Say goodbye to your career

[RESQ_5_1]

Do these studies mean you want a BLS truck for your mother while she chokes on a piece of meat firmly stuck in her larynx where only direct visualization will save her? A BLS truck to the soccer field when your kid forgets his inhaler and has an asthma attack? A BLS truck when your daughter develops severe anaphalytic shock at school? What about when your wife has chest pain where the medic could have done a 12 lead and determined STEMI and brought her to the cath lab when instead she is brought to the local doc in the box ER and dies from cardiac arrest?

Here in Rural Alberta, I work on a BLS car. There is myself and my partner who are both EMT-A's (equivelant of EMT-I in the states). Other than direct visualization of airway blockage and 12 leads, I have protocols and training in place to treat each of these pts to maximize a positive outcome. I'm allowed to give nebulized bronchiodilators. With online medical control, I am allowed to give Epi for Anaphylactic reactions. I'm allowed to give ASA and Nitro for cardiac chest pain.

 

[Arkymedic]

Where in MO do you live? When I was working on the truck I made $10.00/hr FT and 12.50 pt and most EMTs in MO made better than I did. Also, I have a BS and an AAS and the AAS is not worth :censored::censored::censored::censored:. Since it is a technical degree, many colleges will not even accept it for anything but elective credit.

I agree with you.
There are a lot of problems though. Around here EMT B usually only get paid a little over minimum wage and medics not much better. Pay varies greatly by company and area.
With more education people will expect and need to be paid more. There will be education loans to pay back and so forth. EMS just needs a major reworking.

More education would be great. It would be nice to see paramedics with at least a AAS. I don't think they would need a 4 year degree.
Students don't get near enough training. A few hours on an ambulance and your ready to go! HAHA

 

[daedalus]

myycroft, I would not allow PA on my truck. The Paramedic is designed for field work, not the other way around. I'm not going to give up on that model.
Some things need to change, but so do they in all areas of medicine, including the primary care crisis and the emergency care crisis (in hospital).

If they want evidence based paramedicine, we are already integrating that into our practice. I can think of implementation of field diagnosis of STEMI and reduction in door to ballon time is one pathology we ca make a real difference in. CHF patients placed on CPAP in the field are able to stay out of ICU and off vents at the hospital. Soon we will be able to cool down our arrest patients, saving more for neurologically acceptable outcomes. Decompression of tension pneumothoracies is needed emergently in patients with cardiovascular collapse.

Anyone care to add>

 

[VentMedic]

Yes, you can train military medics quickly (or basic EMT's, or maybe even paramedics if you cut back the academic undergrowth), but the longer the transprt and the trickier the case, the greater the likelihood for negative outcome. How about concentrating funding for higher-end responders to areas with longer response times (as well as more PA's FNP's, etc), and expand non-ER resources in short response areas to stop wasting your time on non-emergency calls and trying to find an ER with an open bay?

myycroft, I would not allow PA on my truck. The Paramedic is designed for field work, not the other way around. I'm not going to give up on that model.
Some things need to change, but so do they in all areas of medicine, including the primary care crisis and the emergency care crisis (in hospital).

If they want evidence based paramedicine, we are already integrating that into our practice. I can think of implementation of field diagnosis of STEMI and reduction in door to ballon time is one pathology we ca make a real difference in. CHF patients placed on CPAP in the field are able to stay out of ICU and off vents at the hospital. Soon we will be able to cool down our arrest patients, saving more for neurologically acceptable outcomes. Decompression of tension pneumothoracies is needed emergently in patients with cardiovascular collapse.

Anyone care to add

You are confusing a few skills with education and knowledge to treat definitively.

We have been doing STEMI recognition almost since the beginning of EMS time and 12 lead EKGs for at least 25 years. MAny services have tried to take the patient to the most appropriate facility long before they came up with fancy names for it. Decompressioning pneumos and cardiac tamponades have been skills for over 35 years. CPAP has been around for well over 50 years just not as portable as it is today. I did CPAP in transport almost 30 years ago.

But, these are just skills to get the patient from point A to point B. CPAP is not a cure nor is needling the chest. Hypothermia is useless unless you have the ability to keep that patient stabilized for the duration. Snags have been hit in that area also when it comes to prehospital hypothermia. Some may have over estimated their abilities in the prehospital setting.

