Progression of EMS
- Thread starter VentMedic
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Ridryder911
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Well, Vent you are one of the few that can answer this as much anyone here.
I realize many do not care where EMS has been. I can understand that, but unless one realizes where you have been then you definitely cannot ever understand how you became as a profession where you are, or where you might go.
We became to we are by a strange group of people. In the 70's many post Vietnam era youth that had grown up under the influence of watching Emergency every week. Yes, I hate to admit it, but it was for not for that television show EMS would had never got off the ground. Uniquely, we had to struggle and fight just to be able to perform any tasks.
In the earlier days we always had to "justify" anything we did. I actually seen physical altercations, and poor behavior because everything we performed was belittled, scrutinized, and put down. As well, I had seen medics deliver a child, or treat a raped female, resuscitate a patient, only to be denied to even enter the ER. The nurse and physician would actually take the stretcher from the medic at the door and whisk it away, not allowing the medics past the door. Maybe, this is why we developed such a "cocky" attitude of why we have to feel we must act like there is a chip on our shoulders.
Fortunately, it was not much later in the 80's that those in field felt we must be recognized as a professional. Observing nursing and how they were previously treated, many endorsed collegiate level programs. It was at this time the NREMT finally developed the Paramedic level. Yes, until that time most Paramedics were authorized by local sources only. The 80's actually, was one of the best times for EMS. Special grants, and foundations had been started in the 70's was finally being spent for education and equipment. People entering the field were actually considering this occupation as a potential career. We were finally beginning to be recognized as a peer in the medical profession.
Alas, this would only last for a short period. Apparently, many did not want to continue the trend. Multiple levels were developed. Where small communities once had Paramedics, now cried that they could no longer afford such luxuries, as well as communities that once were progressing towards full ALS coverage now resorted to excusable levels such as the Intermediate or multiple developed levels in partial comparison to the Paramedic level. Part of the blame can be placed on the AED device. Albeit, it is a wonderful device, it was purchased by many communities with the false intentions that by having EMT/D's they would provide ALS similar to Paramedic care. Unfortunately, many EMS personal rather attend a week-end course than a two year Paramedic program, but portraying themselves as "delivering the same care" with the ability to "defib" someone if needed. Thus, the false presentations began, which still continues today with multiple levels.
We have seen EMS climb, then plateau out and now decline.
Other than a few skills such as twelve lead and CPAP, RSI there has not been much movement. Many now enter the EMS with NO intentions to ever work in this profession, thus having apathetic feelings on the longevity of this profession. Fire Departments that had earlier refused to participate in EMS activities now realize their profession is danger, see EMS as a "security blanket" for productivity, and public relations. Unfortunately, we have began to see that EMS again is at the bottom of the pole. These Fire Services are degrading EMS personal by only hiring them as "non-uniformed" thus; they do not obtain benefits, pay structure, etc.. however; may someday be able to be honored to be a "real firefighter" if they are real good... again the step-child syndrome.
So this lead us to today. We have a few that enter EMS for multiple reasons. Thus part of the problem. If one was to ask why they entered medicine, nursing, or any other health career, the general consensus would be to deliver patient care and to work in that profession by doing so. Unfortunately, not EMS. There are those in EMS because they had no choice. FD requiring them to participate, those that feel it can be used as a stepping stone, and those that performing in EMS makes them feel good about themselves and perform it as a charity, or community service.
There are very few that enter EMS to actually participate in direct patient care, that want to stay the longevity and participate in professional development. Not that there are not any... just are the minority.
EMS is one of the few health care professions that has to fight each other to progress. This is why other medical careers, scratch their head looking upon us. Where others rallied together and fought obstacles among the way, EMS continue to fight within each other. With the division of those that want to move forward and those that want to dilute and keep status quo. Excuses are generally made in comparison as to the location of geography (rural, urban, metro) to employment ( be it paid or volunteer). Thus again, those in the health career do not seem to understand. They realize it does not matter whom, where patient care is delivered there has to consistency with standards. That the respiratory therapist in a town of 5,000 is just as qualified as the ones in 500,000 and the RN working the rural clinic has the same level of entry education working in the Indian Reservation has the same degree as the one in downtown Chicago, the same based equal education. There cannot be multiple entry levels, everyone starts off on the same place, without professional standards and work the profession will NEVER advance.
So what now.. ?
Yes, I believe we will see a tear and a division in EMS. Unfortunately, FD and large corporations will be there to pick up the remains in attempt to control it. I do believe there has to be a final fight to see where we will go. The population that is becoming the consumers will have too much demand on the current system. Yes, volunteers will want to "hold on" but will have to let go due to the demand. Run volumes will be increasing by triple volumes, as well as the responsibility will be increased. It has to.
According to many world and national health organizations, there will not be enough hospital beds, ER facilities to ever meet the demands of the public. Look at the current trend, even within the past ten years. The population has increased more than the facilities that deliver the care. Yes, it is scary.. and yes it will be MUCH worse in the future.
So how will our role change...?
Either we will attempt for maintain as it is... (which will lead to failure), continue to dilute programs and produce EMT's by the hundreds of thousands that have no function or job, or we can look at our neighbors up north. View that they are placing the EMS personal more than in a transporting unit. Utilizing EMS as out of hospital treatment and delivery of care. Yes, our role will change, but it will have to, or we will be replaced. It is too costly for Medicare and other payers to continue paying for high dollar taxi rides.
The decision will be yours what the future of EMS will be like.. either be part of the change, or do nothing and see what comes along.
I realize many do not care where EMS has been. I can understand that, but unless one realizes where you have been then you definitely cannot ever understand how you became as a profession where you are, or where you might go.
We became to we are by a strange group of people. In the 70's many post Vietnam era youth that had grown up under the influence of watching Emergency every week. Yes, I hate to admit it, but it was for not for that television show EMS would had never got off the ground. Uniquely, we had to struggle and fight just to be able to perform any tasks.
In the earlier days we always had to "justify" anything we did. I actually seen physical altercations, and poor behavior because everything we performed was belittled, scrutinized, and put down. As well, I had seen medics deliver a child, or treat a raped female, resuscitate a patient, only to be denied to even enter the ER. The nurse and physician would actually take the stretcher from the medic at the door and whisk it away, not allowing the medics past the door. Maybe, this is why we developed such a "cocky" attitude of why we have to feel we must act like there is a chip on our shoulders.
Fortunately, it was not much later in the 80's that those in field felt we must be recognized as a professional. Observing nursing and how they were previously treated, many endorsed collegiate level programs. It was at this time the NREMT finally developed the Paramedic level. Yes, until that time most Paramedics were authorized by local sources only. The 80's actually, was one of the best times for EMS. Special grants, and foundations had been started in the 70's was finally being spent for education and equipment. People entering the field were actually considering this occupation as a potential career. We were finally beginning to be recognized as a peer in the medical profession.
Alas, this would only last for a short period. Apparently, many did not want to continue the trend. Multiple levels were developed. Where small communities once had Paramedics, now cried that they could no longer afford such luxuries, as well as communities that once were progressing towards full ALS coverage now resorted to excusable levels such as the Intermediate or multiple developed levels in partial comparison to the Paramedic level. Part of the blame can be placed on the AED device. Albeit, it is a wonderful device, it was purchased by many communities with the false intentions that by having EMT/D's they would provide ALS similar to Paramedic care. Unfortunately, many EMS personal rather attend a week-end course than a two year Paramedic program, but portraying themselves as "delivering the same care" with the ability to "defib" someone if needed. Thus, the false presentations began, which still continues today with multiple levels.
