it is closer to expanding the scope for medics since if a bachelors is required you are more likely to get competent care givers rather then these guys who barely pass through a medic program then mess up some point after starting and get some skill or drug taken away from other medics. It would be a long process to do, but I think it is something that eventually will be absolutely necessary for the growth and success of the field. But I think the first step really should be just standardizing everything, if not on a national level at least at the state level. I feel that this county to county thing does nothing but hurt care and make it harder for care givers to move to different spots even within their own state since standards can very greatly from county to county, especially in places like here in California.

 

[lightsandsirens5]

We can't even get the ER docs within our region to come to consensus on this, how are we going to set a national standard that meets all the needs of the different types of agencies?

But, the feds have done such a great job with retirement, taxes, the environment and in regulating such industries as airlines, banking, securities.. what the hey... lets give 'em a shot at EMS!

I sincerely hope you are being sarcastic.:unsure:

I'm all for sticking with the county/state regulated method. The main reason being my county has one of the least resrtictive BLS protocols manual in the state of Washington. We can, in addition to O2, glucose, and activated charcoal, give ASA, Albuterol, and Epi (up to 2 Epi-Pens w/o pt perscription. More with Med Control.) Also, (I'm not sure if this is a state-wide thing or not) we give nine shocks to a pt with a shockable rythm.

Those are just some of the things we do that can't be done in the rest of the state, the reason being, there is no ALS service in this county (not even protocols!), ILS might be 45 min-1 hr away, and there are a ton of radio/cell phone dead spaces in our area, meaning we can't contact med. control or dispatch.

 

[lightsandsirens5]

Personally I think it is a great idea. I feel medic should at least have a bachelors, its one of the first steps towards getting better pay and more respect in the field. Plus it is closer to expanding the scope for medics since if a bachelors is required you are more likely to get competent care givers rather then these guys who barely pass through a medic program then mess up some point after starting and get some skill or drug taken away from other medics. It would be a long process to do, but I think it is something that eventually will be absolutely necessary for the growth and success of the field. But I think the first step really should be just standardizing everything, if not on a national level at least at the state level. I feel that this county to county thing does nothing but hurt care and make it harder for care givers to move to different spots even within their own state since standards can very greatly from county to county, especially in places like here in California.

By medic do you mean paramedic, or EMT in general? Dosent a paramedic already need a bachelors?

 

[NJN]

By medic do you mean paramedic, or EMT in general? Dosent a paramedic already need a bachelors?

Nope, Not even an AAS.

 

[JPINFV]

Nope, Not even an AAS.

Unless you live in Oregon. Heck, in Iowa you only need 280 hours to move from EMT-B to EMT-P.

 

[VentMedic]

I sincerely hope you are being sarcastic.:unsure:

I'm all for sticking with the county/state regulated method. The main reason being my county has one of the least resrtictive BLS protocols manual in the state of Washington. We can, in addition to O2, glucose, and activated charcoal, give ASA, Albuterol, and Epi (up to 2 Epi-Pens w/o pt perscription. More with Med Control.) Also, (I'm not sure if this is a state-wide thing or not) we give nine shocks to a pt with a shockable rythm.

Those are just some of the things we do that can't be done in the rest of the state, the reason being, there is no ALS service in this county (not even protocols!), ILS might be 45 min-1 hr away, and there are a ton of radio/cell phone dead spaces in our area, meaning we can't contact med. control or dispatch.

Here lies the problem. Some just count the number of skills they can do as a measure of their "professionalism".

Imagine where other professions would be if they had wasted as much time as EMS has just listing "skills".

Originally Posted by lightsandsirens5
By medic do you mean paramedic, or EMT in general? Dosent a paramedic already need a bachelors?

Education/training for the Paramedic in the U.S. varies from as little as 500 hours (clock not credit hours) to a 2 year degree. At this time, only one state that I am familiar with requires the 2 year degree.

I could elaborate also on the difference between training and education but that got a thread locked recently. Some just don't want to see the difference or have their "feel good" school of training compared to one that offers a higher standard for learning and education to go with all that training.

It is possible to have a national organization representing EMS, administering the tests and provide guidelines for each state to establish statutes with nationally recognized titles. Every other licensed profession has been able to do this regardless of where/who the healthcare professional works for. Even phlebotomists have now gone national and some states are liking what they see enough to require the same standards to be included in their own regulations.

 

[BossyCow]

I sincerely hope you are being sarcastic.:unsure:

I'm all for sticking with the county/state regulated method. The main reason being my county has one of the least resrtictive BLS protocols manual in the state of Washington. We can, in addition to O2, glucose, and activated charcoal, give ASA, Albuterol, and Epi (up to 2 Epi-Pens w/o pt perscription. More with Med Control.) Also, (I'm not sure if this is a state-wide thing or not) we give nine shocks to a pt with a shockable rythm.