The concept that I also mentioned before, PAs and NPs can treat the minor ailments, order diagnostic tests and write scripts. The patient does not need to come to the hospital. Now, the EMT(P) may tell a patient they don't need to good to the hospital by ambulance, but the care basically stops there. The patient will still need to get into a crowded clinic, ED or doctor's office.

The UK is expanding their moded for patient care in the field.

http://www.emsresponder.com/article/article.jsp?id=8630&siteSection=1

However, the studies done testing the knowledge of U.S. Paramedics' abilities to predict patient care is not good.

How well do paramedics predict admission to the hospital? A prospective study.

http://www.ncbi.nlm.nih.gov/pubmed/16798145

It is concluded that paramedics have very limited ability to predict whether transported patients require admission and the level of required care. In our EMS system, the prehospital diversion policies should not be based solely on paramedic determination.

Can paramedics accurately identify patients who do not require emergency department care?
http://www.ncbi.nlm.nih.gov/pubmed/12385603

In 85 cases where paramedics felt ED transport was unnecessary, 27 (32%) met criteria for ED treatment, including 15 (18%) who were admitted and five (6%) who were admitted to an intensive care unit. CONCLUSION: In this urban system, paramedics cannot reliably predict which patients do and do not require ED care.

You can also compare your EMS training to that of a PA who has 6 years of college and an 18 month residency in Emergency Medicine with the ability as a true Physician Extender to diagnosis and prescribe. Now tell me who may better serve the patient in the field and avoid congestion in the ED. While they are more expensive, they may be worth every penny in the long run.

PA Emergency Med Residency (you can see the requirements under application process)
http://www.hopkinsbayview.org/emresidency/details.html

The Paramedic in the U.S. has a long, long way to go. Some may be prepared since they have continued their education regardless of the minimum requirements but they may still be judged in this country by the lowest common denomonator. It is the attitudes of "not on my truck" that holds some back. That can refer to another trained professional or to a patient they perceive unworthy of transport but do not have the ability to do much more because it is not an EMERGENCY and some heroic skill is not involved. To them it is not about the practice of sound medicine that may also benefit the greater need. Prehospital medicine has to evolve beyond the days of Johnny and Roy.

I also believe the ALS provider is needed who can better determine who is not in need of emergent care. I do not believe in someone having to wait for the "right" level of truck to arrive. That is a waste of resources. The Paramedic should be the entry level and the next step of service should be a PA or NP made available in the field and maybe someday in the future the Paramedic Practitioner as Rid as always hoped for.

 

[daedalus]

I do think we have the right to defend our profession. Just as doctors are outraged with the prospective Doctorate Nurse Practitioner, and Nurses have barred paramedics from in hospital work, I will fight tooth and nail no one other than paramedics on the ambulance. Its the one thing that we do have, and we WILL keep it. I have discussed before allowing paramedics to refuse transport and refer to GP (as it should be. These pts do not need field treatment rather they need followup care. Find me a doctor who wants to go our on house calls for patients who incorrectly dialed 911). Along with this, entry requirements to paramedic programs should contain anatomy/physiology, microbiology, chemistry, biology, physics, and pharmacology. As I continue my medical education I realise more and more you cannot learn medicine without having a solid grasp on basic science. After these entry requirements, paramedic programs should award an AAS just as nursing programs do, and university programs should offer an extension to MS in paramedicine which requires more clinical rotations in more areas including primary care and radiology.

Im sorry but I invested far to much and have worked too hard to see this happen. I am frankly surprised by the dull discussion here, we are discussing out own survival. If we do not continue to fight for evidence based practice and better entry education we will be selected out of medicine.

 

[Arkymedic]

I would go a step further and say it needs to be a BS. An AAS is worth jack crap and as I mentioned above, many schools will not accept it as it is vocational and cannot transfer.