We have seen EMS climb, then plateau out and now decline.
Other than a few skills such as twelve lead and CPAP, RSI there has not been much movement. Many now enter the EMS with NO intentions to ever work in this profession, thus having apathetic feelings on the longevity of this profession. Fire Departments that had earlier refused to participate in EMS activities now realize their profession is danger, see EMS as a "security blanket" for productivity, and public relations. Unfortunately, we have began to see that EMS again is at the bottom of the pole. These Fire Services are degrading EMS personal by only hiring them as "non-uniformed" thus; they do not obtain benefits, pay structure, etc.. however; may someday be able to be honored to be a "real firefighter" if they are real good... again the step-child syndrome.
So this lead us to today. We have a few that enter EMS for multiple reasons. Thus part of the problem. If one was to ask why they entered medicine, nursing, or any other health career, the general consensus would be to deliver patient care and to work in that profession by doing so. Unfortunately, not EMS. There are those in EMS because they had no choice. FD requiring them to participate, those that feel it can be used as a stepping stone, and those that performing in EMS makes them feel good about themselves and perform it as a charity, or community service.
There are very few that enter EMS to actually participate in direct patient care, that want to stay the longevity and participate in professional development. Not that there are not any... just are the minority.
EMS is one of the few health care professions that has to fight each other to progress. This is why other medical careers, scratch their head looking upon us. Where others rallied together and fought obstacles among the way, EMS continue to fight within each other. With the division of those that want to move forward and those that want to dilute and keep status quo. Excuses are generally made in comparison as to the location of geography (rural, urban, metro) to employment ( be it paid or volunteer). Thus again, those in the health career do not seem to understand. They realize it does not matter whom, where patient care is delivered there has to consistency with standards. That the respiratory therapist in a town of 5,000 is just as qualified as the ones in 500,000 and the RN working the rural clinic has the same level of entry education working in the Indian Reservation has the same degree as the one in downtown Chicago, the same based equal education. There cannot be multiple entry levels, everyone starts off on the same place, without professional standards and work the profession will NEVER advance.
So what now.. ?
Yes, I believe we will see a tear and a division in EMS. Unfortunately, FD and large corporations will be there to pick up the remains in attempt to control it. I do believe there has to be a final fight to see where we will go. The population that is becoming the consumers will have too much demand on the current system. Yes, volunteers will want to "hold on" but will have to let go due to the demand. Run volumes will be increasing by triple volumes, as well as the responsibility will be increased. It has to.
According to many world and national health organizations, there will not be enough hospital beds, ER facilities to ever meet the demands of the public. Look at the current trend, even within the past ten years. The population has increased more than the facilities that deliver the care. Yes, it is scary.. and yes it will be MUCH worse in the future.
So how will our role change...?
Either we will attempt for maintain as it is... (which will lead to failure), continue to dilute programs and produce EMT's by the hundreds of thousands that have no function or job, or we can look at our neighbors up north. View that they are placing the EMS personal more than in a transporting unit. Utilizing EMS as out of hospital treatment and delivery of care. Yes, our role will change, but it will have to, or we will be replaced. It is too costly for Medicare and other payers to continue paying for high dollar taxi rides.
The decision will be yours what the future of EMS will be like.. either be part of the change, or do nothing and see what comes along.
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Wow, Rid... Tell us how you REALLY feel!
What is the NAEMSE proposal, anyway?
What is the NAEMSE proposal, anyway?
Ridryder911
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In general paraphrase to remove all the ABCDEFG and the other 132 acronyms after the EMT title. There would be an EMT Basic, Advanced EMT and then EMT Paramedic. That's it..
As well, as increase the hours required for each level and increase the anatomy and physiology in the Paramedic level. Of course, we know that this is desperately needed. A mere 120 hour course, is just past the advanced first aid level, and the Paramedic requirements are a sham.
Unfortunately, the ugly heads of lobby groups of the IAFC and Volunteer groups are beginning to object changes that might actually increase our professions knowledge... citing they would loose members, (oh well to he*l, with the patient, as long they feel good about themselves).
Here is the link to the site, review the changes. ( www.nemses.org - "right click on related docs" to view ).
It's time for EMS to grow up, if we don't do it ourselves, someone else will.
R/r 911
As well, as increase the hours required for each level and increase the anatomy and physiology in the Paramedic level. Of course, we know that this is desperately needed. A mere 120 hour course, is just past the advanced first aid level, and the Paramedic requirements are a sham.
Unfortunately, the ugly heads of lobby groups of the IAFC and Volunteer groups are beginning to object changes that might actually increase our professions knowledge... citing they would loose members, (oh well to he*l, with the patient, as long they feel good about themselves).
Here is the link to the site, review the changes. ( www.nemses.org - "right click on related docs" to view ).
It's time for EMS to grow up, if we don't do it ourselves, someone else will.
R/r 911
firecoins
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I would hope EMS is going to the closest approriate medical facility, wellness clinic or hospital.
Ridryder911
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Wellness clinic? What can they do? Most of them do not perform any major medications, or even IV's .. We are banned from transporting any patient to such, in actuality we do more for the patient than they do. They call us to treat emergency patients.
I am glad to see you acknowledged appropriate instead of just closest. This may mean bypassing two other hospitals while doing so, and increasing transportation time, but saving time in the long run.
R/r 911
Rid...while sometimes you come across as a rather pious and pompous medic, right now all I want to do is shake your hand. It is always very heartening to see other people out there acknowledge that EMS is in trouble and that changes need to be made. Thank you sir.
If nothing changes, in another 30 years, EMS will be almost unrecognizable to todays system. My guess would be that there would be some local areas that had well trained people and well run systems, but EMS on a national scale would be very scaled back, poorly trained, and not used in many areas. A big reason for this would be the complete lack of education and training that is required to become a nationally certified EMT, and way to many places base their programs on the national model. So, change the training requirements. The medic course should be a 2 year associates degree program (while some of the classes required are somewhat pointless, having a degree would help paramedics become more accepted into the "professional" medical world); no more 90 day wonders or shake and bake medics. This course would include an approximately 1000 hour medic course, full year of A&P, pharmacology course, medical terminology, biology, chemistry courses, psychology, hx of EMS, CISM, chart writing, and basic rescue courses plus whatever else was needed for a degree. And this should be the bare MINIMUM that all states are REQUIRED to follow. If they refuse, then the schools should not be accredited (which means that only accredited schools are allowed to train medics) and the people there would not be allowed to be called paramedics. For anyone out there that complains that this is to long...shut your mouth right now. Paramedicine has been around for about 30 years now, and that is way to long to be content with having the monkey skills without the knowledge to back it up. If you want to call yourself a professional EMT-Paramedic, then you need to be prepared to spend some time learning how to do it.
The same should apply for any lower levels of EMT. (for starters, there should only be 1 or maybe 2 lower; all the states with 4 different versions of an EMT-I...tough). The standards for education and training must be rigorously followed, and if that means that there will be rural areas that loose their "EMT-IV with meds and combitube and defib and...that's tough. The way to solve it would be...
