Requiring Post-High School education? (Associates Degrees / Bachelor Degrees / Etc)

[systemet]

Agree with all except this one.

I know of no paramedics that use anything more than simple suture techniques outside of the hand, face, or joint outside of the war/remote environments, where anything is better than nothing anyway.

Even things like delayed primary closure or reclosing a (forgive my spelling) dehisced wound are relatively simply procedures.

(far simpler than interpreting an EKG or intubating)

Mea culpa.

The training I received in suturing was extremely limited / very poor, and was limited to exactly what you described. But, a common argument for advanced practice has been that paramedics could irrigate and close a simple wound, and dispense a small pack or a full prescription of prophylactic antibiotics (if judged necessary). I think some of the UK paramedic practitioners may be doing elements of this.

Doing this in a treat-and-release environment would definitely required extra education beyond what I believe most paramedics have received.

 

[Veneficus]

Mea culpa.

The training I received in suturing was extremely limited / very poor, and was limited to exactly what you described. But, a common argument for advanced practice has been that paramedics could irrigate and close a simple wound, and dispense a small pack or a full prescription of prophylactic antibiotics (if judged necessary). I think some of the UK paramedic practitioners may be doing elements of this.

Doing this in a treat-and-release environment would definitely required extra education beyond what I believe most paramedics have received.

Stop by the neighborhood, I will teach you all there is to know about suturing in about a day

 

[systemet]

Stop by the neighborhood, I will teach you all there is to know about suturing in about a day

Can you teach me how to stop dropping stuff on the floor? And how to not immediately contaminate my sterile field?

 

[Veneficus]

Can you teach me how to stop dropping stuff on the floor? And how to not immediately contaminate my sterile field?

practice

 

[mycrofft]

Ahem...
good nurse assisting...?

Like any medical procedure, know when NOT to, also.
------------
The amazing thing is not how poorly trained paramedics may or may not be, but how good a job so many of them do on the cases requiring more than BLS and despite/because of their training?

Somehow, some good folks and great instructors have sneaked (snuck?) into The System. Kudos to them.

 

[MedicBrew]

I think some of the UK paramedic practitioners may be doing elements of this.

Doing this in a treat-and-release environment would definitely required extra education beyond what I believe most paramedics have received.

Agreed. I would not feel comfortable doing this with the education I received in Paramedic class.

I can see the application with additional training. I’ve heard some offshore medics doing simple suturing on the rigs.

My first paramedic preceptor was finishing up his med school and it was funny to walk through the dayroom seeing him stitching on a Butterball turkey. Looked like fun, but I’ve never done it.

 

[MedicBrew]

Can you teach me how to stop dropping stuff on the floor? And how to not immediately contaminate my sterile field?

Off topic, but reminds me of a funny story during clinicals.

During our OR rotation we had to do 80 hours in the OR to get as many airway contacts as possible, intubations, SG airways whatever. We went in pairs.

The head scrub tech, or whatever his title was, during our orientation we did a walk through for the do’s and don’ts in the OR. Walking through the ortho room, gowned and masked up (no gloves), he was describing some instruments. My partner walks over and points to a particular tool with his hand DIRECTLY over this guy’s sterile field and inquires “what’s that”? The head scrub or whatever he was, sighs loudly obviously very upset marches over to the table, picks up the instrument and flings it against the opposite wall resulting in loud bang. He states “THAT WAS STERILE!” He points to a corner and says stand over there and keep quite.

The poor guy spent the next 2 weeks standing in the corner with his hands behind his back watching me tube something like 40 patients.

I still chuckle when I think of that, and it was over 12 yrs ago.

 

[Maine iac]

Serious question: Do you think that paramedics should be constrained to following a cookbook like protocol, or that they should have the ability to exercise judgement on what interventions they provide and how they provide it? The fundamental question of "How should paramedics think?" is what should drive education. Please note that this should not be constrained to the current demands and limitations in place, but a long term, "where should paramedicine be" goal.

One thing that is present in a hospital that is obviously not available in an ambulance is a pharmacy. Even if you were to open up the protocols you are still limited by what meds you have available. In that way I see the meds that you currently have as the limiting factor on your protocols (and thus your thought process).

Just curious but what are some protocols that you want to change? Do you not like that particular one because you are limited by the skills or by the medicine that you would want to give to the pt?

