Progression of EMS

[Ridryder911]

Vent, I agree there are some interested parties to be a flight nurse, however; the service I worked at was 24 hr shifts.... which many did not want to participate. As well, the services in my area do not have any pay differential for flight crews as those that are med-surg nurses.

My point, was more to emphasize that most nurses do NOT enter health care for the adrenline type scenarious like medics. Many and majority are very pleased with providing compassionate, intensive care, without any drama. For example many prefer nursery and L & D or even case manager social services.

ICU and ER's in my area are always short. Yes, they prefer to have experienced applicants, but like anyone else.. happy to get what they can get.

What I do get angered about is medics should not have to make the choice to leave the profession for better pay and working conditions. About the time we finally get a medic with some real clinical experience to perform well (>5 yrs.) they go to another profession. This leaves a void in the profession and patient care. If administration was really wise, they would observe that they loose about $5000* for every employee that quits. (*costs of hiring, physical, drug tests, orientation, over time for empty shifts, etc)

I do disagree with job vacancies for Paramedics. We crank out about 200 Paramedics every 16 weeks for about 10 openings in that area, and this is rural state. I know of at least one Wal-Mart greeter that wears their NREMT/P lapel pin on their vest.

Yes, nationally there are openings, usually because there is a reason for vacancies. As long as there are schools that can produce them in <16 weeks and every 10 months, then there will never be a shortage. Thus supply and demand will never work and pay will never increase. Why should they?.. just wait in a month or two, and new batch comes out that will work for pennies. Unfortuntely, there are few collegiate level and many Vo-Tech (trade) in my area. Which the Vo-Tech does not require any entry requirements.. straight through from basic to Paramedic in < 1 yr... hard to compare education levels.. in which the LPN has the exact same hours (actually more clinical hours).

Hopefully, the NEMSE will reform at least anatomy and physiology ata collegiate level requirement.. this desparately needs to be performed.

Well, I off for a state meeting. They are attempting to make Paramedic an on-line program from start to finish.. with observation & eval of skills at a site. Now, this type of program will present some type of credibility huh ?

R/r 911

 

[triemal04]

Again vent, you need to remember that your system is not the nations. EMS has isolated itself, extremely so in some places, but in others it hasn't. In some it's an accepted field in the state health dept. And there is nobody to blame about the lack of understanding about what a paramedic is and does other than us. Yes, us medic's. Not anyone else. Don't know anyone would think otherwise. EMS is so fragmented and split among different states, providers, skill sets, services etc etc that it really isn't surprising that the public doesn't have a good picture of what goes on. (this is where having a national group behind is would help fix the problem.)

Where are you hearing so much about medics wanting to work in the hospital? That may be more of a local problem; I can tell you that here it's the exact opposite, and I've never heard a lot (a little though) about medics wanting to move indoors anywhere. Personally I don't see the point. There are allready multiple different types of providers that are trained to work in house. We get trained to work in the field, which is very different. Far as I'm concerned the place for a medic is in the field, not a hospital. That being said, there are multiple services I've seen/heard of that are hospital based and, when not on calls, or sometimes as part of a rotation, the medics work in the ER. For most of those they work essentially as an ER nurse using the same protocols they have for the field with some additional meds and the ability to call for labs, x-ray, etc etc. It works for those places which is great, but, if you become a medic, you should go into it knowing that your workplace will be in the field. If you want to go indoors, get your RN, or RT, hell, even a CNA.

Increasing education would help with wages sure, and like I've said, that should be one of the first changes made in EMS. But don't for a minute think that a private company would be willing to pay someone $20/hr unless something forced them to. A union is a decent way to do it, as long as they have the mucle to get it done. It is long past the time when medic's should be able to work a single job as a medic and get paid a decent living wage with decent benefits. This won't happen easily though. (be really hard in privates anyway; part of the reason that for-profit services should go away) And there are benefits to it that I've mentioned allready.

I don't know that many people who underestimate nurses. While I'm all to happy to call some floor nurses bed pan changers to thier faces when they deserve it, I (and everyone I've ever talked to) still recognizes that there are very talented nurses out there (just like medics) and some crappy ones (just like medics). Still doesn't change the fact that the place for a nurse is in the hospital, and the place for a medic is in the field.