Private ambulance services need to go away. It's been 30 years of the dash for the cash, and now it's time for something different. Begin a push (a very strong push) for third service EMS. Local gov't agencies (from city to county) should start being responsible for running an EMS program; in rural areas this would actually help as it would more than likely let them maintain some paid medics for the area. Get federal money out there when neccasary to help, and advance the use of fixed wing and helicopter transports for the very rural areas. It'll take time and money, but it can be done.
Volunteers need to stop wanting all the fancy toys and skills without the training. The arguement that they need them because of the distance to a hospital doesn't cut it. There are ways to get ALS units into the area, it'll just take work.
A national voice for EMS needs to be created; best way for that would be to have a union, either national or international that represents EMTS ONLY and isn't afraid to flex it's muscle. Unfortunately, this is a slow process that should have started decades ago but didn't (privates), and I can't say with a straight face that it's biggest competitor wouldn't be IAFF. (and private services, but we allready covered that) But, if the public was made aware, and I mean really made aware of how EMS works, and how it's supposed to work, a lot of support could be raised. That is one of the biggest issue; the public for the most part has no clue how EMS is run, what an EMT is, and what a paramedic is. That must change for any postive change to come about.
Now, some of this is sort of being done; I don't have a whole lot of faith in the new standards for paramedic, advanced EMT etc, because really, what has changed? EMS is no longer part of the DOT, but the skill set for the medic has gotten smaller if anything, the training requirements aren't that much improved, and states can still pretty much do what they want. Really, I think the single thing that would have the biggest impact would be having a national voice/union for EMS personell. When someone is willing to fight for you and can make good on any threats, things will get done in a much more timely fashion.
EMS is still a very young thing compared to the rest of the medical field, and I don't think it's bad that there are "growing pains." What is wrong is that people don't want to recognize the problems or do anything to fix them.
Edit: Forgot this part. The final testing that is done to certify people must be changed. A bigger emphasise needs to be placed on how the person performs in the oral stations and trauma/medical scenarios than on the skills they perform. (not to say that those should be rigourously tested) And the internship program needs to be a bit different as well; stop basing it on getting X calls in X area and XXX hours (normally 10 resp', 10 cardiac, 10 med, and 10 trauma and 200 hours minimum) and instead base it on if the person knows what they are doing and can function as a medic ALONE. There is something of a push to do that here, which I think is great, but the problem will be in finding enough preceptors that are really qualified to make that judgement. Still, it can, and should be done.
If nothing changes, in another 30 years, EMS will be almost unrecognizable to todays system. My guess would be that there would be some local areas that had well trained people and well run systems, but EMS on a national scale would be very scaled back, poorly trained, and not used in many areas. A big reason for this would be the complete lack of education and training that is required to become a nationally certified EMT, and way to many places base their programs on the national model. So, change the training requirements. The medic course should be a 2 year associates degree program (while some of the classes required are somewhat pointless, having a degree would help paramedics become more accepted into the "professional" medical world); no more 90 day wonders or shake and bake medics. This course would include an approximately 1000 hour medic course, full year of A&P, pharmacology course, medical terminology, biology, chemistry courses, psychology, hx of EMS, CISM, chart writing, and basic rescue courses plus whatever else was needed for a degree. And this should be the bare MINIMUM that all states are REQUIRED to follow. If they refuse, then the schools should not be accredited (which means that only accredited schools are allowed to train medics) and the people there would not be allowed to be called paramedics. For anyone out there that complains that this is to long...shut your mouth right now. Paramedicine has been around for about 30 years now, and that is way to long to be content with having the monkey skills without the knowledge to back it up. If you want to call yourself a professional EMT-Paramedic, then you need to be prepared to spend some time learning how to do it.
The same should apply for any lower levels of EMT. (for starters, there should only be 1 or maybe 2 lower; all the states with 4 different versions of an EMT-I...tough). The standards for education and training must be rigorously followed, and if that means that there will be rural areas that loose their "EMT-IV with meds and combitube and defib and...that's tough. The way to solve it would be...
Private ambulance services need to go away. It's been 30 years of the dash for the cash, and now it's time for something different. Begin a push (a very strong push) for third service EMS. Local gov't agencies (from city to county) should start being responsible for running an EMS program; in rural areas this would actually help as it would more than likely let them maintain some paid medics for the area. Get federal money out there when neccasary to help, and advance the use of fixed wing and helicopter transports for the very rural areas. It'll take time and money, but it can be done.
Volunteers need to stop wanting all the fancy toys and skills without the training. The arguement that they need them because of the distance to a hospital doesn't cut it. There are ways to get ALS units into the area, it'll just take work.
A national voice for EMS needs to be created; best way for that would be to have a union, either national or international that represents EMTS ONLY and isn't afraid to flex it's muscle. Unfortunately, this is a slow process that should have started decades ago but didn't (privates), and I can't say with a straight face that it's biggest competitor wouldn't be IAFF. (and private services, but we allready covered that) But, if the public was made aware, and I mean really made aware of how EMS works, and how it's supposed to work, a lot of support could be raised. That is one of the biggest issue; the public for the most part has no clue how EMS is run, what an EMT is, and what a paramedic is. That must change for any postive change to come about.
Now, some of this is sort of being done; I don't have a whole lot of faith in the new standards for paramedic, advanced EMT etc, because really, what has changed? EMS is no longer part of the DOT, but the skill set for the medic has gotten smaller if anything, the training requirements aren't that much improved, and states can still pretty much do what they want. Really, I think the single thing that would have the biggest impact would be having a national voice/union for EMS personell. When someone is willing to fight for you and can make good on any threats, things will get done in a much more timely fashion.
EMS is still a very young thing compared to the rest of the medical field, and I don't think it's bad that there are "growing pains." What is wrong is that people don't want to recognize the problems or do anything to fix them.
Edit: Forgot this part. The final testing that is done to certify people must be changed. A bigger emphasise needs to be placed on how the person performs in the oral stations and trauma/medical scenarios than on the skills they perform. (not to say that those should be rigourously tested) And the internship program needs to be a bit different as well; stop basing it on getting X calls in X area and XXX hours (normally 10 resp', 10 cardiac, 10 med, and 10 trauma and 200 hours minimum) and instead base it on if the person knows what they are doing and can function as a medic ALONE. There is something of a push to do that here, which I think is great, but the problem will be in finding enough preceptors that are really qualified to make that judgement. Still, it can, and should be done.
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firecoins
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don't take the wellness clinic too seriously. It was a joke. The OP was clearly not asking about the transport of patients. But yes appropriate medical facility. For some patients who seem to not understand the term emergency, a wellness clinic might be the appropriate facility.
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disassociative
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It's kind of funny that this topic showed up today, as I just completed a presentation in my communications class in regards to the ever-increasing role of emergency medical personnel in prehospital and post-hospital medicine.
The main focus was on how as a profession, we have moved from prehospital medicine into emergency departments, and even I.C.U.'s in some places.
I think, in order for us to grow as a profession; we must introduce a formal structure, as Rid said. We must implement a system in which the levels of the EMS provider are consolidated to one simple framework and the skills set forth for this framework are clearly defined.
