Opinion: Should states limit entry into EMT B/Paramedic courses?

[Bullets]

Must be an EMT for 3 years before you can apply to medic program.

Must pass a general intelligence test to enter EMT class, must get an 80% or better

Must get 80% or better on EMT certification test to get cert

Must pass general EMT test with 80% or better to enter Medic school

Must pass medic boards with 80% or better to get license

Deal with it

 

[WhiskeySix5]

I think Medic schools should have a prerequisite of working as an EMT for at least 6 months. .

I could not agree more, though I would say 12 months. I am amazed how many medic students we get for internship that do not know how to perform an assessment, or cannot communicate with a patient.

 

[Veneficus]

Should states limit EMT and Paramedic course entry?

Only Clergy, Lawyers, and Doctors decide who can be one of them.

EMS persons cannot.

However, why would it benefit the state to limit the numbers? If quality was the true measure instead of quantity, wouldn't it make more sense to raise standards?

Pretty much, anyone willing to pay can get into EMT B and Paramedic school. (obviously the school, states etc want the money). But this just FLOODS the job market and makes it extremely difficult for people to get hired.

You are right, and it is designed that way. It gives people the opportunity to change or train for a career quickly. That has its own financial benefits.

In the US the state does not have the responsibility of providing jobs. That has been tried a few times before with rather unpleasant and economically unsustainable results.

The role of the state is to provide opportunity. If you went to EMT school and passed, you have an opportunity to get an EMS job.

Your (in)ability to market yourself, provide a service worth more, distinguish yourself from your contemporaries, or move somewhere else for a job, is really of your making.

It is not the fault of other students, the state, immigrants, or any other bogeyman you want to attribute this to. The state owes you nothing.

In many EMT programs in CA, they have lowered the passing rate to 75%...and I know for a fact that at one junior college they lowered the acceptable passing rate to 69%!!!!!!!!!!!!!!!!!!! (I know because I was a volunteer instructor there, and I was against the policy)

So what? I have sat in classes much harder than paramedic class where passing was 44%. A grade of B was 49%, and you would be damn proud of a B in that class. Arbitrary percentages of passing mean nothing. You could know 100% of paramedic class and still know less than 1% of medicine.

Of course, as a "volunteer instructor" for a program that charges students tuition and I am willing to bet pays instructors, maybe you should ask for some money or quit doing work somebody else is being paid for for free.

To keep up your skills? You have no substantial skills.

If they did this, there would be fewer EMTs and PArmedics, thus giving those that do graduate from these courses a much better chance at finding employment. Unfortunately, most of my EMT and Paramedic friends/colleagues spend money, time and put forward many emotions to become an EMT or Paramedic yet they find NO JOBS!!!! HOW SAD.

Let me be the first to tell you, students do this with all sorts of degree programs every day. The limited amount of jobs is because of market forces. How many people with degrees in advanced basket weaving (or other liberal art) find themselves with a job that didn't require a degree or no job at all?

How many doctors are out of work? How many engineers?

True not everyone can get into those jobs, but the reason they are paid what they are with the opportunity they have is because they are extremely valuable to society. 150 hours (or less) of first aid training, well... not so much.

In fact I'll be willing to bet the 1500 hours of training barber isn't complaining there are too many barbers.

It is the responsibility of student to research their career choices. It is the responsibility of said student to have a plan or ability to market themselves to employers after they acheive thier academic goals.

Going to school gives the opportunity for a job, it does not promise one. Many paramedics and EMTs have an unrealistic expectation of the job market. It is not the responsibility of the State to make up for the FAILURE of the students to appreciate their prospects after school.

Why should The State be involved in covering for your failures and inability?

Should it be more like law enforcement? where you are only trained if they have decided to hire you (for the most part).

This is not a universally true statement. In many places you are free to pay to go to a Police academy. You will even graduate. You are not promised a job. There are plenty of these people working security jobs at the mall and other places.

Any ideas on how to fix current lack of employment in EMS?

Absolutely,

Join the rest of the civilized world and make working on an ambulance a 4 year degree to start. Not only will it raise the caliber of provider, it will eliminate everyone trying to do a quick career change to healthcare or try to get a job requiring just a few weeks of training and a high school diploma which is an absolutely useless minimum in most modern societies.

Actually on the topic, we could probably eliminate US high schools totally and just send people right to university. After all, the passing criteria for high school in the US no longer meets the needs of US society. (the quality is simply too low)

Remove EMS from the fire service, this will allow market forces to influence not only the amount of providers, since they still will likely not be paid the pay and benefits of a government worker, but increase pay and demand for those who provide a higher quality of service. (especially in California)

Students could figure out that just about every EMS training program grossly over charges. If you divide the cost of the average EMT+ Paramedic program and lost wages by the hours you will have to work to recoup those costs at current salaries, it likely is going to be years of life. (aka not worth the investment, because you could have gotten more valuable training or education in another field)

A higher educated provider can provide services other than a glorified taxi ride. Services that can be charged for and recouped to offset the loss of providing emergency transport. Of course then they would have to do more than "true emergencies."

