Rank the EMS systems of the world

[tazman7]

Firstly, I don't know what you think is so simple about treating and transporting. Why is it that so many paramedics insist on judging the complexity of their role by the number of drugs they carry and the thickness of their protocol books. Secondly, not everyone gets transported. Not everyone fits the cook book.

How do I make it seem like we're doing heart surgery? I think its depressing that the mere mention of taking pride in higher education and putting a value on knowledge is seen as taking it all too seriously. Going overboard. Honestly, you mention and bloody associates degree on this board and 7 different idiots come out of the wood works to piss and moan about too much education. Like, woah dude, lets not go nuts now, I'm a professional, I memorised my protocols normal BSL range in under two days, what else could I possibly need to know?

Its not even just about "need to know". Probably 70 percent of my degree won't be directly relevant when I start. How much of a nursing degree is directly relevant to my ex-girlfriend in the first days of her nursing grad year on a cardio-thoracic ward? Couldn't she just go to a tech school for 6 months and learn everything she needed to know about that particular ward and memorise some dot points on "chests and junk"? How much of my best mate's computer science degree is relevant in his grad position drafting induction literature? Probably less than me. Nobody whinges about having to have a degree in his field though. What is it with American EMS's obsession with the bare essentials?

If in 10 years, maybe I move into teaching, other parts of my degree may be relevant, the parts on health systems and adult education. I'm thinking about an MPH, expanding into epidemiological research on acute care. Pretty hard to do a masters with a certified 6 months in the back of a fire department though. Maybe I want to move into emergency management. Do a post grad cert, maybe a masters if I'm desperate , some research, maybe publish a few papers, be seen at the right conferences, smooze the right managers, move up the ranks of the Ambulance service's emerg management department. My degree doesn't specifically prepare me for any of that, but, like any degree, it provides a good baseline level of education that can be built on in the right ways.

I believe this obsession with the bare essentials and only those directly relevant to one's current position is a quality of a technician not a professional. The continued adherence to that model really makes EMS's utility in a changing future questionable.

In subtle ways, education can raise the standards of the entire field.



This whole paragraph is a joke. Lets call ourselves professionals and but constantly resist any improvements in education or changes in practice and only memorise a few directly relevant edicts. High quality care? In many cases I doubt it. But it seems like many providers are too stupid to conceive of the idea that the blind adherence to protocol may not equal high quality care. That if you get your patient to the ED doors breathing, that's not necessarily a win.

Medical school? Yeah because every EMT out there was sitting in front of an acceptance letter from Johns Hopkins but thought, "Nah I just don't feel like all that glory, I'll get my EMT cert instead".

Come on mate, I'm willing to take the piss out of myself as much as the next bloke but that facebook group paragraph is ridiculous and this thread is a serious comparison of EMS systems.

There is nothing easy about treating and transporting, trust me. Im just simply saying that there are only so many things we can do for the pt out in the field. We cant perform surgery, we can only give a limited amount of drugs, and sometimes the only thing people need is time, so what do we give for that? Diesel fuel...

Where I work, anybody that calls an ambulance gets transported, if they want to be transported. Im not sure if you guys dont get bs calls, or have the ability of saying to them that they can drive their car to the hospital but we cant. We have to transport them as long as they want us to. It sucks I know, but thats how it works. I really dont like waking up and bringing the guy into the ed at 300am for stubbing his toe either, but thats part of this job. I hate to say it but we run a Medicaid taxi where I work, and thats why the burn out rate is so high.


I think its great that you are continuing your education in the field of EMS and so on. I actually just finished my associates degree in EMS but have yet to find anything to get a bachelors in for it.



And for the paragraph, I personally find it funny because somedays thats exactly how I see it. Where I work the medics get pooped on. The nurses hate us because they are all overworked and see us as the people who bring them work, they dont take report from us half of the time. I have literally watched the nurse on the radio take an inbound by sitting the phone down, going and talking to the doctors, come back on the radio and say "your radio is very broken up, can you repeat the vitals and chief complaint and ill see you in five."

I guess I have full intentions on taking my job professionally and seriously, but somedays it seems very hard to do when the hospitals you transport to dont care what you have to say...kinda makes you think, why do I even try.

 

[tazman7]

And you have nobody to blame but yourselves for that. The system does not want more education and we look at Fire Service based EMS, it is actively discouraged.




We have exactly the same drugs as you and see the same pathologies the world over, well, thats not true we are given drugs it seems American Paramedics are not trusted with (ketamine, combination analgesia, suxamethonium, heparin etc).

The difference is in how we approach clinical praxis and the modalities we have at our disposal. American EMS seens obsessed with "emergencies" and "getting the patient to the hospital" and it seems you learn just enough to cover that, whereas we take a more broad view ie does this patient require treatment, do they require transport, is an ambulance the most appropriate transport mechanisim or can they be left at home?

We also seem to have different priorities; rather than craming 15LPM NRB down everybodies throat and strapping them to a longboard we see providing adequate analgesia and packaging as more important hence why we have a large number of pain relieving medicines and RSI.

We are also trusted to be a professional capable of using the tools given to us and not have to run off to the medical control physician and ask for permission to do our job.

Brown is not a university educated Paramedic but rather completed the old vocational stream.

Im not going to blame myself for what I get paid. I am willing to do the education. Did I receive a raise with my Associates degree?? No...so your right, the system doesnt care about education and its sad, but its not MY fault.