We should really take notes from nursing in regards to how the profession has grown since the medicine of the World Wars and has adopted collegiate level credentialing in order to provide a more informed care with a multi-system approach to medicine. I believe the beginning of this process is currently taking place with degree programs in EMS. I feel in many ways, that the EMS provider should have the same basic curriculum as the nursing student, substituting the nursing core coursework with the paramedic curriculum.
This way the provider would be well versed in Anatomy & Physiology, Pathophysiology, Microbiology, as well as the over-all human condition as it relates to medicine and changes in the bodies homeostatic mechanisms.
In summation, I feel that formal education along with formal licensure and consolidation of EMS levels as a whole would prove beneficial to emergency medical services as a profession. Of course, this is just my opinion.
The main focus was on how as a profession, we have moved from prehospital medicine into emergency departments, and even I.C.U.'s in some places.
I think, in order for us to grow as a profession; we must introduce a formal structure, as Rid said. We must implement a system in which the levels of the EMS provider are consolidated to one simple framework and the skills set forth for this framework are clearly defined.
We should really take notes from nursing in regards to how the profession has grown since the medicine of the World Wars and has adopted collegiate level credentialing in order to provide a more informed care with a multi-system approach to medicine. I believe the beginning of this process is currently taking place with degree programs in EMS. I feel in many ways, that the EMS provider should have the same basic curriculum as the nursing student, substituting the nursing core coursework with the paramedic curriculum.
This way the provider would be well versed in Anatomy & Physiology, Pathophysiology, Microbiology, as well as the over-all human condition as it relates to medicine and changes in the bodies homeostatic mechanisms.
In summation, I feel that formal education along with formal licensure and consolidation of EMS levels as a whole would prove beneficial to emergency medical services as a profession. Of course, this is just my opinion.
The majority of the 2 year degrees for EMS were started prior to 1983. I graduated in 1979 while I believe Rid got his degree in EMS around that time also. Everybody was excited about the new "profession". Then the PDQ marts appeared fueled by the demand of both the students and employers for immediate satisfaction. It also allowed many people to enter the field that otherwise may have been weeded out or quit when they realized there's alittle more to EMS than lights and sirens.
It was disheartening to see people who strived to increase their education and make the field a profession be over shadowed by the skills jock who has little knowledge of the BASICS as Rid eloquently described in another thread. The BASICS are not to be confused with EMT skills.
Unions are also not the answer to representation. They will just bring another divide to the already divided and fragmented field. I still can not see how a group of people that work predominantly in prehospital (regardless of public or private) and have similar skills be in such disagreement about their future. While there is variance in education, it still comes down to approx 1000 hrs for paramedic and 120 for EMT. There lies the problem.
Unions are paid representatives that negotiate for many differents types of workers ranging from welders to paramedics. Many have no idea of what skills the "laborers" actually perform. They are just focused on contractual agreement. Many professionals chose not to belong to unions but rather build a strong professional national organization. This is what the allied health professions have done. Nurses also have some of the strongest national organizations.
Nurses do have unions in many states and they are strong. But, they are strictly unions for nurses. There is not another branch out of the same office for welders. Even then they have their problems especially on education issues. However, many of this country's nurses are not covered by a union. Some find more satification with the different clinical ladders available to them via education rather than senority. More hospitals are recognizing that pay for education is an incentive for retention of more motivated and educated employees.
More skill certifications should never have been used as the answer for a patch to a leaky state system. A solid foundation of education is necessary. The biggest difference between EMS and other healthcare professionals is the realization by the other professionals that more education was needed to perform their basic duties. Nurses and RTs especially saw that the techs (LVNs and Resp Tech) could not keep up with the changing patient environment and technology. They realized that a minimum of 2 years in basic health education was a must while months or years would be spent specializing in their chosen specialties after the college education finished. I still can not see how new parmedics are put in the field with little more than 2 weeks of being precepted.
People criticize Florida for allowing RNs (and just about everybody else) to challenge the EMT-P. More often than not, the RNs that do challenge the test are already involved in some aspect of transport. Some challenge it with the idea that it is not that hard. And, they are right, the written test is written in such a way that very few practitioners fail. The written tests are generally not very impressive in a field that promotes itself by skills.
It is just by the nature of the training that RNs and RTs do not accept assignments that they have not had an orientation to. At least with the PHRN certification, it is a training certification that comes with 80 - 130 hours of hands on skills as mandated by some of the states promoting this certification. This more hours than most EMS "skills" certification plus the nurse has a solid education foundation. It is not to replace the paramedic, but to meet a growing need to transport sicker patients to various facilities. Healthcare has created a distribution situation where hospitals owned by the same company must channel their resources to the most appropriate facility. It is not feasible to have a cath lab on every corner. The transfer liability is also enormous for any hospital.
While hospitals are supposed maintain ICUs, often times the company says only ICU can do CVVH or other advanced procedures. The patients requiring CVVH are very sick. I'm using this as an example because I just finished packaging a patient for transport to a sister hospital. The hospital sprung for another ICU nurse to accompany our dedicated Critical Care transport nurse (used a float or procedure nurse when not transporting) because of the ventilator and numerous med pumps. No matter how well the CC Paramedic perceives their introductory course prepared them for ICU transport it would be arrogant to get in over your head or expect an on the scene inservice at the hospital. This would also not instill much confidence in the transfer of care to someone that is supposed be an equal caregiver. Without some serious hands on training and knowledge of the ICU patient, it could be very easy to make a fatal mistake.
Will there be more paramedics in the hospital environment? Possibly. The ED is more of a reality now. Of course, then what would be the reasoning of "prehospital training" if you want to work in the hospital? To see it from the hospital's view as it stands now; they would be bringing back in the minimally educated technicians, regardless of your skills, that they thought they got rid of with the LVN and Resp Tech. There are many professionals around the ICUs now that can do all the "skills" a paramedic can plus they have the education and internships to back them up.
There are paramedics who have made critical care transport a reality, but they must have intense support from their medical directors for continuing education. The most successful have been part of flight medicine. But, the applicant process, as discussed in another thread, is intense. However, again, without a solid educational foundation, it is difficult to build in areas that require a mastering of the BASICS.
It was disheartening to see people who strived to increase their education and make the field a profession be over shadowed by the skills jock who has little knowledge of the BASICS as Rid eloquently described in another thread. The BASICS are not to be confused with EMT skills.
Unions are also not the answer to representation. They will just bring another divide to the already divided and fragmented field. I still can not see how a group of people that work predominantly in prehospital (regardless of public or private) and have similar skills be in such disagreement about their future. While there is variance in education, it still comes down to approx 1000 hrs for paramedic and 120 for EMT. There lies the problem.
Unions are paid representatives that negotiate for many differents types of workers ranging from welders to paramedics. Many have no idea of what skills the "laborers" actually perform. They are just focused on contractual agreement. Many professionals chose not to belong to unions but rather build a strong professional national organization. This is what the allied health professions have done. Nurses also have some of the strongest national organizations.
Nurses do have unions in many states and they are strong. But, they are strictly unions for nurses. There is not another branch out of the same office for welders. Even then they have their problems especially on education issues. However, many of this country's nurses are not covered by a union. Some find more satification with the different clinical ladders available to them via education rather than senority. More hospitals are recognizing that pay for education is an incentive for retention of more motivated and educated employees.