I still can't figure out where you're coming from. EMS training and educational standards need to be improved, we both agree on that. But beyond that...this isn't an insult in anyway but curiosity more than anything; when did you last work in the field as a medic responding to 911 emergencies? Not transfers, no flight medic work, but working for a FD, third service, private, whatever as a garden-variety street medic? You seem to be more of the mind that bringing hospital personell outside instead of improving paramediciene is the way to go.

 

[skyemt]

"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."

Wow... triemal04... you say this and you call Rid pious and pompous??
we are a volunteer agency, including volunteer ALS and Paramedic service...
We bust our butts for 1200 calls per year, and we are advocates for increased education. We work for free, and have no benefits. But we do it because we want to help our patients. we don't need unions, and we don't :censored::censored::censored::censored::censored: and moan about hours or pay, because there isn't any.

yet, you belittle volunteers...

either you have forgotten the reason you got involved in EMS in the first place, or you really don't quite have a handle on what you are talking about.

if you want to be helpful, triemal04, tone down the judgements and be part of a solution, it would be a little more helpful.

nothing personal, of course.

 

[triemal04]

"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."

Wow... triemal04... you say this and you call Rid pious and pompous??
we are a volunteer agency, including volunteer ALS and Paramedic service...
We bust our butts for 1200 calls per year, and we are advocates for increased education. We work for free, and have no benefits. But we do it because we want to help our patients. we don't need unions, and we don't :censored::censored::censored::censored::censored: and moan about hours or pay, because there isn't any.

yet, you belittle volunteers...

either you have forgotten the reason you got involved in EMS in the first place, or you really don't quite have a handle on what you are talking about.

if you want to be helpful, triemal04, tone down the judgements and be part of a solution, it would be a little more helpful.

nothing personal, of course.

Actually I usually call myself a belligerent sometimes arrogant @#$hole.

But, if you look at what I wrote, I'm not sure why it's a problem for you. If you maintain a high level of training and standards, then that is great. To many don't though, and to many want the extra skills without the extra training and education that is required. I figured that was pretty clear in that quote. Now, this does not need to be turned into a volunteer vs career thread, so leave it at that.

 

[VentMedic]

I still can't figure out where you're coming from. EMS training and educational standards need to be improved, we both agree on that. But beyond that...this isn't an insult in anyway but curiosity more than anything; when did you last work in the field as a medic responding to 911 emergencies? Not transfers, no flight medic work, but working for a FD, third service, private, whatever as a garden-variety street medic? You seem to be more of the mind that bringing hospital personell outside instead of improving paramediciene is the way to go.

triemal04
HEMS: Helicopter Emergency Medical Service
As a paramedic on a helicopter that also responds to 911 scenes as well as interfacility, am I less of a Paramedic than you? Where are you coming from? Should all paramedics only work for your perception of normal to be "street wise"? You need to get out more. Maybe attend a national conference or something to see just how many different EMS systems there are.

I prefer to also work in a hospital as an RRT on my off days to stay current in the hospital. There are several of us on this forum who hold several credentials in the medical professions as well as other professions.

Where are you hearing so much about medics wanting to work in the hospital? That may be more of a local problem; I can tell you that here it's the exact opposite, and I've never heard a lot (a little though) about medics wanting to move indoors anywhere.

I take it you are also new to EMS and forums. Search any forum and you will find extensive threads on Paramedics questioning what they can and can not do in the ER and why they can and can not do. I also hear this a just about every recert class, seminars as well as the FD picnics.

Some of the skills and knowledge of the paramedic can be used in areas besides the street. Don't criticize someone that may have found a great opportunity working oil rigs, industrial, prisons, jails, theme parks or college campus medic jobs as well as hospitals. This is a free country and should be a land of opportunity for those who want to work hard and maybe be creative in finding a great job that fits well into their life.

National standards will definitely increase opportunites for employment if various agencies can petition for reimbursement.

Still doesn't change the fact that the place for a nurse is in the hospital, and the place for a medic is in the field.

There are many paramedics that do work in the hospitals for various reasons: hours, family, injury, benefits etc. Don't criticize someone who may have taken the opportunity to do something different with their paramedic training. You are way too quick to criticize those who do not fit your stereotype.

If paramedics have a future in public health as described in several recent articles, attitudes that lack flexibility will definitely hinder the progression into a new territory.

