Problems with the EMS Training/Education system.

[jeepmedic]

Ok This is not a Flame throwing thread. I am just interested in what other providers see as the most common problems with the Training systems in EMS today.

As for me I think it is the diffrent ways you get you Cert. at diffrent areas of the country. I would like to see one standard system that all states have to abied by. The way it is now some states will honor other's Cert and then again others will not. I know we have NREMT but in reality what good is that? All it is a test, and a difffrent patch that you can brag on and wear. I understand that there are national standards for EMS but some states go by them and some do not. Some states make there requirments harder and others are easier. I would like to see one system of education not training. Make it a course of study not a class. This does not have to involve the college system but they have the infastructure there to implament it. Yes you can go to class one night a week and in 7 to 9 months you are an EMT-B I think this is great I even teach the class but I would like to see it exanded to a course of study not one class and bam you are an EMT. This is just my .02 worth.

Now Please do not start throwing the insults and flames to other levels of providers.

 

[trainSTAT]

I agree with you, but my perspective is that this problems basis is in politics. Government is constantly at war with who has the decision making power, and therefore money that goes along with it; federal, state, or local government. Since each state, and even each local government in some instances, ultimatly decide on the traning curriculum, it is difficult to get one governing body. I think that the National Curriculum initiative is a start, and hopefully we can get each state to agree to the requirements for certification of EMT's at various levels. If this gets put into place, then we can begin to look at accreditation standards, like those found between the Continuing Education Board for EMS (www.cecbems.org) and the NREMT program. That would then allow different training or learning organizations to innovate and create learning programs so long as they abide to the single curriculum and there would be no more intra state power struggle because an emt in PA and an EMT in CA would be certified at the same level under the same curriculum.

Now ask me about how I'd like to see that training offered - haha

just my 2 Cents as a provider. Oh, and as a provider, open conversations such as this one between providors and the field are critical.

Robert

 

[Stevo]

fair question to ponder Jeepmedic

iirc, the only reason the dot was picked to produce a cric was because it was funded

but now that ems is all grown up, with many seasoned participants it would seem a consortium of these sorts would be best to make the call

yet it seems i'm always reading about some trauma center study influencing what is done in the field, or the ever present influence of manufacture's with thier lastest mousetraps......with little rebuttal from the field save for the results of blind studies we are subjected to

perhaps it's better to ask what end result would be best for ems in general here.

myself i'd propose a more universal system also, in which it's participants can not only elect to advance, but also decide democratically on what said advancement should be. If one considers the state of the I-tech cert alone here this becomes appreciable. It's a mess imho.

however, once some sort of agreeable menu is implimented, i would ask that local medical directors be empowered to choose who does what and when.

This would be the best of both worlds imho, a universal menu subject to local scrutiny and discrimination (i'm sure you guys could forward your share of examples to this end)

~S~

 

[Ridryder911]

My personal opinion is that since we are a health profession and want to claim such, we should be obligated to meet those standards.

I agree EMS education is fragmented and poorly defined. For us to ever really change things, we will have to start from the top-down. As I addressed earlier, EMS Instructor programs are a farce. One only has to attend an 40 hr EMS instructor course in most states and teach a couple of classes.

I have attended and audited instructors (multiple states) at all levels that obviously did not know the material well enough to teach, mispronounced words, used improper grammar and spelling, as well basically gave false theories and misinformation. As well, ask instructors of the teaching theories and practicalities of adult education and the best way to present, test the students, write objectives and clinical performances they appear clueless.

For example look at education facilities that are accredited by the national accreditation of National Education facilites, and you will find very few EMS education areas meet and pass the criteria. Most schools offer "classes" not programs. Hard earned money pay for these "classes" only to recieve partial training, and many of the classes will never transfer to higher education courses.

I consult and advise many different education facilities from private, vocational, college and universities. They all fall into the same category. Pretesting of applicants should involve testing all students for :
Basic reading (at least 12-14'th grade level). proper English grammar and writing (few to minimal spelling and grammar errors), basic mathematics skills (minimal high school Algebra), Biology (at least high school level).
The reason is because students are failing.. failing hard and fast. Now, on top of that problem is our content is actually easier and yes.. gulp! many of the text(s) are categorized at grade school to junior high level science levels. This is not to be demeaning, just to wake up many whom do not know this. If I was a basic EMT, I would be upset that it continues to be this way!..