More skill certifications should never have been used as the answer for a patch to a leaky state system. A solid foundation of education is necessary. The biggest difference between EMS and other healthcare professionals is the realization by the other professionals that more education was needed to perform their basic duties. Nurses and RTs especially saw that the techs (LVNs and Resp Tech) could not keep up with the changing patient environment and technology. They realized that a minimum of 2 years in basic health education was a must while months or years would be spent specializing in their chosen specialties after the college education finished. I still can not see how new parmedics are put in the field with little more than 2 weeks of being precepted.
People criticize Florida for allowing RNs (and just about everybody else) to challenge the EMT-P. More often than not, the RNs that do challenge the test are already involved in some aspect of transport. Some challenge it with the idea that it is not that hard. And, they are right, the written test is written in such a way that very few practitioners fail. The written tests are generally not very impressive in a field that promotes itself by skills.
It is just by the nature of the training that RNs and RTs do not accept assignments that they have not had an orientation to. At least with the PHRN certification, it is a training certification that comes with 80 - 130 hours of hands on skills as mandated by some of the states promoting this certification. This more hours than most EMS "skills" certification plus the nurse has a solid education foundation. It is not to replace the paramedic, but to meet a growing need to transport sicker patients to various facilities. Healthcare has created a distribution situation where hospitals owned by the same company must channel their resources to the most appropriate facility. It is not feasible to have a cath lab on every corner. The transfer liability is also enormous for any hospital.
While hospitals are supposed maintain ICUs, often times the company says only ICU can do CVVH or other advanced procedures. The patients requiring CVVH are very sick. I'm using this as an example because I just finished packaging a patient for transport to a sister hospital. The hospital sprung for another ICU nurse to accompany our dedicated Critical Care transport nurse (used a float or procedure nurse when not transporting) because of the ventilator and numerous med pumps. No matter how well the CC Paramedic perceives their introductory course prepared them for ICU transport it would be arrogant to get in over your head or expect an on the scene inservice at the hospital. This would also not instill much confidence in the transfer of care to someone that is supposed be an equal caregiver. Without some serious hands on training and knowledge of the ICU patient, it could be very easy to make a fatal mistake.
Will there be more paramedics in the hospital environment? Possibly. The ED is more of a reality now. Of course, then what would be the reasoning of "prehospital training" if you want to work in the hospital? To see it from the hospital's view as it stands now; they would be bringing back in the minimally educated technicians, regardless of your skills, that they thought they got rid of with the LVN and Resp Tech. There are many professionals around the ICUs now that can do all the "skills" a paramedic can plus they have the education and internships to back them up.
There are paramedics who have made critical care transport a reality, but they must have intense support from their medical directors for continuing education. The most successful have been part of flight medicine. But, the applicant process, as discussed in another thread, is intense. However, again, without a solid educational foundation, it is difficult to build in areas that require a mastering of the BASICS.
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reaper
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I agree with everyone that we need better education in the paramedic field. The one thing I do not agree with is the comparison to RN's, like they are the top of the line. I have been around RN's my whole life. Mother,sisters,wife, and in laws, All RN's. There are great RN's and :censored::censored::censored::censored:ty RN's. Not all RN programs are BSN. Most are two year programs. They do require more prereq's, Which I think medics should have too.
My point is that a good percentage of RN's out there are not that great and some are down right a disgrace to the system. Does this mean that all RN's should now have MSN to do their job. ICU RN's are a top notch group,(I know, my wife is one) but they are a select few.
So yes, let's fight for better education in EMS, but stop comparing us to RN's. That is apples to oranges. ICU RN's may know our skills, but very few use them or are proficient in them. So lets keep this education deal about ems. That is the only way we will ever project ems to the future.
My point is that a good percentage of RN's out there are not that great and some are down right a disgrace to the system. Does this mean that all RN's should now have MSN to do their job. ICU RN's are a top notch group,(I know, my wife is one) but they are a select few.
So yes, let's fight for better education in EMS, but stop comparing us to RN's. That is apples to oranges. ICU RN's may know our skills, but very few use them or are proficient in them. So lets keep this education deal about ems. That is the only way we will ever project ems to the future.
The same could be said for many in the EMS profession.
Actually there are many hospitals that do prefer the BSN as well as professions such as Public Health. The BSN will eventually be a reality for nursing licenses. They are finding it hard to be now considered the lesser of the entry level degrees in the hospital. See where I'm going with this? I could compare EMS to just about any health care professional ( or just about any other profession including welders) that saw a need to keep up in education to provide better health care for the patient as a whole.
I was astonished to learn of the education levels and certifications as well as continuing education that our hospital maintenance workers must have. Yeah, I could compare the 90 day Medic Mart wonders that "fix" patients to them also.
I am not comparing EMS to Nursing. Rather, I am stating how the changing patient environment and technology has opened up a need for highly educated and skilled practitioners.
And actually, the nurses that do Critical Care transport in the facilities that I a personally familar with are very proficient with intubation, central lines, defib/cardioversion and numerous medications as well as being very capable of autonomy. They have proven this both inside and outside of the hospital. These nurses participate in both ground and flight. The hospital is their lab. They must do a mandatory set amount of procedures each month to stay an active member. They, too, must pass several verbal tests and observation in the Critical Care situations by the Medical Directors before even being invited to apply for the team. This standard is not heard of in EMS.
Maybe it is a comparison in the fact that we no longer monitor the skills or knowledge of our EMS crews until some article is published and then everyone is shocked at the findings. Intubation is one such topic that is controversial. Why? Because, as a whole EMS has failed to set standards to police themselves. EMS has continued to lower the bar to allow lower credentialed people the privilege of intubating.
As EMS has already proven, skills can be taught to just about anyone. So, why not teach them to nurses who have already have a strong educational background?
If the paramedic had some resemblance of a national educational standard then there may not be any discussion or question about how to bring them into other patient care areas. The question might be "when can they start to work?."
Of course, there will be exceptions and there are some fantastic professional EMS providers out there and some very proficient systems. But, given as a whole, there's a lot of work to be done.
I'm curious why someone would say that a national/international union for EMS providers would be detrimental to it. A union that only represents a certain type of job and is willing to go to bat for them and has the clout to do it...that's bad because...why? A national organization with a backbone would be great too, but so far we don't have that today. About the closest there is is NAEMT which get's about zip done. Really, both would be very helpful in the future of EMS, but a union would have the advantage of being able to be more involved with contracts, ie getting medic's and EMT's paid appropriate wages. I'm at a loss why you would think that this is a bad thing. Look at IAFF (union) and NFPA (national organization); both have done very good things for the fire service. Why is it wrong to want the same for EMS? Of course getting these going would be a long, slow process that should have started long ago, but it's not to late.