The laws of economics, reimbursement and professional recognition will determine many of wages in healthcare and this includes EMS. Muscle? Forcing an employer to pay? Would you be the first to abandon a patient to walk a picket line? The vastness of healthcare, politics and the many types of EMS systems to fund present more variables than one can imagine. One must understand how legislation and reimbursement is obtained.

Volunteers are not the reason for problems in the EMS community as a whole. Chances are if you lack professionalism as a volunteer, you probably will not change your ways as a paid employee. Even in the paid services you have the haves and the have nots. That goes for both public and private.

quote from triemal04

While I'm all to happy to call some floor nurses bed pan changers to thier faces when they deserve it,

I can not believe someone who is preaching professionalism would do this.
Showing disrespect to others that you probably do not know is not the way to promote your own profession. If you want to bash nurses and other paramedics, I can point you to a couple of forums and their threads. Calling another healthcare professional names of disrepect in the work place is just wrong. Nobody deserves to be treated like that no matter how much they screw up. Again, we have extensive threads in various forums about the paramedic who thought he/she got disrespected in the ED. Yet, it is okay for a paramedic to do the same? Someone has to be the example of professionalism.

 

[Ridryder911]

triemal04
Obvious your a union man... and we see how much that has helped EMS....no where! Look at AMR's dilemma. No EMS union has made any progression except in their own pocket books.

We can not get more money from Medicare who then pays administration, until we increase the reimbursement rates.. no matter if your union or not! Union wil not increase payers rates..

Go union, I love them ! I definitely love working for hospitals and services when they strike.. the best pay possible, and guess what.. they always have to settle out, plus pay the old union dues.

Read any EMS journals lately?... hmm... let's see Get your RN! .. oh here's another one Paramedic to RN... wow! Now, if there was not an interest, do you really beleive they would spend the amount of money advertising. As well, the bridge courses are in high demand, we have 5 in our state with 2 year waiting list. I don't see become a Paramedic in any my nursing journals... then again, it's too easy to be one, just go to most trade schools for a couple nights a week & in a few weeks, your one! Heck, there is even a "boot camp" Paramedic school in < than 6 weeks, with guaranteed passing NREMT.

Sorry, I teach Paramedics at various institutions, over 60% of the students only take the course because they think it will improve their chances of getting on at a FD or promotion for FD, the other 40% want to get into nursing school.

Don't know where you work, but I travel and lecture abroad, and this is a general topic nationwide. Like Vent said, just read the forums... very few want to make the field their home..

For Paramedics to survive, the will have to get the "EMS" mentalility out of their head. Emergencies (shootings and stabbings) do not pay.. no one (insuers and Medicare) is going to pay high bucks for a taxi ride with an IV. Again, I suggest to read this months JEMS, and observe what is occuring north of us. Await, the new national health care reform, and see what all you will be doing in the future. People, expect more bang for their buck, albeit Fire Service, private, hospital, or third party.

As many national EMS educators and those that deal with EMS more than ditch medicine, say .."Look outside the box, if one does not, they will be passed by".

R/r 911

 

[Canoeman]

Progression

This is a great thread.

Actually I am impressed with all the responses, but as I look at the thread I can see the the opinions on where we have been and what has been the EMS progression are different as seen through a prizm according to the individual.

I see many various topics that you all see as hot potatoes tossing it around, yet no one seems to what to take the heat and stance to solve the various components. Can we expand our thought process a bit more and divide the issues into catagories and come up with a brainstorming session that can deal with the items.

All of the multiple topics are issues for all of us and yes things are diffent regions to regions.

Above all to me is the unification:

This has been brushed on a bit here but one othe most criticical things that I here in almost every seminar I go to, every EMS management tree, and every EMS station I visit, is the unification of all the providers under one department, association, union or what ever you want to call it and that we have no national representation for EMS in general. We need this ----and we all know it -----but we sit and fuss wringing our hands. Why can't we seem to get this accomplished?
I for one do not want to be represented by IFFA or NAEMT or the like. I would like an EMS Federal Boss and a department who can tackle (all) of things that we are mentioning here.

Canoeman

 

[VentMedic]

I have got to reference a thread Ridryder started a few months ago. There were some excellent points made about skills, knowledge and education of both past and presesnt.