I do think we have the right to defend our profession. Just as doctors are outraged with the prospective Doctorate Nurse Practitioner, and Nurses have barred paramedics from in hospital work, I will fight tooth and nail no one other than paramedics on the ambulance. Its the one thing that we do have, and we WILL keep it. I have discussed before allowing paramedics to refuse transport and refer to GP (as it should be. These pts do not need field treatment rather they need followup care. Find me a doctor who wants to go our on house calls for patients who incorrectly dialed 911). Along with this, entry requirements to paramedic programs should contain anatomy/physiology, microbiology, chemistry, biology, physics, and pharmacology. As I continue my medical education I realise more and more you cannot learn medicine without having a solid grasp on basic science. After these entry requirements, paramedic programs should award an AAS just as nursing programs do, and university programs should offer an extension to MS in paramedicine which requires more clinical rotations in more areas including primary care and radiology.

Im sorry but I invested far to much and have worked too hard to see this happen. I am frankly surprised by the dull discussion here, we are discussing out own survival. If we do not continue to fight for evidence based practice and better entry education we will be selected out of medicine.

 

[VentMedic]

daedalus[/b];110362]I do think we have the right to defend our profession. Just as doctors are outraged with the prospective Doctorate Nurse Practitioner, and Nurses have barred paramedics from in hospital work, I will fight tooth and nail no one other than paramedics on the ambulance. Its the one thing that we do have, and we WILL keep it. I have discussed before allowing paramedics to refuse transport and refer to GP (as it should be. These pts do not need field treatment rather they need followup care. Find me a doctor who wants to go our on house calls for patients who incorrectly dialed 911). Along with this, entry requirements to paramedic programs should contain anatomy/physiology, microbiology, chemistry, biology, physics, and pharmacology. As I continue my medical education I realise more and more you cannot learn medicine without having a solid grasp on basic science. After these entry requirements, paramedic programs should award an AAS just as nursing programs do, and university programs should offer an extension to MS in paramedicine which requires more clinical rotations in more areas including primary care and radiology.

Im sorry but I invested far to much and have worked too hard to see this happen. I am frankly surprised by the dull discussion here, we are discussing out own survival. If we do not continue to fight for evidence based practice and better entry education we will be selected out of medicine.

Defend the profession? What is to defend as it is? Are you wanting it to stay in the same state? Yes, you idea for more education is great but in reality, just this month we have had at least 3 more FDs announce they would be training their own Paramedics in the backroom of the station.

Arkymedic

I would go a step further and say it needs to be a BS. An AAS is worth jack crap and as I mentioned above, many schools will not accept it as it is vocational and cannot transfer.

Agreed.

daedalus

I have discussed before allowing paramedics to refuse transport and refer to GP (as it should be. These pts do not need field treatment rather they need followup care.

Great.. they refuse transport and sign your refusal form. You tell them to see a doctor and go back to your lazy boy recliner. Having a practitioner on board that can provide the same level of care they would receive in the ED makes one patient less at the clinics, Doctors' offices and EDs.
daedalus

Just as doctors are outraged with the prospective Doctorate Nurse Practitioner,

Doctors do not have a problem with this since it was explained properly. Educated people understand what a Doctorate is and how a degree and scope of practice must be determined. NPs, Advanced Practice Nurses and Doctorate Nurses have existed very well in progressive hospitals and doctors' offices for quite some time. At least nursing has the foresight to keep their profession growing and offer opportunities for RNs to advance with jumping to a totally different profession. What do you think EMS providers could learn from this?

and Nurses have barred paramedics from in hospital

Read your state's statutes. Nurses DID NOT do this to the Paramedics. EMS did this by defining PREHOSPITAL care. Nurses also know they need extra training to work out of hospital be it Flight, CCT, EMS or Specialty. Why do some in EMS want to blame everyone else for their own profession's problems? Nurses didn't tell Paramedics to stay at a 700 hour certificate or to create so many "certs" that one doesn't know what to call someone that could be an EMT or Paramedic.

It is also ridiculous every time I hear a Paramedic say "I can intubate therefore I am better than a nurse and should be working in the ED". Doing a few skills without the extra education about disease processes, patient teaching and long term care does not qualify you to be a nurse. You were trained specifically for PreHospital medicine.

Find me a doctor who wants to go our on house calls for patients who incorrectly dialed 911).

Doctors are again making house calls in some areas.

Fight for your own profession through being active in lobbying for more education instead of making inflammatory statements toward other professions. If you want advanced legislative measures, the RN, PA and MD associations are the ones you want on your side. If you want to just get into a peeing match with them you will loose miserably. Take some lessons from what all of the other allied health professions have learned.