Since you brought it up in this thread as well, my problem with Florida isn't RN's challenging to get their paramedic cert (as long as the process is run well I'm ok with it) but with the whole idea of a "pre-hospital registered nurse." Now, like I've allready said, a nurse from an ICU or other specialty unit is probably better suited to run an interfacility transfer with a pt from that unit than a medic, and I think that is a perfectly acceptable use for RN's. (this isn't to say that medic's (in some areas I suppose) can't be used for the same role or won't be able to provide adequate care, but, admittedly, there will be a difference in knowledge when it comes to some meds/equipment, so an RN who's familair with those AND the pt is probably better) But, with this being the case, where is the need for a PHRN certification? Why not just use an ICU, or Critical Care or whatever the name happens to be nurse with more autonomous protocolls? Pre-hospital means just that; care given BEFORE reaching a hospital, all this sounds like is a backdoor way for RN's to get on an ambulance as RN's and not paramedics. I've allready said why this is a bad idea so I won't go into that here, but I will say this again: I can see why this could be an attractive option for some places with the state that some areas EMS system is in. But, that is exactly the kind of situation that we should be working to prevent by increasing the education and training of EMT and medics and increasing understanding of EMS. Those of us who are medics should not be advocating for another group to step in to do our job, we should be advocating to change things so that is not needed. I hate repeating myself.
Oh, and you may want to always remember that your system is not everyone's system; requirements for specialty RN's in your area are not the requirements for specialty RN's somewhere else. (and yeah, that goes for me too)
I'm kind of at a loss here. You really don't think very highly of EMS anymore do you? That's fine, you've moved on, but like I've said, this is where you started...why not try and improve the system instead of looking to take it down?
Since you brought it up in this thread as well, my problem with Florida isn't RN's challenging to get their paramedic cert (as long as the process is run well I'm ok with it) but with the whole idea of a "pre-hospital registered nurse." Now, like I've allready said, a nurse from an ICU or other specialty unit is probably better suited to run an interfacility transfer with a pt from that unit than a medic, and I think that is a perfectly acceptable use for RN's. (this isn't to say that medic's (in some areas I suppose) can't be used for the same role or won't be able to provide adequate care, but, admittedly, there will be a difference in knowledge when it comes to some meds/equipment, so an RN who's familair with those AND the pt is probably better) But, with this being the case, where is the need for a PHRN certification? Why not just use an ICU, or Critical Care or whatever the name happens to be nurse with more autonomous protocolls? Pre-hospital means just that; care given BEFORE reaching a hospital, all this sounds like is a backdoor way for RN's to get on an ambulance as RN's and not paramedics. I've allready said why this is a bad idea so I won't go into that here, but I will say this again: I can see why this could be an attractive option for some places with the state that some areas EMS system is in. But, that is exactly the kind of situation that we should be working to prevent by increasing the education and training of EMT and medics and increasing understanding of EMS. Those of us who are medics should not be advocating for another group to step in to do our job, we should be advocating to change things so that is not needed. I hate repeating myself.
Oh, and you may want to always remember that your system is not everyone's system; requirements for specialty RN's in your area are not the requirements for specialty RN's somewhere else. (and yeah, that goes for me too)
I'm kind of at a loss here. You really don't think very highly of EMS anymore do you? That's fine, you've moved on, but like I've said, this is where you started...why not try and improve the system instead of looking to take it down?
reaper
Working Bum
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Very well stated Triemal04!
Vent,
I agree with you on all you are saying about the need for better education. I just hate seeing EMS compared to nursing. Yes, they both have the same problems, but we need to find our own fix for EMS. Every time this is brought up someone starts comparing us to RN's. What if a lay person is reading these. They say well if EMS has problems and nursing is so great, then lets just put RN's on the ambulance. This is one thing I do not want. I am a medic, I have no desire to be a nurse or a firefighter.
Ems has a lot of things that need fixed. Like you said, until we get the masses on one page, where do we start. I agree that a union is not the answer. They have been around and get nothing done for EMS. Like you said, we need a national org. that will get it done at the legislative level. I heard a supervisor of one place say that unions didn't scare them. What leverage did they have. They could not strike, it was illegal. So they had no leverage. The bean counters could not fight it, if it came from the legislative level.
So lets keep up the fight for improvements, but lets keep it geared toward EMS.
Vent,
I agree with you on all you are saying about the need for better education. I just hate seeing EMS compared to nursing. Yes, they both have the same problems, but we need to find our own fix for EMS. Every time this is brought up someone starts comparing us to RN's. What if a lay person is reading these. They say well if EMS has problems and nursing is so great, then lets just put RN's on the ambulance. This is one thing I do not want. I am a medic, I have no desire to be a nurse or a firefighter.
Ems has a lot of things that need fixed. Like you said, until we get the masses on one page, where do we start. I agree that a union is not the answer. They have been around and get nothing done for EMS. Like you said, we need a national org. that will get it done at the legislative level. I heard a supervisor of one place say that unions didn't scare them. What leverage did they have. They could not strike, it was illegal. So they had no leverage. The bean counters could not fight it, if it came from the legislative level.
So lets keep up the fight for improvements, but lets keep it geared toward EMS.
No disrespect to your personally triemal04, but you must look at 50 states and healthcare as it has evolved in legislative issues. EMS has isolated itself by saying "it's different". "We're not like them." But if you are about patient care, then you must include your position in the bigger scheme of things. It's time stop blaming FF, nurses and John Q Public who can't tell an EMT or Paramedic by the way they walk. Paramedics say they want to work inside the hosptials yet don't want to be compared to nurses. "We are prehospital". You can't have it both ways unless you understand the roles. Are you in or out. If you're in, well too bad because your job description may overlap with other professionals. If you are basing your argument purely on the skills you can do, the profession with the most education along with those skills will win out.
I guess you haven't read my posts closely. I haven't moved on entirely. I am still active in HEMS. I've just broaden my opportunities to better keep up my skills and knowledge. My RT job definitely has added a level of education, skills and autonomy that being a Paramedic didn't in many ways. My co-workers who are nurses and I both do this inside of the hospital. I recognized my paramedic training was going to limit what I could do even with the A.A.S. in EMS. As I said, I have watched my education take a slap by co-workers who were just happy to have the 6 month certificate. I chose to go toward Flight medicine because of its competitiveness and education did matter to most companies.
There's a lot more to the wage thing than just negotiating for better wages. EMS providers must establish professionalism to lobby for better reimbursement at the government levels. That is another reason why so many allied health professionals increased their education standards. They can now lobby as professsionals for recognition of their services. With the 46 different certifications throughout the country, legislatures don't know what or how to classify any standards for the profession.
I actually even haven't mentioned what skills and knowledge the specialty nurses and RTs possess. I've only discussed CC and prehospital (and yes, HEMS is prehospital also as are nurses that transport from various clinics to the hospitals). The various agencies that employ PICU and NICU specialists follow NATIONAL guidelines. There are certain criteria that must be maintained for these specialty units to be accredited. It doesn't matter who possesses the qualifications as long as they are met.
The vision of a nurse in starched whites should be vanished. Nurses are the largest group healthcare professionals in the world. Underestimating what they can be capable of is where EMS has made some mistakes. Also, it has been nurses who have supported the paramedics in their education when there were few others qualified to teach them in the early days. Nurses are also on almost every states EMS boards and paramedic licensing committees. A lot can be learned from them. They are also serving in our Armed Forces. Do you also think they should "know their place also"? I admit that is hitting below the belt, but I find these nurses to also be extremely well trained and professional. The sterotyping can go right back to the paramedic in so many ways that, too, has been discussed at great length on the forums.
I've participated in almost every EMS function possible and have been on various committees as well as educational boards. The plans have been laid out a hundred times. But, it has been the EMTs and Paramedics themselves that have not be willing to accept change. They are afraid of giving up their "identity" which they have yet to define.