Basics before Advanced
http://www.emtlife.com/showthread.php?t=4830

 

[medicprof]

Its great to see the thoughts flying around about making our profession just that, a profession. I'm doing the research and will be presenting the facts about paramedic degrees. The minimum should be the Associate Degree.

 

[disassociative]

Its great to see the thoughts flying around about making our profession just that, a profession. I'm doing the research and will be presenting the facts about paramedic degrees. The minimum should be the Associate Degree.

You should also compare your findings with the advent of formal credentialing for nurses. I believe the degree process holds the key to our future. This way, the provider is proficient in College level composition, Collegiate mathematics, psychology, etc. If only Paramedic degree programs would have the same gen ed as nursing: A & P, Microbiology, Patho, etc.

For those of you who are wondering why the comparison to nursing is even in this thread, I would suggest to you to research Post-War nursing and how these providers fought for formal licensure, and credentialing. As for the process, we are all involved in continuation of care. Neither one of us(EMT/Paramedic or Nurse) can be defined a definitive care of any patient.

Our job is to get them to the hospital under a physician's care. The nurses job is to care for the patient during the duration of their stay.

 

[triemal04]

Whoa there ventmedic...I told you, I didn't mean the question to be insulting in any way, I'm honestly curious. (still am if you don't mind, when did you last work on a car?) I'm not sure why that question upset you so much, flight medics here are required to go above and beyond the normal medic requirements, and that holds true for several out of state services I've heard of, and hopefully holds true nationally. So no, it doesn't make anyone less of a medic. What it might do is change someones perspective of EMS; not always bad, but how you see EMS at the bottom tier may be different than someone working in a car. Think about it, most flight services I've seen are generally well run with highly educated, well paid employees. They usually only run on critical pt's and have a lower call volume than a lot of street-level services. A lot of the work may be done in a more clinical environment; picking someone up from an ER/ICU/hospital, you'll have a lot more info (hopefully) than someone walking into a house, and certain treatements may allready be done (again, not bad, and if you respond to the scene sometimes not always true) Now, none of that is bad, but it may lead to a different perspective, which is what it seems to have done for you. Now one last time: that isn't neccasarily a bad thing. My only problem with some of what you've said is that you seem to be turning your back on EMS and advocating more for bringing hospital based personell outside and not improving the level of paramediciene.

No, I stand by what I've said about medics working in hospitals. I know of people who have tried to get jobs as ER Techs or something like that because they could not find a job on an ambulance, but I still have never heard of anyone going through medic school so that they could work in a hospital. There is no push that I've seen or heard of to create a role for a paramedic in the hospital as a replacement for, or equivalent to, a RN. There's no push to create a role for a paramedic in the hospital period.

Now I'm sorry, but when have I critisized someone for working in a prison, oil rig, industrial site? You need to pay more attention and not get so angy at comments. Working at a place like that is still different than working in a hospital. For a lot of oil rig work, given that the medic may be the ONLY medical care around...nothing wrong with that, and my hat's off to people who do it. Doing that is no different than doing what your average paramedic does, except they need to know a lot more clinical mediciene. Which is a good thing. Bottom line: the place of a paramedic is not in the hospital. It is not what we get trained for, and hospitals are allready well staffed with people with different levels of training. There is not a need for another. If people do, they do, fine, but it isn't the primary spot that we belong in.

The comment about volunteers was specifically aimed at people wanting a skill without the required knowledge. They aren't the main problem with EMS, but they can contribute. Just like many paid providers can also contribute.

Now look, I don't care if you call it a union, national organization, or a breakfast club, EMS needs a voice on a national scale that will speak for us and us alone. Since you're so fond of pointing it out, changing legislation and the way that we get reimbursed (especially through medicare) will take a lot of work. Who is doing that now? Who's working on that at a national level? See the problem? There are a miriad of problems with EMS and changes to be made, but nobody is pushing for them to be done nationally, and pushing hard. For the pay...you can be happy with what you make and not care about anyone else, but personally I am sick of seeing medics make 10-12 dollars an hour with no benefits while the owners/directors/trustees of the company they work for walk away with 4 times that. Private sector EMS sucks...the compensation won't increase unless someone makes it happen. The same could happen with fire or third service. Paramedics will not be paid an appropriate wage until we are recognized as a true medical professional, people know what we do, we are well trained in all areas, and someone is look out for us. Again, I don't care if you call it a breakfast club, but something needs to be there.