Let us find the weaknesses and correct those before pushing or even allowing students to go into advance areas and struggle and possibly fail.

This is obviously apparent when an instructor receives students from a basic EMT and attempts to advance them into higher level classes. They are not able to perform, or have extreme difficulties reading, low comprehension levels, unable to calculate IV drips (basic math skills), and they have no clue of basic science (cellular patho, pH, etc.) All in which is considered high school level.

The other platform is "training" versus " education". Sorry, there is a major difference. For example .. protocols are usually trained.. not educated. This is not demeaning, but should be endorsed by EMT's. Knowing multiple treatment modalities, the kinetics of how, why, and what is going on each treatment modality. Does this mean you won't follow policy..no, but you may offer another approach, suggest changes in protocols, consult with a physician on other options, and to do so.. one has to have formal education enough to be able to describe and paint a pertinent picture.

So... to end my big rant... Yes, basics should be taught well and introduced into EMS. There role should be limited and not expanded for more responsibilities, however should be more in depth of what responsibilities they already have.

Advance levels should be only taught at higher education facilities. Sorry, detailed anatomy and a separate physiology course should be required (you can't fix, what you don't know is broke) as well as complimentary courses such as psychology, English.. (sorry, you are based upon communication skills), and expectations of understanding of scientific methodologies.

We want to be treated as a professional, then we have to do as other professionals do.. (we are one of the few non-degree health care professions). Then we can progress, increase levels, and responsibilities, and hopefully pay.

Again, no flame towards any one or group..

R/r 911

 

[FFEMT1764]

Just my thought, lets make EMS education a complete national course, no variancies from state to state so that an EMT in ME and one in HI can do the same thing, period. And making these courses college level credit classes would be nice too. And making medics obtain at minimum and AS degree would be a good idea too.

Now, I think that in areas of the country where EMS providers are scarce the Fed's should pay for people to get the AS degree and their medics so people dont have huge student loans hanging over their heads.

Just my ideas, and we all know what ideas are worth.

 

[trainSTAT]

I have attended and audited instructors (multiple states) at all levels that obviously did not know the material well enough to teach, mispronounced words, used improper grammar and spelling, as well basically gave false theories and misinformation. As well, ask instructors of the teaching theories and practicalities of adult education and the best way to present, test the students, write objectives and clinical performances they appear clueless. R/r 911

Your point on the lack of uniformity of classroom instruction is one positive for a blended learning program. Here, you might receive your knowledge based info (disease, ops, etc) from a standardized online course and then go to a classroom for pull through and skills demo/practice.

The other platform is "training" versus " education". Sorry, there is a major difference. For example .. protocols are usually trained.. not educated. This is not demeaning, but should be endorsed by EMT's. Knowing multiple treatment modalities, the kinetics of how, why, and what is going on each treatment modality. Does this mean you won't follow policy..no, but you may offer another approach, suggest changes in protocols, consult with a physician on other options, and to do so.. one has to have formal education enough to be able to describe and paint a pertinent picture.


R/r 911

For this one I agree, but we have to be careful how we're using words. The word "Training" is under most instances a noun (at other times an adjective) http://dictionary.reference.com/browse/training . At no time should it be used as a verb like learning or educate. I disagree that protocols are trained, people are receive training so that they can be eductaed or learn the protocols. I think what you are trying to convey that there are different levels of cognative complexity, which I would agree. And there are appropriate methodologies to educate for the different levels of cognative complexity. (I have a graphic that depicts the very well which I can dig up for you).

Great conversation and I think it is healthy!

 

[trainSTAT]

Just my thought, lets make EMS education a complete national course, no variancies from state to state so that an EMT in ME and one in HI can do the same thing, period. And making these courses college level credit classes would be nice too. And making medics obtain at minimum and AS degree would be a good idea too.

Now, I think that in areas of the country where EMS providers are scarce the Fed's should pay for people to get the AS degree and their medics so people dont have huge student loans hanging over their heads.

Just my ideas, and we all know what ideas are worth.

I don't disagree with you so far ast he feds paying for it - but the chances are slim to none. It would be difficult for them to give more money to one state than to another as there are people in every state who cannot afford higher education. This is why student loans exist. Now, if you want to talk about medic salaries so that they can cover for the cost of the Associates, or even grants to allow EMT's to become medics and obtain their AS then thats great, but I think the deciding factor for these awards would need to be on something besides population.