I will again use the example that happens at many state and national EMS conferences. Someone in a political position who could make a difference in a piece of legislation for the betterment of EMS is asked to speak and answer questions. Maybe out of 10,000 attendees, 20 - 30 attend the session and those may be ones that have their own interests in mind and not for the betterment of EMS. Often they are the Fire Chiefs or representatives of the Fire unions who don't want change. Their voice is heard. The other 9,970 conference attendees, that didn't want to listening to some boring politician, are hangin' at the pool bar *****ing about some of the things that this one piece of legislation could have resolved.

 

[daedalus]

Vent, I did not make inflammatory statements against other professions. Medicine is team work, where medical doctors are the leaders but cannot function with out the radiological techs, nurses, RRTs, etc.

Where as RNs are known to be the top of the food chain of Nursing practice, Paramedics are known traditionally to be on top of pre-hospital medicine (both supervised and given orders from a physician).

I will not lose an ounce of sleep however demanding that as a paramedic, I will be the end all for prehospital medicine (with increased educational standards).

On on the contrary to whining about this on the internet, this is a self proclaimed EMS board, where I intend to bring this issue up so that others can see what the good doctors see us as right now. It should scare us into doing more, and attending those conferences.

Im not sure why you pick apart my posts, or what your negative experiences may have been with EMS, but I assure you my intentions are sound.

 

[daedalus]

Great.. they refuse transport and sign your refusal form. You tell them to see a doctor and go back to your lazy boy recliner. Having a practitioner on board that can provide the same level of care they would receive in the ED makes one patient less at the clinics, Doctors' offices and EDs.

Its unacceptable to call for an ambulance for non-emergent health concerns. This will always be my point of view, and its such a radical idea to convert medicine to fleets of vans that bring doctors to the patients homes that this will never be realised. Medicine will stay at doctors offices and hospitals where is belongs, and paramedics as extenders will bring advanced care to patients out and about who need urgent attention. I do not ever see this changing, and to suggest otherwise without extensive theory and studies is pretty strange.

 

[VentMedic]

Im not sure why you pick apart my posts, or what your negative experiences may have been with EMS, but I assure you my intentions are sound.

Because I hear some of the same statements at every EMS meeting I attend be it regional, state or national.

I am politically active in two professions in two states. I have seen the different approaches of each. Right now, Florida is going to remain a hold out with the NREMT at the Paramedic level and the medic mills are flourishing with the FDs' backing.

Not pick on you personally but you just gave me a little fuel to continue with my speech. I hope to get some to think and not just go with flow of that's the way its always been or that nursing controls the profession's destiny. Things were much easier 40 years ago in prehospital medicine and issues with the nation's healthcare system. EMS has failed to respond to the growing needs over the past few years and have created the opening for the FDs to "continue the tradition" in the 1970s style. Yes, there are some exceptional FD departments providing EMS but the mentality from the article I posted from the FD doctor in 1998 still exists. You can also see it from reading the forums and I know you for one is very aware of the issues since you do recognize the need for education and do present good discussions.

 

[VentMedic]

This will always be my point of view, and its such a radical idea to convert medicine to fleets of vans that bring doctors to the patients homes that this will never be realised. Medicine will stay at doctors offices and hospitals where is belongs, and paramedics as extenders will bring advanced care to patients out and about who need urgent attention. I do not ever see this changing, and to suggest otherwise without extensive theory and studies is pretty strange.

My mother was treated by her physician at her home in Florida. His van had a portable X-ray and lab. He started this about 12 years ago. The concept of house calls is now growing. California also has physicians involved in home practice.

The PA and NP are trained/educated now. The Paramedic has yet to get the very minimum established to be in the running with other healthcare professions at even the entry level at the lowest acceptable licensed professional in the hospital.

Sidenote: The RRTs with Bachelors degrees are already petitioning for more privileges and reimbursement in out of hospital environments (homecare, clinics, doctors' ofcs) to expand their profession.

 

[daedalus]

Lets hope we can win this battle than, the alternative is grave for us.

 

[VentMedic]

Lets hope we can win this battle than, the alternative is grave for us.