I think I made the analogy once before. Look at IAFF (union) and NFPA (nat'l org). Together they have done great things for the fire service in almost all areas. Why shouldn't we have 2 groups like that for EMS? Unions can, and should be doing more than just working for better wages, and I've said as much. Please, tell me what the problem is with having someone advocating for EMS?

Actually, my comment about bed pan changers was mostly a joke. I've never said that to someones face...wanted to several times, but haven't, mostly for the reasons you listed. Plus I really like my job. And it's not nurse bashing, like every profession, including EMS, there will be good ones, and bad ones. Does that mean that you should never point out the bad ones?

Rid...I have no ideas where your "medic to RN" comments are coming from. Someone wants to become a nurse? Ok, good for them. What's the problem? The bootcamp medic school...that is a huge problem and one of the things I'd like to see go away.

I'm going to go out on a limb and say that your 60/40 split is completely false. Unless the only ambulances in your area are FD run, and then I suppose it could be possible. On the off chance that it is true...shouldn't we, or some group anyway, be helping to inform people of what paramedics do so that people go through medic school with the express goal of being a paramedic, FD based or otherwise?

I know about what Canada is doing. I think it's great, and I think there are definetly applications for it down here. Definetly in rural areas, but with a few tweaks and changes it could even have some use in more urban areas. Probably won't have any complaints on that from me.

 

[triemal04]

1. EMS needs a voice at the national and local level to advocate for us, be it union or otherwise.

2. EMS needs an organization that will work for change in the system.

3. Pay paramedics an appropriate wage.

4. Increase the training requirements for paramedics.

These are the 4 things that I've harped on in almost every post in this thread. Why are any of them a bad idea?

 

[skyemt]

Triemal04, you seem to have many criticisms, and of course, you seem to "inadvertantly" offend some people along the way... so as to offer an opportunity for you to clarify something for me, would you mind creating a reply outlining what you think is "good" about ems...

surely, while debates on areas to improve are important, it is also important to keep a balance between what works, and what doesn't... perhaps you come across as too weighted on the negative side...

so, triemal04, what works for you in ems?

 

[disassociative]

You know, this sounds like a good group project: Define a better EMS.

 

[triemal04]

Triemal04, you seem to have many criticisms, and of course, you seem to "inadvertantly" offend some people along the way... so as to offer an opportunity for you to clarify something for me, would you mind creating a reply outlining what you think is "good" about ems...

surely, while debates on areas to improve are important, it is also important to keep a balance between what works, and what doesn't... perhaps you come across as too weighted on the negative side...

so, triemal04, what works for you in ems?

Sure. In a nutshell: the entire concept of EMS. Of all the changes made to medical professions over the last 30 years, of all the new fields created, personally I see EMS as the most important one and the one that has had the most impact and helped, and can continue to have the most impact and help the general public at large. The ability to have hospital level care at your door within a few minutes is an absolutely wonderful thing.

A tiered level of training is very appropriate.

The fact that many advances in mediciene and equipment come from field work; EMS is a great way to improve mediciene as a whole and try new things.

I can go on, but the first part really says it all. EMS works. I love it. End of story. If I come across as "weighted on the negative side" it's because there are problems with EMS at the national level and changes must be made. Anyone who thinks otherwise isn't paying attention. My problem is that if nothing changes I can see EMS spiralling downwards until, in another 30 years, there will be some good local agencies, but on a national level EMS will be much more basic and not always used. Like I said several pages ago.

Most of the things that bother me are happening beyond the local level; we've been around for 30 years now, it's time for EMS to grow up and start acting like a true medical profession.

Now, what are all these critisims that I have? The lack of mandatory quality education? The lack of a strong nat'l body working for improving EMS? Poor pay for medics? Are these things not true? Should we just ignore the problems and hope they go away? Hell no. Part of improving things is looking at the problem and acknowledging it, not downplaying it. And if doing that means that I offend some people...I'm not going to lose any sleep over it if that means that people will start wanting to make a difference and make some changes.

Now you tell me: look beyond your own service at what EMS is like throughout the US. What are the problems you see, and how should they be resolved?