Like I mentioned before, we cant sign a pt off if we dont think they need transport, and again, thats not my decision.

We cant even give drugs to RSI....so basically on the guy that needs to be intubated that is still breathing at six times a minute but still has enough gag reflex to gag on the tube and is crashing, we either have to wait for him to stop breathing to intubate or call for orders for sedation and nine times out of ten our orders will be denied...so BVM it is.


For a pain relieving med we have morphine.. thats it.





(This was supposed to go in the above post but I exceeded the time limit to edit.)
Just last week I brought a guy into the ed that got crushed by a fork lift. I tried giving my report and the Trauma doctor told me to get myself and "the cart" out of his room and he didnt care what I had to say...this was right after we transported him from our cot over to the bed. One of the nurses did stick up for me though and called the guy an a-hole. And this was at a Level 1 trauma center so its not like they havent seen trauma before, and I even called it in as a level 1 trauma so they were prepared.

 

[tazman7]

So what you are saying is that you want to get paid more so you can at some point pursue higher education?

Formal education solidified by way of degrees are the bargaining chip for a good salary. A minimum degree requirement in EMS of Associates at a minimum (Preferably bachelors) where individuals must take college level anatomy & physiology, microbiology, pharmacology, etc is the starting place for moving EMS toward being considered a profession as opposed to a stepping stone to another allied health career. At this point, the argument for higher salaries would be more readily accepted.. However, expecting a higher salary because you attended a 6 week EMT-B course and a paramedic course that lasted a year at best just doesn't compute.

Look at the other allied health professions, most of them require an individual to complete a formal degree before being allowed to practice in the profession.

No, I have paid for all of my education myself so far. Im just saying for the job we do and the level of responsibility we carry we should be paid a lot more than what we do.

My cousin just got hired as an ED security guard and makes more $$$ an hour than I do...

A friend that is a radiology tech that went to school for two years (I think) pulls down $58k.

What type of responsibility do these two examples carry? Damn near none.

Kind of off topic, im just saying. We do deserve more than what we get.


But I do agree with you that paramedics should be required to have more prerequisites than are required right now.

 

[Shishkabob]

I hate this thread.



Why? Because it has no legitimate basis for the rankings, especially when it comes to US based agencies. There is so much fluctuation in the US alone that classifying it is silly. It can be ranked #1 AND last and both would be right, based solely on which agency and standard you're going off of.



There are American agencies that blow the water out of UK, Canada, Australia etc etc, and there are American agencies who I woudn't trust to touch me with a bandaid and Q-tip.

 

[MrBrown]

\There are American agencies that blow the water out of UK, Canada, Australia etc etc

Please name them.

 

[boingo]

Please name them.

How? What criteria are we using? Education requirements? Patient outcomes? Pay? Scope of practice?

 

[jjesusfreak01]

Please name them.

This is going to be interesting...

 

[Dutch-EMT]

Worldwide, there are a lot of systems working on a different way.
But they work!

The Dutch system is a high quality, good skilled nurse-based system.
But it is expensive, there are problems recruiting staff (because it needs specialized nurses).
There is a pilot started educating Technicians for ambulance and ER.
Problem is that those people are very young, have no (life) experience at all, and the law forbids them technical skill's like i.v., meds, etc.

So, where quality is a strong point of the system, there are other weak points.

The best ambulance-system on the world doesn't exist.

 

[MrBrown]

Problem is that those people are very young, have no (life) experience at all, and the law forbids them technical skill's like i.v., meds, etc.

Brown agrees with you; the biggest problem we have faced here in New Zealand and Australia (Brown has also heard it from Canadians) with the move of Ambulance education from vocational training to University is the lack of maturity in young applicants.

Does NL not have some legal instrument whereby delegations can be made in order to permit them to administer medications and perform certain skills under a standing order?

Lets face it, as much as Brown raves about our clinical autonomy its via delegation from an Ambulance Medical Advisor under the Medicines Act.

The best ambulance-system on the world doesn't exist.

Yes it does, in Brown's mind

How? What criteria are we using? Education requirements? Patient outcomes? Pay? Scope of practice?

Brown doesn't know, for it was Linuss who said ....

There are American agencies that blow the water out of UK, Canada, Australia etc etc,

So he must have a list or he would not have said that

 

[usalsfyre]

No, I have paid for all of my education myself so far. Im just saying for the job we do and the level of responsibility we carry we should be paid a lot more than what we do.

My cousin just got hired as an ED security guard and makes more $$$ an hour than I do...

A friend that is a radiology tech that went to school for two years (I think) pulls down $58k.

What type of responsibility do these two examples carry? Damn near none.

Kind of off topic, im just saying. We do deserve more than what we get.


But I do agree with you that paramedics should be required to have more prerequisites than are required right now.

Your cousin is kind of an irrelevant example, as much as I hate EMS annual compensation tends to be based on a 48-56 hour work week, meaning your yearly pay is probably more when OT is factored in.

Rad techs have a fair bit of responsibility. There's actually quit a bit that has to be determined by the operator to obtain a good quality image safely. In addition are educated fairly heavily in the theroetical physics of what they're doing. Not to mention have real (not applied) A&P, and opportunities to branch out with in the field. $58k does sound high for entry level, unless it's in an urban area.

The fact remains paramedics in the US are VASTLY undereducated for the level of responsibility held. One only has to have a few students ride with you to realize that.