My 2 cents

 

[Ridryder911]

Okay, let's look at another angle. Let's say for simplicity to play Devil's advocate ..

No.. slamming intended, but remember the best offense is knowing your defense.

For example:

1. If I was to propose to grant writers funding for education (which I know a few, that would ask 10,000 questions) Why should EMS personnel obtain grants .. over those that are in peace corps, cancer research.. again, grants compete with each other, so we have to come up with some logical facts.
Other health care professionals, take out student loans... if EMS is that important to potential EMT's .. why should we be partial to them?


2. In comparison of pay and education, the Basic EMT attends about the same length of training, as most Certified Nurses Aides, and the Paramedic that attends private or vocational has almost the same length of time as the LPN/LVN nurse equivalency..The pay then should be about the same ?.. If not, why?

Again, no rage.. just logically answer these. These are typical questions that is addressed when I attempt to get Fed. Grant writers and task committee ad-hoc committee to evaluate EMS pay.. etc. These are not as easy to answer as it seems, without anecdotal answers....


Let's see your answers....

R/r 911

 

[Stevo]

well Ryder, it would seem your entire focus comes down to respect and renumeration here.

you would like all EMT's to be respected as a profession, and paid as one. Somehow this alludes to better $$$ attracting better help, but can you honestly say this formula will work for ems?

out here in volly land we are content to help our nieghbors, we have the respect of our community, as well as the recieving facilities in doing so, and nobody i ever served with came in the door asking what s/he could assume for pay, in fact it has rarely even come into the picture

and inasmuch as we do have fancy dress uniforms , with all the bells and whistles, i have never heard any of my mates lament ems for being less than a profession, needing to be a profession, or sorely lacking some basic element we need to do what we do because some entity doesn't consider us one.

seems the source(s) i've heard from saying this are entities looking to feather their own little empires , more than help us out as a group. The issue of ems being health cares orphaned child comes into play more via who's responsible for us , than that of what sort of stature we can assume on our own doesn't it?

now i'm sure your farmiliar with the first responders in the world, iirc that's a 40 hr entry level course, very basic. we've convinced many a brother in blue or FF that s/he would be more help to us with those basics , which they are as they are often first on scene

40 hrs=doing patient care, and by god they're doing a very good job of it too, because it all starts out that basic....without them the continuity of care would not be what it is

do you honestly think our first responder contingent demands to be seen as a profession?

methinks the term profession is somewhat over rated and confused here....


~S~

 

[Fedmedic]

Very good post Stevo

I agree 100%

 

[trainSTAT]

I think that the discussion has started to take a turn, and that's a good thing. Getting at the question or issue behing the question or issue is important, but let's not miss the origional debate - Should EMS education be standardized, and if so how and by whom? Should government partner with the private sector? How does the experience of the field play into the conversation? We know how many decisions by the suits go...

 

[jeepmedic]

Now this is what I had in mind when this was started. Very good responses.

Now Stevo- You are correct. With the Volly side. Now one way I see to help with the Education and Volly system. Is to have a system like the Public Health Service incorpirate Paramedics. This way you could have your education paid for and have a job after your education is finised.

As far a Professional this is a state of mind. In order to be treated as a professional then you have to act professional. It matters not if you are a Volly or get a pay check for your services. The way you treat other health care providers is what will determine if you are a professional in there eyes.



Next. I had a conversion with someone that adminsters the State EMS test for Virginia last night. It was broght up about the education level of the test. I was told that the test was changed this year and it was upgraded from a 8th grade level and that the test scores went from an avg. of 92-95 to mid 80's. This is something that need to be addressed. Yes the test need to be up to a level so you can treat patients but you also need to educate this students up to this level.

Once again this thread is what I had hoped for when it was started. Thanks and keep the ideas coming. If we make enough postive noise then maybe we can change things for the positive.

Brian

 

[trainSTAT]

So the test was upgraded from 8th grade to what grade level?

 

[jeepmedic]

She didn't say. But it has cut down on the Passing rate.

Have you got approval for you classes through the Office of EMS here in Virginia?