I think it depends on your location as there is a HUGE difference between urban and rural medicine. I've dealt with a few stabbings in the chest, but I was never in a position for a needle decompression because our response time was fast and the transport time was quick. Maybe if it took 45 minutes longer to deal with the pt, I would have been in a position to start thinking about pneumos. Similarly, with meds.. There are a few meds that I would like to give but most of them can wait my 10-15 minute transport time. My protocols are quite aggressive, compared to others, but I wouldn't mind having a little more leeway for a APE, or high acuity asthma attacks.

 

[mycrofft]

Old sidetrack..

I still think we need some way to get around the urban/suburban preconceived mindset when we talk about PEMS. Folks here did not in the past think a separate category was warranted. Maybe use the WIlderness section?

 

[STXmedic]

I've dealt with a few stabbings in the chest, but I was never in a position for a needle decompression because our response time was fast and the transport time was quick. Maybe if it took 45 minutes longer to deal with the pt, I would have been in a position to start thinking about pneumos. Similarly, with meds.. There are a few meds that I would like to give but most of them can wait my 10-15 minute transport time. My protocols are quite aggressive, compared to others, but I wouldn't mind having a little more leeway for a APE, or high acuity asthma attacks.

Really? I work in a city where we've got about 20 hospitals, very short transport times. Made many stabbings and shootings as well and done many decompressions. I've said it many times before, and it relates to many different areas, but transport time and time to treatment do not correlate. If it's an immediate life threat, yeah they'll get seen immediately. However, if it's an immediate life threat that you can address, why would you not address it?

 

[MedicSmith]

So... Anyone have a State that is requiring a degree (at some level) to become a Paramedic? How about for EMT's?

There has been rumors here in Oklahoma of such a mandate. At least for paramedics. But as of yet, nothing has officially changed. As far the idea behind it is concerned: I am a bit torn. I see the logic behind demanding an individual prove his/her commitment to the career field by undertaking an associates track in education, and I also see how it could help medics demand higher pay down the road.

On the other hand, EMS is a young industry in respect to medicine in general. The majority of us are in it because we want to help people. Our longevity in it has much more to do with the service(s) we end up working for, the experiences we go through, and our long-term goals. I think a decent medic without an associates degree working in the field for a year or two before moving on is anything but a bad ordeal. They will have helped people... Goal achieved.
As a fraternity, we can be a bit egotistical in this profession. We are the first to tout our accomplishments, and to question those of our peers'. That can be a dangerous and most certainly a counter-productive attitude towards the big picture- That being a stronger, more robust and respected field of medicine.

"Eating our young" rolls off of too many medics' tongues these days as if it were a good thing. I was fortunate to have patient instructors and preceptors, as well as peers and supervisors, who all understood that the majority of my education would take place when I was cleared and on my own. And that is exactly how it has been. I try to remind myself of that when I see a Basic student struggling with a BVM or taking a manual Bp. Showing them patience and understanding will only strengthen their skills, their love for the field, and their abilities as a future preceptor/instructor someday.

We are very few compared to the rest of the medical community, and again, we are a very young and evolving field. We MUST stick together and help each other succeed.
Cheers

 

[mycrofft]

Amen

 

[MedicBrew]

That's not gonna happen anytime soon. There still trying to rollout the new NREMT transitions as far as changing the levels, i.e. EMT, AEMT, and Paramedic, getting rid of intermediates all together..

It will happen I'm sure, but not in my lifetime.

 

[Maine iac]

Really? I work in a city where we've got about 20 hospitals, very short transport times. Made many stabbings and shootings as well and done many decompressions. I've said it many times before, and it relates to many different areas, but transport time and time to treatment do not correlate. If it's an immediate life threat, yeah they'll get seen immediately. However, if it's an immediate life threat that you can address, why would you not address it?

Sorry... What I meant by that was because of the short response times and transport times some of these issues don't present themselves like they do in a more rural situation (for instance a pneumo isn't instant and I might not see S/S right away). I'll do what ever my pt requires me to do (within reason).


My question was are people not happy with particular protocols because of lack of wiggle room, or because of what they are/aren't allowed to do.

Would more education cause the protocols to change, or allow us more medications?

 

[jjesusfreak01]

That's not gonna happen anytime soon. There still trying to rollout the new NREMT transitions as far as changing the levels, i.e. EMT, AEMT, and Paramedic, getting rid of intermediates all together..

It will happen I'm sure, but not in my lifetime.

For what it's worth, the new NREMT levels don't really change that much. Medics are still medics, basics are still basics, and I85s are now AEMTs. I99s were just undertrained medics and really needed to be done away with regardless.

