Replacing EMS with nursing revisited

[usalsfyre]

Those other professions that you listed evolved out of nursing. Evolved out of the generalist education base.

EMS did not evolve out of a standard body of education.

Bull malarky. Nursing can't claim ownership of all allied health professions. While nurses may have actually turned the knobs on a ventilator or pressed the button on an x-ray machine, the body of knowledge in these professions is far more medicine than nursing based. If nurses had the base knowledge to perform these task it would just be another add on certification, instead of a "wound-care specialist" you'd be a "radiography specialist".

EMS, unfortunately evolved out of the quick and dirty "call the doc for everything" approach.

 

[Veneficus]

Actually, if you talk to nurse educators many of the new nursing schools that have sprung up and contributed to the surplus of new grads are the equivilent of "patch factories". And according to my wife, 9 to 10 month non-degree rad-tech programs exist.

Fair enough. I must then admit they do exist. I am surprised. But how many compared to medic mills I wonder?

EMS failed when we let other people (the government, the fire service, private services) set the standards for entry. Until a committed group of career paramedics seizes control and raises the entry standards (yeah right) then EMS will continue in the crapper.

I don't really think there exists a large body of commited paramedics.

It has been demonstrated by some places like Seattle, Outside of DC (forgot the dept name) and even Oregon that the fire service has the capability to do EMS well. Unfortunately a majority of fire service EMS has chosen not to emulate them. I could advocate for such a universal system.

Government will always set the standards, because government is the majority payer. (He who pays the piper dictates the tune)

As for private service, I think seperating both the requirements and pay for IFT only providers would solve that problem. It could even make it a more profitable business if things were done properly. (I am a dreamer) Because if you reduce the training and vehicle requirements for the dialysis derby, (which no EMS curriculum prepares providers for) I think it is entirely possible to reduce payments and and increase profit margins when they don't need the same requirements as an emergency ambulance.

 

[Shishkabob]

Unfortunately a majority of fire service EMS has chosen not to emulate them. I could advocate for such a universal system.

So, than, how is that a failure on EMS and not a failure on fire? Or a failure on the beaurocrats that allowed themselves to be conned by fire? Or on the general population for letting themselves being conned into accepting crappy service?

 

[Journey]

And EMS isn't specialized? Only difference between RT and Paramedic is one currently requires a degree nationally, other only in certain states.

Are you referring to Radiology or Respiratory Therapy? I have never seen a Paramedic do anything in the Radiology department.

For Respiratory Therapy, You might be trying to compare just giving a nebulizer or intubation.

About the only medication a Paramedic does from just the Respiratory specialty is Albuterol. Even RNs don't mess with some of the drugs and gases the Respiratory Therapists use. Paramedics also get very, very little training on ventilators, gas laws, hemodynamics or most critical care medicine topics which is where the RTs excel. They also get a whole semester in neonatal and pediatrics along with several days of clinicals with expected hands on. For intubation, the RT will have to be ready to do more than the actual skill. They also work with many other tubes that most Paramedics will never see.

Linuss, if you get your nursing degree and make it to the ICUs, you will see just how much each different profession does and their value to a health care team.

 

[Veneficus]

So, than, how is that a failure on EMS and not a failure on fire? Or a failure on the beaurocrats that allowed themselves to be conned by fire? Or on the general population for letting themselves being conned into accepting crappy service?

It is all one in the same. A fire service that does not provide EMS cannot fail at it.

A fire service that does provide EMS can fail to provide good EMS. In such a case, the area EMS system fails. Like I said in my earlier posts, look at the amount of EMS coverage by fire service, a failure there, is a large percentage of EMS.

You are asking me if I blame the failure of EMS providers both individual and organizational to set a standard, increase their own education, demonstrate their value, and evolve with the changing demands of medical care on third parties who EMS had the same opportunity as Fire to demonstrate itself as superior and did not capitalize on?

Doctors tell people why doctors are valuable.

Nurses tell people why they are valuable.

The fire Service tells people why they are valuable.

