The ideal paramedic program -- how would you do it?

systemet

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I partially derailed someone else's thread about A&P textbooks in the "EMS Talk" section the other day by talking about how I would change EMS education if I was in charge.

<stands on soapbox>

I think we should have a four year bachelor's degree for entry to practice. I'd like to see the first two years being similar to any biology degree, including MCAT pre-reqs.

The idea behind this, is it would give paramedics a grounding in biological science, so that they can better understand pharmacology, (patho)physiology, and perhaps more importantly, the scientific process.

I think this would go a long way towards professionalising paramedicine (much as the BSN has done for the nurses).

<off soapbox>

What do you think? Is this a good idea? Is there anywhere where a bachelor's degree is already required for entry to paramedic practice? What would you guys do to improve paramedic (or EMT) training? Or is the current training good enough?

I have no ulterior motive here. I'm just interested in people's opinions.
 

medicRob

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TransportJockey

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thegreypilgrim

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medicRob

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+1

This is how things ought to be.


Absolutely. You guys know how I get on here and rant about how Paramedic programs should have chemistry, real A & P, micro, etc... When I saw this program in one of JT's posts, I was impressed. Dare I say, my faith was restored in EMS education.

I also like the idea of an EMS Academy that is ran by a medical school, especially one with an EMS Physician program. I think we should institute these programs across the US and have the BS programs ran by med schools and universities, while leaving the AAS to the Community colleges, and find some way to incorporate training in community health (for that magic day when we are able to bill as urgent care and actually get paid for Paramedic skill hours rather than mileage).

:)
 

Rykielz

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It's a great idea and a lot of other countries such as Australia actually do that. However, the current system would have to change and I'm sure an ambulance ride would more than double if this were to happen. Lot of unhappy patients:p
 

medicRob

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It's a great idea and a lot of other countries such as Australia actually do that. However, the current system would have to change and I'm sure an ambulance ride would more than double if this were to happen. Lot of unhappy patients:p

EMS Levels would have to be consolidated and standardized across the US, The role of the EMS provider would have to be redefined to include specialty training in areas of Critical Care, Community Health, and Emergency Dept Paramedicine, requiring us to re-evaluate how EMS is billed (i.e. When Paramedic is recognize as licensed professionals, they can start being billed based on Skill hours like nurses, rather than mileage and generate more revenue). Moreover, for community paramedicine, we would have to explore the utilization of Urgent Care billing in EMS by insurance companies since treating and streeting a patient with no transport = No revenue. Furthermore, we would need to seek the Federalization of EMS in which a single agency oversees EMS as a whole while providing federal funding for Equipment under homeland security grants (Since EMS is an integral part) as well as funding for prehospital research studies which would evaluate specifically the efficacy of interventions in the prehospital field where they are more applicable to us as opposed to those conducted in hospital settings under different environments, thus leading to an evidence base, moving us that much closer to being recognized as a profession.
 
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Rykielz

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Haha I've had those mornings. =P I think the big problem right now, across the board, is back in the 1970's the DOT placed the responsibility of EMS with the fire departments. Today, with advancements in building construction and fire prevention the fire departments have practically put themselves out of a job. They now rely HEAVILY on the EMS side of things to justify their existence. If the idea were to be proposed to create a separate EMS authority I'm sure there'd be a lot of opposition because of this.
 

medicRob

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Haha I've had those mornings. =P I think the big problem right now, across the board, is back in the 1970's the DOT placed the responsibility of EMS with the fire departments. Today, with advancements in building construction and fire prevention the fire departments have practically put themselves out of a job. They now rely HEAVILY on the EMS side of things to justify their existence. If the idea were to be proposed to create a separate EMS authority I'm sure there'd be a lot of opposition because of this.

It has been proposed and legislation passed by Homeland Security gives them the ability to Federalize EMS. Here is the white paper:

http://www.jems.com/sites/default/files/Consolidated Federal Leadership for EMS 02-14-2011.pdf
 

Rykielz

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The laws Homeland Security passed were more to satisfy public outrage for the disaster they made with Katrina. The governments already broke with its thousands of pointless programs. I doubt they'll be able to take on such a huge and expensive, but imperative, responsibility such as EMS.
 

MrBrown

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Associates degree for a "Paramedic" (ie upskilled ILS provider) and a bachelors degree for "Intensive Care Paramedic" (traditional ALS provider).

EMT should be preserved for volunteer only crews as a reasonable alternate.
 
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systemet

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The UNM program looked interesting. I was suprised to see things like psychology, philosophy, and sociology / anthropology in the course list. I've taken some philosophy myself, just professional ethics and introduction to epistemology, but I've never taken any sociology / anthropology.

What do people think about this? Are these courses useful for a paramedic? Or would it be better to have more physiology? Are there things in this program that people would change? Things they would add?

Mr Brown -- you say associate's for an ILS paramedic (Do you have associate's in NZ? I thought the associate's degree only existed in the US?), and bachelor's for the intensive care paramedic. I think you already have these programs, right? What works well / doesn't work? What sort of traditional university courses are included? Does the current system allow for lateral movement of RNs and medics? Will I ever stop asking questions?
 

medicRob

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The UNM program looked interesting. I was suprised to see things like psychology, philosophy, and sociology / anthropology in the course list. I've taken some philosophy myself, just professional ethics and introduction to epistemology, but I've never taken any sociology / anthropology.

Those courses are to satisfy general education requirements as well as to better prepare students who are doing the Pre-Med focus of this program.