While some believe that the "intermediate" level needs to end, it has to be asked how we intend to frame the future EMS system in the US. Do we want a model like the UK or Australia, where ambulances are staffed with Intermediates and Paramedics (Paramedics and IC Medics), or do we want to have highly trained medics on every truck with a basic driver. Do we want to go dual medic. Can't do that because it's too expensive. What do we want the minimum level on a truck to be, and what should be max level be?

 

[JPINFV]

One thing that is present in a hospital that is obviously not available in an ambulance is a pharmacy. Even if you were to open up the protocols you are still limited by what meds you have available. In that way I see the meds that you currently have as the limiting factor on your protocols (and thus your thought process).

Just curious but what are some protocols that you want to change? Do you not like that particular one because you are limited by the skills or by the medicine that you would want to give to the pt?

Well, medications have more than 1 use. There's also a question about how medications are administered. For example, there's evidence that lower concentrations of dextrose than D50 is better for adult patients. Can paramedics in your system dilute down D50 prior to administration, or are they expected to only administer D50 directly? More importantly, how often to patients fall between protocols?

Similarly, for a lot of the psychomotor skills, there's more than one way to skin a cat. Should all paramedics, for example, be expected to intubate the same way, or can a paramedic go to an airway CME and learn an alternative method and make that method his method of choice?

Is there any one single protocol I want to change? Well, I no longer operate under protocols, so the question is a rather moot point. I do, however, advocate giving educated paramedics more latitude to provide care consistent with good practices, if not necessarily always following the protocol to a T. I think paramedics should be able to, and expected to, use good clinical judgement instead of following a protocol to a T.

 

[tnoye1337]

Just curious. Would that mean a degree specifically geared towards EMS, or would my undergrad for PA school count?

 

[triemal04]

That being said, where is the data showing that any of that is true? Evidence-based medicine is a beast, isn't it?

Evidence based medicine is a good thing. Endotracheal intubation is a good thing.

When done correctly and used appropriately. When done correctly and used/interpretted incorrectly, they are terrible things.

The best analogy I saw was based on parachutes. In a nutshell, if you ever going skydiving, don't bother to pack a parachute. There has never been a study done that compared outcomes of using a parachute vs not using one. So, to follow along with some advocates of EBM, why bother taking one?
http://www.bmj.com/content/327/7429/1459

Funny, but appropriate.

 

[triemal04]

This thread turned in to same as all others on this issue which is respect and money. You not going to get government to require minimum level of education because it will result in you getting more money at work and be more respected.

A practical reason is needed and there is none. You can argue all you want on this issue but at the end of the day it's not going to happen anytime soon if ever. You're not a doctor, not RN and not PA. You work in ambulance for the most part doing transport. Even for those medics that run 911 they control bleeding if necessary, control pain(make patient comfortable), etc and get to the hospital ASAP. If there was real need for more education we would have doctor work on ambulances.

No, the (national) government won't require any changes without a lot of prodding. But where does it say that those of us in the profession can't force changes from within? Or at the state level?

Maybe we should try and fix the problems that we have created instead of looking for someone else to do it.

Perhaps you should stop trying to line your pockets to the fullest extent and give some thought to the system as a whole. Maybe if you did that you'd actually realize that, if standards were increased and that standard included a degree and was met by everyone nationally, it would be easier to increase reimbursements from medicare and insurance companies.

Which would mean that you, as the owner would actually be making more money. Of course you'd have to pay your employees more, and they might start asking for pesky things like health insurance, but you'd be ok with that...right?

Perhaps if you weren't so concerned with making a profit as a horizontal taxi service that shouldn't even need to employ EMT's you might realize that having a minimum level of education that has a recognizable standard attached (associate's or bachelors) is a large step in being seen as a real profession, and makes it much easier to argue about the "need" for services rendered.

I know you'd hate to see a degree required as it would, most likely, eventually cause an increase in wages, improvement in working conditions, and decrease the number of wannabes who will work for a shady/horrible company because they have no choice. I get that. Really...I can see where you are coming from. I just think you have more important things on your mind...like your personal profits.

EMS, EMT's, and paramedics have been, are are being misused across the country. Increasing the standards for entry (in this case requiring a degree) is one way to start fixing that. While it doesn't make any sense for someone concerned with profit, it does make sense for anyone who is concerned about our profession.

 

[mycrofft]

National government doesn't dictate standards (except maybe on national property and in their employment), they suggest and lend examples strongly suggested to be followed.