Those are just some of the things we do that can't be done in the rest of the state, the reason being, there is no ALS service in this county (not even protocols!), ILS might be 45 min-1 hr away, and there are a ton of radio/cell phone dead spaces in our area, meaning we can't contact med. control or dispatch.

You and I are in the same state and apparently the same boat. The epi is state wide. Its the Kristine Kastner act and we not only can use Epi-pens but are required to carry them.

Which county are you in? You can PM me with it if you aren't comfortable posting it to the forum.

 

[lightsandsirens5]

Here lies the problem. Some just count the number of skills they can do as a measure of their "professionalism".

Imagine where other professions would be if they had wasted as much time as EMS has just listing "skills".

Well that is not exectly what I ment. I guess I thought we were discussing something else.

 

[lightsandsirens5]

You and I are in the same state and apparently the same boat. The epi is state wide. Its the Kristine Kastner act and we not only can use Epi-pens but are required to carry them.

Which county are you in? You can PM me with it if you aren't comfortable posting it to the forum.

Wasn't the Kristine Kastner act enacted after that girl died because BLS couldn't give her Epi and no ALS was available?

 

[jrm818]

Here lies the problem. Some just count the number of skills they can do as a measure of their "professionalism".

Imagine where other professions would be if they had wasted as much time as EMS has just listing "skills".

I'm all for increased education (the real, college-y kind) for paramedics in general, but I think in fairness L&S was pointing out that a national level regulation of EMS is rather one-size fits all approach for a very large country...and I think it's a fair point.

Extremely rural areas - it sounds like that's where he/she is - probably won't be well served by increasing the educational standards, and thus the expense, of paramedics, unless there is some way to improve access to ALS care in these areas. The cruel paradox is that where good paramedics would be most useful, outlying areas with very long transport times, also have very low call volumes and tend to have very restricted revenue streams to support ALS as it exists now, never mind a more expensive version. Urban areas with very short transports are much more likely to be able to provide 100% ALS coverage even now.

In these really rural areas many places would have no ALS. In such places other more local solutions to providing EMS need to be considered, and national plans are generally not good at dealing with regional differences.

I can think of a few solutions to this - possibly some sort of telemedicine program where lesser educated/volunteer EMT's are allowed expanded scopes of care under the direct supervision of a hospital based EM physician, or possibly the integration of ALS as a two-tier fly car system where the medics are based in the hospital as a tech (although this may well operate at a loss...the hospital near my family in Mass (admittedly a land unto itself, EMS wise) looses about 200k a year providing ALS to the neighboring towns...I'm guessing that is why this isn't seen more).

That said, I do like the idea of a "college" of EMS to control standards for paramedics and to require a 4 year degree, but I think more needs to be done to address the problem that the places with some of the greatest need have the worst access.

 

[lightsandsirens5]

I'm all for increased education (the real, college-y kind) for paramedics in general, but I think in fairness L&S was pointing out that a national level regulation of EMS is rather one-size fits all approach for a very large country...and I think it's a fair point.

Extremely rural areas - it sounds like that's where he/she is - probably won't be well served by increasing the educational standards, and thus the expense, of paramedics, unless there is some way to improve access to ALS care in these areas. The cruel paradox is that where good paramedics would be most useful, outlying areas with very long transport times, also have very low call volumes and tend to have very restricted revenue streams to support ALS as it exists now, never mind a more expensive version. Urban areas with very short transports are much more likely to be able to provide 100% ALS coverage even now.

In these really rural areas many places would have no ALS. In such places other more local solutions to providing EMS need to be considered, and national plans are generally not good at dealing with regional differences.

I can think of a few solutions to this - possibly some sort of telemedicine program where lesser educated/volunteer EMT's are allowed expanded scopes of care under the direct supervision of a hospital based EM physician, or possibly the integration of ALS as a two-tier fly car system where the medics are based in the hospital as a tech (although this may well operate at a loss...the hospital near my family in Mass (admittedly a land unto itself, EMS wise) looses about 200k a year providing ALS to the neighboring towns...I'm guessing that is why this isn't seen more).

That said, I do like the idea of a "college" of EMS to control standards for paramedics and to require a 4 year degree, but I think more needs to be done to address the problem that the places with some of the greatest need have the worst access.

Darn. I need to work on my "speaking"! This is exactly what I was trying to say.

National regulation would hit agencys with large areas of coverage, agencys in rural areas, and voulenteer agencys hardest. Taking into account that most agencys in rural areas do cover large areas and are voulenteer, they would be hit extra hard. That is the situation I am in and thus that is where my viewpoint is from.

So, is national regulation a good idea? In some cases, what could it hurt? But in other cases, it would be a very bad idea. So in the intrest of providing the best patient care possible to the people we serve, it is overall a bad idea to go national.