EMS providers failed to do so and nobody even knows the difference between an EMT-Basic and a medic. It seems that EMS has nobody to blame but themselves to me.

 

[Shishkabob]

Actually RTs and paramedics are quite different....

In the context of being a specialty, not in education/ role / skills / medications, as Journey incorrectly assumed.

 

[Journey]

In the context of being a specialty, not in education/ role / skills / medications, as Journey incorrectly assumed.

Since two of us thought you were comparing Paramedics to RTs, maybe it was how you wrote it.

 

[Shishkabob]

EMS providers failed to do so and nobody even knows the difference between an EMT-Basic and a medic. It seems that EMS has nobody to blame but themselves to me.

Or nurses trying to keep them down.

Or the IAFF trying to keep them down, take over EMS and water it down.

Or private agencies trying to keep their bottom dollar down.




There's more to blame than just the providers...

 

[Shishkabob]

Since two of us thought you were comparing Paramedics to RTs, maybe it was how you wrote it.

Yet you're the one who cut out the "And EMS isn't specialized?" part, which following logical thought and English language rules, means that the following sentences in the same paragraph are probably about the same idea... the two being a specialty.

 

[Veneficus]

Or nurses trying to keep them down.

Or the IAFF trying to keep them down, take over EMS and water it down.

Or private agencies trying to keep their bottom dollar down.

There's more to blame than just the providers...

I faulted organizations in my last post as well.

But compare the EMS providers to Australasia or Europe. As Meclin pointed out, in places where EMS providers have advanced themselves and demonstrated value that could not be copied or better provided, nurses cannot hope to replace the paramedics there.

Unfortunately in the US, paramedics (all EMS providers) cannot say the same.

 

[Journey]

Or nurses trying to keep them down.

Or the IAFF trying to keep them down, take over EMS and water it down.

Or private agencies trying to keep their bottom dollar down.




There's more to blame than just the providers...

Other professions got past the blame game to move on. The other professions also had much more to overcome since many of those professions you pointed out were done by nursing. It was a matter of proving a specialty was needed. EMS does not have this issue with many RNs in the field working on an ambulance and the Paramedic is the new kid.

 

[Shishkabob]

I faulted organizations in my last post as well.

But compare the EMS providers to Australasia or Europe. As Meclin pointed out, in places where EMS providers have advanced themselves and demonstrated value that could not be copied or better provided, nurses cannot hope to replace the paramedics there.

Unfortunately in the US, paramedics (all EMS providers) cannot say the same.

And in how many countries where it is "accepted" that their EMS is better, is EMS run in any significant number by private agencies or fire departments, and not just the government?



I think we found our problem, and at the same time, our answer.

 

[Veneficus]

And in how many countries where it is "accepted" that their EMS is better, is EMS run in any significant number by private agencies or fire departments, and not just the government?



I think we found our problem, and at the same time, our answer.

I think we always knew the problems. My OP was about the solution.

 

[usalsfyre]

Or nurses trying to keep them down.

Or the IAFF trying to keep them down, take over EMS and water it down.

Or private agencies trying to keep their bottom dollar down.




There's more to blame than just the providers...

I'll say yes to the second two. The nursing ivory tower as a whole is far more concerned with thier asault on physicians to do more than growl at medics. Our lack of standardized education has kept us out of the hospitals more than nursing (although they have contributed some).

If you REALLY wanted to see nursing fur fly, fix the LP program, give us a real, honest to God liscense we work on instead of the Doc's and petition legislature to let us opperate in EDs at the same level as RNs. I can hear the screams of "patient safety" from Austin now...

 

[Journey]

And according to my wife, 9 to 10 month non-degree rad-tech programs exist.

Radiology is still trying to find itself with a very rapidly growing field and many different areas to specialize in with each requiring some depth of education and training. Within their profession they have Radiography, Radiation Therapy, Limited X-ray Machine Operators, Nuclear Medicine Technology, Fusion Imaging, Magnetic Resonance, Mammography, Sonography, Computed Tomography, Cardiovascular Technologists and Fluoroscopy. Like other professions, they are still trying to get each and all of these professions licensed in all the states.