You know why I get paid $50/hour to teach ACLS class?

Because I am worth it.

Use that same logic to figure out why you make what you do.

It is not the responsibility of The State, any state, to make up for the shortcomings of citizens who provide no value, or such little value they cannot attain the goals they desire.

While it is the responsibility of The State to provide assistance to its members who struggle to survive, there is a difference between surviving and having what you want.

Ask yourself: "Why do so many foreigners risk their lives to come to the US everyday and are happy earning wages so low US citizens would never consider working for such?"

Perhaps they have a more realistic understanding of what they are worth and the type of life that actually buys?

 

[mycrofft]

Bullets is pretty good above.
How about copying the nursing NCLEX model, including steps to cut out interference with test results to make all pass. *

Adult education generally (and I include the ARC) is turning into a travesty. California passed laws last yeare to help cut some of the worst offenders out but enforcement is lax and the measures weak.

Try this: classes only offered through community or state colleges or a private college meeting similar standards. Testing is uniform nationally and run by one company or government entity, and secured/audited by another. A track record kept at State level of certificate holders being fired for cause or other certificate-lifting offenses, and track kept of which school's graduates are being cited, or who do not pass the standardized testing to get certified; if their per capita failure/citation rate reaches 5%, they are put on probation.

The point isn't to artificailly restrict the supply of EMS workers, it is to assure the public that the ones reaching the job market are competent (in some cases literate) enough to do the job. If students want to learn to treat people at any level up to Wilderness EMT or Medical First Responder, they can go to Am Red Cross or a tech school or whatnot and get that certificate; however, they would not be hireable except at low level capabilities such as a pool or a school until/unless they transitioned into an accredited program (maybe be able to test/challenge some stuff), then certified.

One side effect should be that the plethora of confusing different names and micky mouse subdivisions of EMT would be pruned. If I was in Kentucky and needed an EMT-B, I could hire one from Calif. and be sure of what I was getting (the original intent), and not hear from all the EMT-I, IV, R, W, 1, 2, MSNBC's out there.

*NURSING: when Calif passed mandatory nurse staffing ratio (like that worked!), hospitals got involved with some schools and turned them into mills. Lowered passing rates and even re-taking the finals if they failed was justified partly on the basis of language skills. No idea what their NCLEX passage rates were.


PS: many replies occurred before I submitted this. I didn't address them.
So far.

 

[LifelongEMT]

I believe they should limit. Have the applicants take a pre exam to see what experience they have and how much they want to be there. I myself am a firefighter emt i had to pay my own way through all of it! and we had to do an application and write an essay about why we wanted to be ther then we had an interview and then found out if we made it into the course and had to maintain an 80 average or better to pass the course..

 

[Veneficus]

I believe they should limit. Have the applicants take a pre exam to see what experience they have and how much they want to be there.

So how do you grade a subjective exam?

What objectives could you possibly put on an exam to select people out of highschool?

I myself am a firefighter emt i had to pay my own way through all of it! and we had to do an application and write an essay about why we wanted to be ther then we had an interview and then found out if we made it into the course and had to maintain an 80 average or better to pass the course..

At the 2 places I taught at we stopped doing that.

First the spelling and grammar was painful.

Second, it is a complete waste of time to read dozens of "woe is me I had a hard life and want to help people" stories.

 

[STXmedic]

There sure seems to be a lot of entitlement associated with a 120hr tech course...

Should there be limitations put to entering into EMS training? Sure, by the means of increasing standards. Require more prerequisites prior to admission. Raise the standard of teaching and make the class work more in depth, instead of teaching the material as superficially as possible. Make it more difficult to get in and get through and you'll significantly decrease the number of people wanting to be EMTs, and increase the competency of providers.

As far as needing 1-3yrs EMT field experience before entering paramedic, that's ridiculous and pointless. I disagree 100%.

 

[Veneficus]

As far as needing 1-3yrs EMT field experience before entering paramedic, that's ridiculous and pointless. I disagree 100%.

You say it so much nicer than I do.

But I agree. It is an outdated industrial age labor mentality. It has no place in the modern world.

 

[Chief Complaint]

States dont need to have any control over the number of students.

Fire departments and EMS agencies control the numbers via the amount of job openings.

 

[mycrofft]

Nope. The number of trainees is governed by the number of classes and the number of potential customers in both the "total quality management" and the literal senses. There's been a glut of trainees and trained persons (says so right on this here piece of paper, "trained") ever since "EMERGENCY!" (Johnny and Roy on Squad 51) hit the TV. Just like every time they re-produce "101 Dalmations" there is a (temporary) blurp of Dalmations about.
Companies respond by hiring many part-timers; good for students and servicemen, not so good for people wanting to make a living at it.

 

[Veneficus]

You know...

I think we have been looking at this from the wrong angle.

Rather than attack the number of students, let's reduce the number of instructors by requiring a Master's or above to teach.

or at the very least, weeding out instructors who teach only the curriculum of:

"So there I was locked in an epic batlle with death to snatch another helpless victim from his jaws... When all of a sudden, in a moment of EMS zen, I provided a cookbook treatment which magically saved the patient's life and the day..."