 

[trainSTAT]

Based on our research, Virginia does not accept web based con-ed for CEU's. If you have information that is more current please let me know. We are accredited by the Continuing Education Certification Board for EMS (www.cecbems.org), which is automatically accepted by NR and many other states.

A list of the status of states accepting our training can be found at www.trainstat.com/trainstat/faq.aspx

 

[oldschoolmedic]

No Steve-O that is not what he is saying. Rid is trying to demonstrate how hard it is to justify what we are paid versus what we feel we deserve. If our entry level requirements match those of a CNA, why should we be compensated any more than they are? And if it only takes the educational equivalent of the LPN/LVN to be a paramedic why should we expect more?

Respect is not synonymous with renumeration, but with increased respect comes more pay. Which is harder, to hit a major league curveball, or to take apart a human being and put them back together fully functional? We don't begrudge the baseball player his millions, but howl if a surgeon makes it, why? We admire the player, but a physician is supposed to perform out of the goodness of his heart? Healthcare is a business, whether you want to believe it or not.

EMS where I currently work is four ALS trucks (two 12 hour only) and two QRVs(5 days a week) and a transport truck (5 days a week). As a system we run 5,000 call a year, have a small hospital in the county, with two trauma centers within 45 miles. There are seven volunteer rescue squads (3 solely BLS) within our county, and together they pick up about 750 calls a year. Sounds like pretty good coverage for a county of 35,000, doesn't it? Yeah the taxpayers love it, county council loves it, but there is a downside to it. If you are a frequent flyer, or they don't like you, or it's close to time to go to work, or it's a holiday, etc... they will not respond. That is why I want to get away from a volly approach. There are no repercussions for them failing to respond, hey they're volunteers, what are they gonna do? We get all of the excuses possible, they do the best they can, they do it for free, they do it for the good of the community, etc... It doesn't wash. At night if both EMS units are tied up and you're a frequent flyer who calls 911, you'd better be prepared to wait. While I am tied up on a call I have heard the tones drop five times for the squads without response, then dispatch is hollering for the EMS supervisor to ask him what to do. Does this sound like a train the wheels have come off of?

I used to work for a metro service which ran 50,000 a year, no rescue squads at all. It was paid and had the very highest standards. Those higher standards were used to justify the pay increases we received. You also made more if you held one of the EMS degrees, rather than a state or NR certification. They could justify it, so they did it. All calls were responded to with ALS trucks, anything requiring intubation automatically got you an additional paramedic. It was sweet. Of course, burnout was high because of the call volume.

Higher educational standards are the first step in taking this profession to the next level. Unification and standardization of testing bodies will follow. Another change will have to be nationwide uniformity of position descriptions and skill sets. Do away with emt-1,2,3,a,b,c,d, etc... But our first focus needs to be education. Recognizing there is a problem is the first step. Change is hard on people. No one wants to hear how uneducated they appear, but if you will read through some of the posts on this site, and truly look at them not for what they say, but how they say it, you will see what is being pointed out to everyone.

If we are going to be treated as anything more than "the ambulance guys" we need to start acting like more. Self-policing is the first step. We know what we expect from ourselves and others. Look at some of the flames on here, they show it. Why should we allow education, the easiest and most permanent thing, we can get stand in our way? Once you have it they can't take it away from you. The excuse offered in the past will hold no water in the courts of the future. The majority of monies paid out in EMS cases has little to do with substandard care, but more to do with substandard documentation. In these cases a little education would go a long way.

 

[Rockmedic]

For whatever its worth, I'll throw in my few cents. There needs to be only one standard which is followed, including education, requirements, Con-Ed, and protocols. An EMT is an EMT is an EMT; A Paramedic is a Paramedic is a Paramedic. My opinion would be to do away with EMT-I, increase A & P, riding time, airway management, and patient assessment in the EMT program- this would allow EMT's to do more. Those are my intitial thoughts, I'll chime in more after while.