 

[skyemt]

triemal04, thank you for your answer and your candor...
it wouldn't be fair for me to comment on hours or pay, since i work for a fully volunteer agency...

however, lack of a national body is a concern... better education is a concern... i am hopeful with the advent of cme, that very good, informative, educational classes will be coming down the pike...

i see lack of standardization in levels as an issue... it seems like a mess sometimes when some counties have emt-i, some don't... some have three levels, emt-b,cc and emt-p, and some have five... first responder, emt's b,i,cc,p...

i also would like to see more standardization among protocols for different levels... some b's can administer certain meds, and some can't administer any... while puzzling for the emt's it also creates confusion for patients who have been treated by a bls crew who could administer meds, and then is treated by one who can't... i have run into that before...

but to me, these issues are more about "quality control", and not about a faulty product... like you, i believe that EMS works, and if improvements can be made in these areas, it will only continue to work and grow...

those are some of my thoughts... any comments?

 

[triemal04]

See? Look at that, we pretty much agree completely.

I guess you could call some of the problems "quality control" issues, but that leads back to...who is responsible for fixing those issues? It can, and is fixed at the local level in many places, which is a great start, but it needs to go further. I agree with all the things you pointed out, but now that the problems are known about, we need to be asking ourselves "how do we fix this for EVERYONE, not just our local service?"

EMS definetly works and is not a faulty product, and it is most definetly NOT broken. But it is cracked, and I don't want to see it go any further than that.

 

[VentMedic]

So, how many people here talking up education have at least a two year degree in EMS? or the health sciences?

For those that have 2 year degrees in EMS: How many obtained their degrees before 1990?

How many were encouraged by their instructors to continue on to a two year degree?

How many were told "you'll get every thing you need to know about being a Paramedic without wasting time on other classes"?

How many believed it then and still believe it?

How many are planning to get a two year degree in EMS or the health sciences even it doesn't become a standard?

How many have encouraged your co-workers to get a degree in EMS or the health sciences?

I know there are many people on this forum who also hold degrees in other areas of medicine and people who hold degrees not related to medicine. In each class, were you encouraged to go further in your education? How many were encouraged to get a Bachelors or go on to graduate school?

Did anyone have a mentor in the profession (any profession) to encourage them to go further?

How many have belonged or do belong to a state or national professional organization (NOT UNIONS) that promotes EMS? Or a specialty EMS organization?

 

[triemal04]

So, how many people here talking up education have at least a two year degree in EMS? or the health sciences?Yes.

For those that have 2 year degrees in EMS: How many obtained their degrees before 1990? No. Not sure why that's relevant, unless you're checking to see how long someone has been a medic.

How many were encouraged by their instructors to continue on to a two year degree? Required to be a medic here. Also known as how it should be everywhere.

How many were told "you'll get every thing you need to know about being a Paramedic without wasting time on other classes"? That's funny. Show me people who say that, and I'll show you someone who is holding EMS back.

How many believed it then and still believe it? Come again?

How many are planning to get a two year degree in EMS or the health sciences even it doesn't become a standard? It needs to become standard if EMS is to survive.

How many have encouraged your co-workers to get a degree in EMS or the health sciences? Again, required here. And most people I know hold the opinion I do: a degree should be REQUIRED to be a paramedic.

I know there are many people on this forum who also hold degrees in other areas of medicine and people who hold degrees not related to medicine. In each class, were you encouraged to go further in your education? How many were encouraged to get a Bachelors or go on to graduate school?

Did anyone have a mentor in the profession (any profession) to encourage them to go further? Yep. Try to do the same for others when it's appropriate as well.

How many have belonged or do belong to a state or national professional organization (NOT UNIONS) that promotes EMS? Or a specialty EMS organization?

Look. You can get angry and upset if you want. That's ok. Please though, before you do I do honestly want to get a couple of answers from you. This isn't from spite, but I really want to know, I'm curious. I can repeat the questions, but they should be clear by now, given the number of times I've asked them in this thread, and others.

 

[VentMedic]

For those that have 2 year degrees in EMS: How many obtained their degrees before 1990? No. Not sure why that's relevant, unless you're checking to see how long someone has been a medic.

The majority of the more than 300 two year paramedic degree programs were started well before 1985. Students were encouraged from 1975 to 1985 to get a degree in EMS because that was the future. So if you entered a program in 1985, you probably graduated prior to 1990. We were preparing for something bigger and it came close to happening.