Yes, I think we should start there by laughing at them at every opportunity, not inviting them to professional functions, cutting their pay to zero, and perhaps tearing their patches off in front of an honour guard.

Or students could just quit going to the schools they teach at...

 

[Bullets]

So how do you grade a subjective exam?

What objectives could you possibly put on an exam to select people out of highschool?

How do private highs schools select people? they use entrance exams...civil service exams, SATs, ACTs, there are plenty of employment entrance exams

If you want to get really crazy, EMTs should need an Associates degree or 60 credits at a 4 Year college. Medics 4 years Bachelors

In NJ cops are required to have a Associates or better, but i know thats not common south of the Mason-Dixon

 

[STXmedic]

How do private highs schools select people? they use entrance exams...civil service exams, SATs, ACTs, there are plenty of employment entrance exams

Those tests don't judge "experience", which is what he originally stated the purpose of the entrance exam should be. They test knowledge and comprehension.

If you want to get really crazy, EMTs should need an Associates degree or 60 credits at a 4 Year college. Medics 4 years Bachelors

Now you're talking! Glad to see we're on the same page!

 

[281mustang]

Obviously there is a problem with the flooded market, but the solution isn't to get the state/government involved(as it pretty much never is), but to increase the standards, which the NR is starting to get around to doing.

If you were to drastically increase the standards to something taking longer than a semester to break into the field, the flooded market would be no more. Not to mention it would weed out a good portion of the half-asses.

My neighbor is an 18 year old Freshman in college that's EMT certified. His EMT-B course was offered in high school for free to anyone eligable that thought it might be interesting to take. What does that say about our profession when an EMT course is a high schooler's 4th period class?

 

[Handsome Robb]

As far as needing 1-3yrs EMT field experience before entering paramedic, that's ridiculous and pointless. I disagree 100%.

I'm glad someone agrees with me. That's a ridiculous statement. Are nurses required to be LPNs for a certain amount of time before school? No. Are doctors required to be a mid level practitioner for a certain amount of time before school? No.

 

[STXmedic]

I'm glad someone agrees with me. That's a ridiculous statement. Are nurses required to be LPNs for a certain amount of time before school? No. Are doctors required to be a mid level practitioner for a certain amount of time before school? No.

To be fair, getting some EMT-B experience before going to paramedic could really solidify some of the core practices of medicine: High-flow NRBs for everybody, large blouses of diesel, delay transport so paramedics can meet you on scene, and of course, my personal favorite, Tredelenburg...

 

[Handsome Robb]

To be fair, getting some EMT-B experience before going to paramedic could really solidify some of the core practices of medicine: High-flow NRBs for everybody, large blouses of diesel, delay transport so paramedics can meet you on scene, and of course, my personal favorite, Tredelenburg...

That's how you save lives! Duh! :rofl:

Honestly the only thing I personally think helps is the operations experience. Not clinical experience, but that's just me.

 

[DrParasite]

To be fair, getting some EMT-B experience before going to paramedic could really solidify some of the core practices of medicine: High-flow NRBs for everybody, large blouses of diesel, delay transport so paramedics can meet you on scene, and of course, my personal favorite, Tredelenburg...

To be fair, when the education advocates (written by people with MD, DO, and PhD after their name) high flow NRB for everyone, and trendelenburg position, we well as backboarding any neck or back pain, can the provider really be faulted? and how can you practice large diesel boluses and delay transport so paramedics can meet you on scene? don't those practices oppose each other?

in 10 years, when ACLS is shown to not improve walking out of the hospital neurologically intact, and gets taken out of the protocol (since my former medical director is convince most of ACLS doesn't help save lives), will you be calling all the paramedics who followed ACLS protocols stupid?

 

[STXmedic]

To be fair, when the education advocates (written by people with MD, DO, and PhD after their name) high flow NRB for everyone, and trendelenburg position, we well as backboarding any neck or back pain, can the provider really be faulted? and how can you practice large diesel boluses and delay transport so paramedics can meet you on scene? don't those practices oppose each other?

Somebody looked a little too far into my post...

in 10 years, when ACLS is shown to not improve walking out of the hospital neurologically intact, and gets taken out of the protocol (since my former medical director is convince most of ACLS doesn't help save lives), will you be calling all the paramedics who followed ACLS protocols stupid?

If +10 years after that evidence is released, people are still performing practices proved detrimental, then yes. However, I am fairly certain that will not be the case. And if by some chance it is, I plan on being much further in my education and well out of EMS by then anyway

 

[DrParasite]

If +10 years after that evidence is released, people are still performing practices proved detrimental, then yes. However, I am fairly certain that will not be the case. And if by some chance it is, I plan on being much further in my education and well out of EMS by then anyway

you missed my point. the fact that the evidence proves the practices are detrimental is kinda inconsequential. stupid, yes, but not the point I was trying to make.

It's unfair to judge any group of people as stupid or wrong when they are only doing what they are taught by a higher medical authority, or by the course curriculum that is designed by more educated people. When they don't know better, and are taught the incorrect practices by more educated people, they can't be faulted for following their training.