 

[Guardian]

well Ryder, it would seem your entire focus comes down to respect and renumeration here.

you would like all EMT's to be respected as a profession, and paid as one. Somehow this alludes to better $$$ attracting better help, but can you honestly say this formula will work for ems?

out here in volly land we are content to help our nieghbors, we have the respect of our community, as well as the recieving facilities in doing so, and nobody i ever served with came in the door asking what s/he could assume for pay, in fact it has rarely even come into the picture

and inasmuch as we do have fancy dress uniforms , with all the bells and whistles, i have never heard any of my mates lament ems for being less than a profession, needing to be a profession, or sorely lacking some basic element we need to do what we do because some entity doesn't consider us one.

seems the source(s) i've heard from saying this are entities looking to feather their own little empires , more than help us out as a group. The issue of ems being health cares orphaned child comes into play more via who's responsible for us , than that of what sort of stature we can assume on our own doesn't it?

now i'm sure your farmiliar with the first responders in the world, iirc that's a 40 hr entry level course, very basic. we've convinced many a brother in blue or FF that s/he would be more help to us with those basics , which they are as they are often first on scene

40 hrs=doing patient care, and by god they're doing a very good job of it too, because it all starts out that basic....without them the continuity of care would not be what it is

do you honestly think our first responder contingent demands to be seen as a profession?

methinks the term profession is somewhat over rated and confused here....


~S~

Maybe I missed it but I don't remember reading anything about first responder's demanding to be seen as a profession. Most don't care because they already have a "real job" ie FF, Police, etc. Full time employed paramedics are demanding more however, I see and hear it all the time. Sadly, most go on to something else (ie FF, nursing, etc) because they don't think it will ever change. Better money does equal better help. Increased education standards equals better help. Of course volunteers don't care because they too already have "real jobs".

 

[Stevo]

Of course volunteers don't care because they too already have "real jobs".

This is one of many many volly's who 'has a real job' that does happen to care Guardian

who do you think pushed for new firehouses, new ambulances, better standards to start with here?

who do you think pushed for pilot programs, and ALS intercept?

we did....not big brother....not the selectboards, municipal managers, or small time mayors, not some ems agency....we did it

that said, if it's not broke we are not seeking to fix it. prove to me that it is, and i'll side with the group here.

now i just happen to be a big advocate of the first responder program because it allows people an introduction into ems to see if it's for them or not.

to date i've run two courses myself, and helped as assistant on a number of others.... not much to brag about, but i did see that we sparked the interest of many youngsters in our community who we took on our ride along program

one of my students who really liked ems recently earned her emt-p at Northeastern.

I've seen the advantages of education and enlightenment in ems, yet that said who has the riens of what we are and can do is a tedious thing...

and that, my friends, is the crux of the issue

~S~

 

[trauma1534]

Well... here goes my two cents worth, and I guess it will get me in trouble, but here goes.

The agancy where I spent many years as a volly before I bacame paid made a big mistake. Maybe this is not related directly to the education thing, but it is related to the volly thing.

That agency when I first went there only had two paid providers, Mon-Fri, 8-5. They were EMT-CT's if I remember correctly. One may have been a shock trauma at the time. At the time, we had approx. 100 members, who were actively pulling thier volunteer duty shifts. We had more volunteer ALS providers than any other volunteer agancy in the state. They were very picky as to who became members, and they had that right at the time.

The membership came up with this bright idea of hiring 24/7 staffing. They called it the "career support staff". They were to be there to run calls when the volly's were tied up, or when the BLS trucks needed ALS. We put on a 24/48 scheduled staff. And our problems were born, and that squad made in my opinion the biggest mistake of thier time. Our volunteer members started slacking off, because the career staff were there and being paid to run calls, and they were not. Some, not all of the career staff, got egos. It has evolved to a 24/72 schedule now, and they don't just have 2 paid on a shift, they now have 3. They have lost almost all of the original members, with the exception of about 3 or 4. The career staff is running the squad now, and volly's no longer are appreciated. They got more calls covered before they went to this system. They had better turn outs for squad functions, and our meetings were always full and running over. There was respect there for eachother and the senior members. If you were a rookie, you knew it. You did not do anything without permision from your shift leader. There was quality there when it was volly based.

I said all that to say this. I think where we had our down fall is when we tried to get fancy and have a full paid staff. Although I work now for a squad who is going to the 24/7 paid coverage, I don't like to see it, even if it means job security for me. It has taken one of the best, and biggest squads in our state down and down fast. Now, no one respects that squad anymore. Since they went all paid, they have ran off more good providers than they will ever see.

That is my opinion.

No, Fedmedic, not all of the career support staff was bad. It mainly got bad after the initial group started going thier seperate ways.