Psychology is absolutely helpful in paramedicine. Moreover, Sociology teaches you about things such as social institutions and the role they play in the belief and thought systems of the people you treat. You are also exposed to the taboos of certain cultures that you may not have taken into account. Furthermore, this program, in my opinion is the best one in the US curriculum wise.
 

HotelCo

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I love the curriculum, but I won't put myself into educational debt and make the same amount that I do now. If there were some guarantee that I'd make substantially more than I do now, I'd be all for it.
 
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Bieber

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In my state becoming a paramedic requires obtaining an Associate's as well, and I STILL think we need more education. I would kill for the chance to attend UNM's program, unfortunately I'm going to have to settle for a Bachelor's in Biology and another Associate's (in Nursing) instead.

I tend to agree with Brown with regards to what the educational requirements ought to be.
 

M3dicDO

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I agree that there should be stronger Paramedic programs across the country. Around Chicago we have hospitals that host paramedic training as a certificate program. They are linked to community colleges so graduates can use the 20+ credit hours towards an associates degree. Beyond that, these credit hours are useless (here in IL). I tried using the hours towards my Bachelor's degree and had no luck at any public or private university. Had no choice but to be a fulltime undergrad student during the day and medic student in the evening....:wacko:

I think UMN's program should be offered in every state. There are a lot of paramedics that go on to higher training MD/DO, PA, CRNA, etc. and having a program like this would have definitely help. I am a big proponent of "professionalizing" EMS and making this medical profession as reputable as any other. Courses like psychology and sociology aren't very important to a paramedic's medical practice individually, but when you add it all together, you have a much better patient advocate (IMO).
 

M3dicDO

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MrBrown

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Mr Brown -- you say associate's for an ILS paramedic (Do you have associate's in NZ? I thought the associate's degree only existed in the US?), and bachelor's for the intensive care paramedic. I think you already have these programs, right? What works well / doesn't work? What sort of traditional university courses are included? Does the current system allow for lateral movement of RNs and medics? Will I ever stop asking questions?

We have two types of higher education - the "University" track which only awards Bachelors and higher Degrees as well as the "vocational/polytechnic" track which has Certificates (six months to one year of study) and two year Diplomas. These however are more towards the "technical" skill base and less towards the high level cognitive knowledge research based side of things that you find in University.

Our education system matriculates students into University after five years of high school so unlike the US, we do not have a "liberal arts" or "general education" component to our post-secondary education. A Bachelors Degree here is a three year course of highly specialised study in a particular field with no room for any coursework outside the sphere of "upper division" or "major" to use US terms. Even Certificates and Diplomas taken at polytech do not have any "general education". The notion of "pre-reqs" is also null and void here, for you take those classes as part of the core program.

The EMS system has three levels, an emergency medical technician (EMT) which requires a Diploma (one year), Paramedic (Bachelors Degree) and Intensive Care Paramedic (Post Graduate diploma). While it is possible secure employment as a paid Ambulance Officer at the EMT level there is a stated (and ever increasing) bias towards Degree graduates and Brown suspects it will soon be mandatory to have the Degree to become a paid Officer.

At the moment there is no movement between Paramedic and Nursing, the two are very seperate, completely distinct qualifications ie Bachelor of Nursing and Bachelor of Health Science (Paramedic). There is however a crosswalk program in development which will see an eighteen month program to convert Registered Nurses into Paramedics and vice versa. There is little movement of Paramedics into Nursing because here Ambulance is a well paid, well respected, seperate profession and not a "stepping stone". Now on the other hand there is some movement of Nurses into the Ambulance Service and with the new crosswalk program it will be considerably easier.

The Degree program works really well as it teaches student ambos a thorough grounding in the fundamental skills and knowledge required to be ambos, think critically, think clinically and prepears them for lifelong learning which is so critical to the profession. It gives them an excellent perspective of Ambulance and Paramedics as a part of the wider healthcare picture and educates to think on a level above "bus monkey" or scoop and run.

Where Brown thinks the Degree falls over a little is that it allows high school graduates with no prior work or life experience to become an ambo. Brown is of the belief that those who are a little older, nontraditional students with work and life experience make for better ambos.

Brown suggests a two and four Degree for your system because your Bachelors Degrees are four years long not three like ours and there needs to be a distinct, thorough qualification for ILS people as well as preserving BLS for volunteer only crews as a reasonable alternate.

Our BHSc(Paramedic) degree is as follows:

YEAR ONE
Psychology and Lifespan Development, Human Anatomy and Physiology I, Knowledge, Enquiry and Communication, Health and Environment, Introduction to Paramedic Practice, Human Anatomy and Physiology II, Risk Management

YEAR TWO
Methods of Research and Enquiry, Pharmacology for Professional Practice,
Professional Practice and Ethics, Intraveous Therapy, Paramedic Science, Clinical Practice I, Clinical Practice II, Cardiology

YEAR THREE
Health Law & Policy, Disaster Theory, Clinical Reasoning, Paramedic Theory and Management, Paramedic Theory and Management, Clinical Practice III, Emergency Planning

Our levels are as follows:

Emergency Medical Technician
Oxygen, OPA, NPA, LMA, entonox, methoxyflurane, aspirin, GTN, salbutamol, glucose, glucagon, paracetamol, ondansetron, 3 lead ECG monitoring, defibrillation, CAT.

Paramedic
12 lead ECG interpretation, manual defibrillation, cardioversion, IV cannulation, IV fluid administration, adrenaline, naloxone, morphine

Intensive Care Paramedic
Endotracheal intubation, cricothyrotomy, intraosseous needle access, chest decompression, atropine, amiodarone, midazolam, ketamine, frusemide, pacing, rapid sequence intubation, thrombolysis (select Officers only)
 
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