There is vast world out there. Very few people take the opportunity to look past their own backyard and most of them don't recognize when its time to clean up their own backyard.
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EMS has a bright future.
EMTs are more than Ambulance drivers these days, and people are starting to expect ER-quality care when the paramedics arrive on scene. Paramedics are learning how to do more in the field, and how to provide a higher level of care, and - to put it bluntly - are becoming better recognized as serious medical providers. With the progression, care in the field is going to become even more in demand.
Edit: Here in Lansing, Paramedics receive the same level of training as RNs.
EMTs are more than Ambulance drivers these days, and people are starting to expect ER-quality care when the paramedics arrive on scene. Paramedics are learning how to do more in the field, and how to provide a higher level of care, and - to put it bluntly - are becoming better recognized as serious medical providers. With the progression, care in the field is going to become even more in demand.
Edit: Here in Lansing, Paramedics receive the same level of training as RNs.
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Ridryder911
EMS Guru
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A few things..
First, I have yet seen a nurse that would actually want to go to the field full time that was not a Paramedic previously. Actually, most nurses view EMS and out of hospital care as needed but not really health care. Their view on the subject is why would they want to go in the trenches, to get dirty, puked upon and sweaty, glass- hazardous materials ? Usually, they reply .. "you got to be kidding!"
It is even hard to get them to work in critical areas such as ICU, ER, CCU etc.. I realize it is hard for medics to understand, but in comparison those areas are not the "best" areas. The profession is MUCH different than medics. They much rather have more time with the patient, much rather be in a controlled environment with no exposures to the element, not work 24 hour shifts and only get paid for partial, or have to have 2-3 jobs to survive.. otherwise they would had been EMT's.
I know it may seem hard to believe that I had a hard time recruiting Flight Nurses. Again, why be exposed to possible death, dangerous situation for the same amount of money?
I do agree, we should be in charge of ourselves... definitely. The reason we compare is because the first time a medic wants more money guess who they compare themselves too ?.... Again, we want the same money, respect and all the extras (as we should be able to obtain) but we do not want the same requirements in education or professional responsibility. This does mean, no more free gratis for services, entry level requirements, and of course at the least an associate degree level for entry level.
Unfortunately, those in EMS has seen the typical behavior of we want, want, b*tch and moan.. but when it is time to dig in and to change things.. no one has the time, financial support, or participation to ever get things done. We much rather complain than to ever really be progressive. Heck, we can't even get people to quit complaining about increasing the current level of our poor training requirements.
Again, you are correct, we should be able to monitor ourselves. Our boards should be governed by EMT's for EMT's... no one else except maybe a medical representative (M.D.) for clarification. No special consideration for FD, volunteer, paid, nurse representative, etc.. Just EMT's. Then again, look around and see what and whom you would have to represent you. Do you really want to have these person being responsible for our profession? Most no nothing about curriculum development, EMS systems development, or EMS more than just field medicine and cannot read above the 10'th grade level. Hopefully, if our profession does mature and become more educated we can have individuals represent us in a better light.
R/r 911
First, I have yet seen a nurse that would actually want to go to the field full time that was not a Paramedic previously. Actually, most nurses view EMS and out of hospital care as needed but not really health care. Their view on the subject is why would they want to go in the trenches, to get dirty, puked upon and sweaty, glass- hazardous materials ? Usually, they reply .. "you got to be kidding!"
It is even hard to get them to work in critical areas such as ICU, ER, CCU etc.. I realize it is hard for medics to understand, but in comparison those areas are not the "best" areas. The profession is MUCH different than medics. They much rather have more time with the patient, much rather be in a controlled environment with no exposures to the element, not work 24 hour shifts and only get paid for partial, or have to have 2-3 jobs to survive.. otherwise they would had been EMT's.
I know it may seem hard to believe that I had a hard time recruiting Flight Nurses. Again, why be exposed to possible death, dangerous situation for the same amount of money?
I do agree, we should be in charge of ourselves... definitely. The reason we compare is because the first time a medic wants more money guess who they compare themselves too ?.... Again, we want the same money, respect and all the extras (as we should be able to obtain) but we do not want the same requirements in education or professional responsibility. This does mean, no more free gratis for services, entry level requirements, and of course at the least an associate degree level for entry level.
Unfortunately, those in EMS has seen the typical behavior of we want, want, b*tch and moan.. but when it is time to dig in and to change things.. no one has the time, financial support, or participation to ever get things done. We much rather complain than to ever really be progressive. Heck, we can't even get people to quit complaining about increasing the current level of our poor training requirements.
Again, you are correct, we should be able to monitor ourselves. Our boards should be governed by EMT's for EMT's... no one else except maybe a medical representative (M.D.) for clarification. No special consideration for FD, volunteer, paid, nurse representative, etc.. Just EMT's. Then again, look around and see what and whom you would have to represent you. Do you really want to have these person being responsible for our profession? Most no nothing about curriculum development, EMS systems development, or EMS more than just field medicine and cannot read above the 10'th grade level. Hopefully, if our profession does mature and become more educated we can have individuals represent us in a better light.
R/r 911
Summit
Critical Crazy
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Some thoughts from an EMT-B
After I took my 180hr EMT-B course with an A+ grade, completed my 40hrs of clinicals, and upon my certification I wondered what the hell I had gotten into. I mostly knew what I was supposed to do how to do it, but understood so little. My first day on a 911 ambulance felt like the first day of a telemarketing job I had once where, after 4 hours of listening to other people making cold calls, I was informed that my training was complete and that I was expected to start generating sales. "This is sink or swim, kid." I swam... but sometimes I didn't understand how...
By the time I recertified my NREMT, I had over 300 eligable CE hours.
I also completed the following relevant college classes (out of ~115 credit hours):
2 semesters of college Biology /w lab
2 semesters of college Anatomy and Physiology /w lab
Microbiology
Pathophysiology
Public Speaking
Human Nutrition
Human Growth and Development
Medical Terminology
IV Therapy
3-lead EKG interpretation
Wilderness EMT
Other relevant classes I'd had prior:
2 semesters of college Chemistry /w lab
2 semesters of college Psychology
2 semesters of college Physics /w lab
1 semester of college English
MY POINT:
POINT 1: NOW, after completing all of that additional education, I finally feel like I have a sufficient understanding that I SHOULD have had before I was let my far-too-short EMT-B clinicals.
POINT 2: I will probably go to P school, but Paramedicine will not be my life's career. There isn't the progressiveness nor the compensation to make paramedicine my sole career.
POINT 3: If I lived in Canada, or if the US had the Canadian EMS system, I'd know right now that my career for life would be prehospital medicine.
POINT 4: Within one week of starting that telemarketing job, I was the best telemarketer in the entire office and I held that status until I quit four months later. (oh the irony) I made more money as a telemarketer than 95% of paramedics. I had better benefits too.
After I took my 180hr EMT-B course with an A+ grade, completed my 40hrs of clinicals, and upon my certification I wondered what the hell I had gotten into. I mostly knew what I was supposed to do how to do it, but understood so little. My first day on a 911 ambulance felt like the first day of a telemarketing job I had once where, after 4 hours of listening to other people making cold calls, I was informed that my training was complete and that I was expected to start generating sales. "This is sink or swim, kid." I swam... but sometimes I didn't understand how...