 

[Shishkabob]

And they freaked out a decade ago when the push was made for the Licensed Paramedic

Thing is, it developed no teeth, and an LP is no different than a CP. It was intended to replace nurses in the trauma room, but alas...





I just love that how out in the field, I can choose to give any number of the 60 different drugs on my truck at my discretion, and give as much NS and LR to a patient as I want, yet I go in to a hospital and they (generic they) freak out if a Paramedic tech pushes 10cc of saline.... Yeah, they got their priorities right...

 

[sir.shocksalot]

I totally agree with Vene, I think EMS could advance way beyond where it is now if we let nurses do it. I would venture that after 500 hours of rides or so a Nurse would probably do just fine on their own. Plus you are not going to have to worry about the nurse on C shift who just wants to get on with fire and so s/he hasn't opened a book since nursing school, and there is a good chance they didn't open one then. Every nurse, regardless of whether they want to be on the rig or not, still wants to do well in medicine, because nursing is a REAL career with real opportunities for advancement clinically and academically.
As for Mel, well we know that AUS and NZ have a way different system that is, in almost every respect, better (hire me; no seriously I'm an Australian citizen so hire me!!!!!). Paramedics are well respected and well educated there, again there is no issue of the one dude that is just waiting for a fire job.

This is the only job I know of that doesn't reward people in it who continue to educate themselves. I went through the best program in the state, and am 2 classes away from my associates degree, yet the hosemonkey medics still tell me what to do even though they have never completed a college level biology course, let alone anatomy and physiology. I recently came of the opinion that EMS is going in the hole, especially in my state, and it's time to get into nursing while I can.

 

[WTEngel]

Good call usal...

I really have nothing but love for my RN colleagues, however, the BNE exerts a HUGE amount of leverage over what is considered safe and unsafe in regards to patient care, and most of what is considered unsafe has quite a bit to do with how no other profession can do certain tasks better than nurses.

Now, can EMS in the US be better? Certainly...so can every other allied health profession and nursing also. No one profession can claim they have reached a point of perfection.

Has EMS in the US failed? Not by a longshot. Education has improved since the inception of EMS. it has a long way to go, but it has improved. Ask patients whose life has been saved by a competent EMS professional if they feel like EMS is a failure.

I understand the point you are making, and I agree with it. What I do not agree with is sensational statements like EMS is a failure.

 

[JPINFV]

If you REALLY wanted to see nursing fur fly, fix the LP program, give us a real, honest to God licsene we work on instead of the Doc's and petition legislature to let us opperate in EDs at the same level as RNs. I can hear the screams of "patient safety" from Austin now...

In terms of medical interventions, there's very little difference between how nurses implement medical orders and paramedics implement medical orders except the mix of patient specific orders (i.e. online control of paramedics, written orders for hospital) and standing orders (offline protocol for EMS). Even when it comes to nurse practitioners, there's a certain amount of legal dancing involved. For example, in California, the scope of practice for a RN and a NP is the same. NPs rely on "standardized procedures" in order to provide medical care beyond what an RN normally does. While I will admit that I am not familiar with the exact wording of the standardized procedures, I would guess that they are basically very broadly written standing orders that cover the "furnishing of drugs and medical devices" under a physicians supervision.

It looks like you're advocating for independent practice rights which won't happen short of making paramedicine a doctorate level, which isn't going to happen for multiple reasons, including necessity. There's a need for better physician involvement, but unless you can separate prehospital care out of medicine like nursing has done in terms of nursing care or the cases of optometry and podiatry (both of which are doctorate level), you aren't going to see paramedics free of physicians.

In terms of license vs certificate, all 50 states license paramedics, even if they don't call it that.

 

[Veneficus]

I understand the point you are making, and I agree with it. What I do not agree with is sensational statements like EMS is a failure.

What I guess I should have said is that EMS has failed to make itself what it could/should be.