There will always be a place for a prehospital practitioner. EMS just needs to determine the direction it takes. There is also a need for more out-of-hospital practitioners. Home care is a growing industry also as more people are returned to their home environment when possible due to the lack of LTC facilities.

EMS providers are behind in learning the new technologies that they will encounter. Many of the textbooks and protocols are still stuck in the 1980s.

Minor ailments should be treated in the field. However, unless knowledge and education are not expanded for the Paramedic they may not be the appropriate option. They may have to be paired with another practitioner (RN, NP, PA) initially as the UK model did until training is up to speed. However, I see a great opposition to this coming which will only delay and add to the existing problems. This is not the time for a turf war. This profession can only become stronger if it allies itself with other MEDICAL professions to move away from Fire based models. I'm am again not saying that EMS is going away but there has to be a change in the way EMS perceives medicine.

 

[Sjames]

Where in MO do you live? When I was working on the truck I made $10.00/hr FT and 12.50 pt and most EMTs in MO made better than I did. Also, I have a BS and an AAS and the AAS is not worth :censored::censored::censored::censored:. Since it is a technical degree, many colleges will not even accept it for anything but elective credit.

Newton County Ambulance
7.6 hr for EMT
8.6 hr paramedic

It does vary though. I believe Freeman pays a bit more and some other ambulance services.
Yah AAS is not worth much. Especially towards a 4 year degree. Usually just transfer your English and Science classes over and the rest is electives.

 

[EMT-P633]

This profession can only become stronger if it allies itself with other MEDICAL professions to move away from Fire based models. I'm am again not saying that EMS is going away but there has to be a change in the way EMS perceives medicine.

Agreed 100%

 

[Arkymedic]

It did not even count that much for me and the AAS bore the same name as the main school I was trying to transfer back into. I know some of the other services in SW MO pay a bit more.

Newton County Ambulance
7.6 hr for EMT
8.6 hr paramedic

It does vary though. I believe Freeman pays a bit more and some other ambulance services.
Yah AAS is not worth much. Especially towards a 4 year degree. Usually just transfer your English and Science classes over and the rest is electives.

 

[Sjames]

Very true

What are your degrees in if you don't mind me asking?

 

[Arkymedic]

Bachelors of Science in Emergency Administration and Management
Associates of Applied Science in Allied Health
Technical Certificate in Paramedic Technology
Technical Certificate in Firefighter Standards

Very true

What are your degrees in if you don't mind me asking?

 

[reaper]

Newton County Ambulance
7.6 hr for EMT
8.6 hr paramedic

It does vary though. I believe Freeman pays a bit more and some other ambulance services.
Yah AAS is not worth much. Especially towards a 4 year degree. Usually just transfer your English and Science classes over and the rest is electives.

I would not get out of bed for $8.60 an hour!:unsure:

 

[mycrofft]

Macro versus micro, and "endless preparedness".

Here's what this looks like from outside the ant farm: Everyone wants to elevate their set of letters' (EMT, etc) permitted treatments in the field and raise the level of education so that there is less of the "observe-decide on protocol-act" going on and more of the "observe-diagnose-treat" deal.

OK, follow the paradigm to its conclusions. One conclusion has the availability of EMS declining for many areas because they cannot support this brontosaurian (OK, tyranosaurian) prehospital treatment mode. Not as many people have what it takes to BE adequately prepared paramedics or uber-EMT's, schools will produce poorly trained people to meet the need like a puppy mill. My favorite example, Cherry County, will see their prehospital care atrophy if the threshold of care is hiked up as though they were in a big town environment like Omaha or Chicago. Heck, its already happening.

Paramedics and EMT's were created to stop the killing of MVA victims in the field through malpractice, by the DOT/NHTSA, period. This fortuitously expanded to include "the Sick and Injured" as the first nationally approved texts said. The role they were created to fill is being vacated by people who want to act like MD's without going through med school (not necessarily a bad idea in all cases, while we are kicking paradigms around here) because they want the thrill and they want to do their patients the most good.

Are we sure we have a good paradigm to replace the old one? Are we all going to be "officers" and there will be no "enlisted" to care for the most people? Can a structure and system be devised to provide adequate prehospital care quickly to the most people in need, everywhere?