By the time I recertified my NREMT, I had over 300 eligable CE hours.
I also completed the following relevant college classes (out of ~115 credit hours):
2 semesters of college Biology /w lab
2 semesters of college Anatomy and Physiology /w lab
Microbiology
Pathophysiology
Public Speaking
Human Nutrition
Human Growth and Development
Medical Terminology
IV Therapy
3-lead EKG interpretation
Wilderness EMT
Other relevant classes I'd had prior:
2 semesters of college Chemistry /w lab
2 semesters of college Psychology
2 semesters of college Physics /w lab
1 semester of college English
MY POINT:
POINT 1: NOW, after completing all of that additional education, I finally feel like I have a sufficient understanding that I SHOULD have had before I was let my far-too-short EMT-B clinicals.
POINT 2: I will probably go to P school, but Paramedicine will not be my life's career. There isn't the progressiveness nor the compensation to make paramedicine my sole career.
POINT 3: If I lived in Canada, or if the US had the Canadian EMS system, I'd know right now that my career for life would be prehospital medicine.
POINT 4: Within one week of starting that telemarketing job, I was the best telemarketer in the entire office and I held that status until I quit four months later. (oh the irony) I made more money as a telemarketer than 95% of paramedics. I had better benefits too.
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Excellent points.
Rid,
We don't have the problems getting applicants for Flight. For nurses, we raise our own and it is competitive. The pay is excellent for Flight Nurses as it compares with the hospital pay. Yes, some of the privates and a couple county services don't pay that well but the county has great benefits.
AMR and a couple of private ambulance companies hire nurses for CCT and their pay is not quite what it is in the hospital, but it is not too shabby either. It is definitely more then the paramedics.
As for as the Flight Paramedics, we will get easily 200 - 300 applicants. We can quickly eliminate down to about 10 immediately. Most will have only the bare minimum requirements to be a paramedic. Very few have taken the initiative toward a career in Flight Medicine as far as getting more formal education or seminars. Skills are easy to teach but we would like the person to know something about the science behind it. The community college offers classes in Flight medicine but there is a catch; prerequisities. They require college level sciences and math. The majority of the applicants, even though we have many reasonably priced Community Colleges most of which also offer a degree in EMS, do not have even college A&P.
Our ER nurses would probably also disagree about your "sissy-fied" description of them. They are the ones who are stuck for 12 hours taking care of the patients that ambulance crews can not wait to unload. Who do you think has to clean up this patients for admission? Nursing Assistants are even harder to come by for those working conditions. And then there's the isolation patients for whatever diseases and bacteria who the nurses must care for all 12 hours with many actual contact hours increasing their risk of exposure.
There has been an overall acceptance of prehospital professionals by hospital employees where EMS services provide well trained staff with a team player attitude. But, when the attitude of "poor me" you don't know what I have to do on the streets, one can only say, go back to school if you don't like it or if you are whining about working conditions and the demands of the job. The whining makes one think you got into the profession for the wrong reasons and patient care is not your priority. Too many people fall for the "you too can do all this" Medic mart commercials. The training is too short to actually give a student a chance to experience some aspects of patient care that we now hear people constantly whine about on the forums.
Rid,
We don't have the problems getting applicants for Flight. For nurses, we raise our own and it is competitive. The pay is excellent for Flight Nurses as it compares with the hospital pay. Yes, some of the privates and a couple county services don't pay that well but the county has great benefits.
AMR and a couple of private ambulance companies hire nurses for CCT and their pay is not quite what it is in the hospital, but it is not too shabby either. It is definitely more then the paramedics.
As for as the Flight Paramedics, we will get easily 200 - 300 applicants. We can quickly eliminate down to about 10 immediately. Most will have only the bare minimum requirements to be a paramedic. Very few have taken the initiative toward a career in Flight Medicine as far as getting more formal education or seminars. Skills are easy to teach but we would like the person to know something about the science behind it. The community college offers classes in Flight medicine but there is a catch; prerequisities. They require college level sciences and math. The majority of the applicants, even though we have many reasonably priced Community Colleges most of which also offer a degree in EMS, do not have even college A&P.
Our ER nurses would probably also disagree about your "sissy-fied" description of them. They are the ones who are stuck for 12 hours taking care of the patients that ambulance crews can not wait to unload. Who do you think has to clean up this patients for admission? Nursing Assistants are even harder to come by for those working conditions. And then there's the isolation patients for whatever diseases and bacteria who the nurses must care for all 12 hours with many actual contact hours increasing their risk of exposure.
There has been an overall acceptance of prehospital professionals by hospital employees where EMS services provide well trained staff with a team player attitude. But, when the attitude of "poor me" you don't know what I have to do on the streets, one can only say, go back to school if you don't like it or if you are whining about working conditions and the demands of the job. The whining makes one think you got into the profession for the wrong reasons and patient care is not your priority. Too many people fall for the "you too can do all this" Medic mart commercials. The training is too short to actually give a student a chance to experience some aspects of patient care that we now hear people constantly whine about on the forums.
reaper
Working Bum
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Vent,
I agree with you. Our education requirements need to be alot higher. I can not stand the whiners and *****ers in EMS. I want to see medics that are doing this, because they want to be medics. If it is to hard for them in the street and they can't handle the pay, then they need to go get their RN degree.
Yes, we do need better pay and more advancement in EMS. This will come, if we can get the quality people in the field. Then you can have all flight medics and not need flight nurses. I agree that you should weed out any flight medics that do not want to further their education. If this is the career you want, then you dam well better prepare for it.
The ones that :censored::censored::censored::censored::censored: about CEU's, that there are too much required. I say, too bad!! You should gladly be doing these, to further your education. I usually have 2-3 times the amount of CEU's required, in the first year.
The ones that :censored::censored::censored::censored::censored: about bad services and no pay, need to move. The nice thing about being a medic is you can pretty much find a job any where in the country. I agree that rural EMS is hard, but it can be made better. Don't volley! If the citizens want the service, then they will pony up to pay for it. If they don't then they don't need the service. Remember, nothing in life is free. Once we start demanding better pay and respect for our service, it will come. We all have to band together, to get this done. If not, it will never happen.
I agree with you. Our education requirements need to be alot higher. I can not stand the whiners and *****ers in EMS. I want to see medics that are doing this, because they want to be medics. If it is to hard for them in the street and they can't handle the pay, then they need to go get their RN degree.
Yes, we do need better pay and more advancement in EMS. This will come, if we can get the quality people in the field. Then you can have all flight medics and not need flight nurses. I agree that you should weed out any flight medics that do not want to further their education. If this is the career you want, then you dam well better prepare for it.
The ones that :censored::censored::censored::censored::censored: about CEU's, that there are too much required. I say, too bad!! You should gladly be doing these, to further your education. I usually have 2-3 times the amount of CEU's required, in the first year.
The ones that :censored::censored::censored::censored::censored: about bad services and no pay, need to move. The nice thing about being a medic is you can pretty much find a job any where in the country. I agree that rural EMS is hard, but it can be made better. Don't volley! If the citizens want the service, then they will pony up to pay for it. If they don't then they don't need the service. Remember, nothing in life is free. Once we start demanding better pay and respect for our service, it will come. We all have to band together, to get this done. If not, it will never happen.