We don't need "training" in EMS

[JPINFV]

No, Paramedics need education, and they receive that education in paramedic school. Not that EMS is as simple as "you call we haul that's all", they do call and we do haul. We can and do provide Advanced Life Support, but isn't the ultimate goal still the same as an EMT-B, to stabilize and get the patient to definitive care at the hospital?

I would argue that EMS should be definitive emergency care for most patients. Hopefully, by the time the patient reaches the hospital, the acute emergency is over in most cases. Now I'm not advocating being able to do surgery or mobile cath labs, but if a patient needs to be intubated, I'd prefer that the provider is educated and trained on a wide variety of techniques and tools to achieve that and to be able to pick the right tool in the first place. This requires looking at interventions in a separate light than just steps in a protocol.

now we do have considerably more resources, training, and education than the EMTB. While I really would love to see advancements in the field of prehospital emergency medicine, at this point in time, I just do not see holding a college degree, affecting patient care.

How can you justify doing more without an educational base to work off of? It's easier to add roles to a provider that has an educational foundation to work off of than a training foundation to work on.

I actually do support prerequisites into Paramedic school, and into our field. But right now there are few, if any in most areas in place. So I do not see anything wrong with the path i have chose. I do not hold a college degree at this point, but I will, and degree or not, with the current scope of practice for the paramedic, I do not see the degree playing a large roll in the quality of my patient care.

Do you see yourself still on the street in 10, 20, or 30 years? What about becoming involved in training, education, administration, or other patient care levels (e.g. Wake Forrest's advanced practice paramedics)? I could see a lack of education as being a road block for those (not directed at you since you are looking at completing a degree) not seeking to advance their education.

 

[JPINFV]

Which is a good point. I believe we should strive for excellence in patient care, so yes we should train for the scenario where a patient is truly accurately ill(still not entirely seeing basic college education helping here). Now I ask you as a medic with your current SOPs, protocols, rules and regualtions what would you do differently for a patient with a commonly occuring illness that you may be able to fairly accurately predict in the field, as opposed to the obviously ill patient that can not possibly be diagnosed in the field, and may be hard to diagnose in the hospital setting. Ultimately would you treat a chronic bronchitis patient any different than a Fabry disease patient, in terms of prehospital care?

First let's be clear about what I am and where I'm heading. I'm an EMT-B with a masters degree currently in my first year of medical school. I am not a paramedic and would gladly yield patient care to a paramedic since a paramedic has completed their training (and hopefully education) and is better equipped (both physically and mentally [i.e. training/education]) to handle acutely ill patients.

As a basic, I know I've picked up on patients being sicker than they outwardly appeared and picked up on patients being more stable despite looking like a train wreck (in terms of acute illness. Most SNF patients are train wrecks of the chronic illness type). I've treated patients with acute psychiatric disorders differently because of my education (book plug: The Man Who Mistook His Wife For A Hat: And Other Clinical Tales by Oliver Sacks. ISBN: 0684853949). I'd argue that my PCRs were better written in large part due to the several writing courses I was required to take (including an upper division biological sciences writing course). I'd argue that taking statistics helped to understand the studies when I'd occasionally pick through the Journal of Emergency Medicine.

 

[Lifeguards For Life]

First let's be clear about what I am and where I'm heading. I'm an EMT-B with a masters degree currently in my first year of medical school. I am not a paramedic and would gladly yield patient care to a paramedic since a paramedic has completed their training (and hopefully education) and is better equipped (both physically and mentally [i.e. training/education]) to handle acutely ill patients.

As a basic, I know I've picked up on patients being sicker than they outwardly appeared and picked up on patients being more stable despite looking like a train wreck (in terms of acute illness. Most SNF patients are train wrecks of the chronic illness type). I've treated patients with acute psychiatric disorders differently because of my education (book plug: The Man Who Mistook His Wife For A Hat: And Other Clinical Tales by Oliver Sacks. ISBN: 0684853949). I'd argue that my PCRs were better written in large part due to the several writing courses I was required to take (including an upper division biological sciences writing course). I'd argue that taking statistics helped to understand the studies when I'd occasionally pick through the Journal of Emergency Medicine.

Well it seems we have come upon an agreement of sorts. congratulations on medical school. I hope you did not take any of my posts personal, and I thank you for a respectful, clean cut debate, as many civilized debates on this forum escalate, turn to name calling and get locked. Good luck to you in School, i'm sure i'll see you in the chat room later on

 

[ResTech]

If the ambulance only had a driver and a gurney, would the vast majority of the calls have a different outcome?

Actually, it some cases and call types, the patient would fair out better! This has been proven. Again, to go along with my point... the field is just that and patients need the hospital no matter how many degrees you hold.

 

[VentMedic]

Actually, it some cases and call types, the patient would fair out better!

I agree especially for medical transfers or dialysis. EMTs know very little about medical diagnoses or disease processes and get very complacent with these patients. The van driver that regularly sees his/her patients will often notice something isn't right immediately and go to the ED. Some EMTs have even brought dead patients to dialysis because they just thought the patient was sleeping.

 

[ResTech]

Attitudes like ResTechs are self limiting and will stunt your growth as a provider. "I only drive em to the ER".

Why is my take "self-limiting"? I am an advocate for increased educational standards and support them. I am even actively pursuing them in a degreed Paramedic program and plan on seeking a BS from George Washington University in EMS Management afterwards. If I didn't support education my plans for the future BS degree would not be in place... I would simply be happy with my Paramedic patch and be done with it.. but no.. I want the A.A.S degree AND the BS degree. Why? because I see the importance of a strong educational background not because I think my degree's will enable me to be smarter in cardiac emergencies or trauma, etc.

I have been in EMS long enough to know what works. I really dont want to get on the education thing.... but I know first hand what it takes to be a good provider and someone not having micro, statistics, or geometry, isn't gonna make a bit of difference when it comes down to the actual clinical care. In fact, the majority of Paramedic's I have worked with over the years... did not have degree's and were great and very knowledgeable Paramedics.

I'm just not willing to accept the condescending attitudes of you ppl towards Paramedics who do not have degree's or who think a non-degreed provider can not be as skilled.

 

[ResTech]

No, Vent... I'm talking about trauma patients where you have Paramedics who **** off for way too long on the scene...

 

[VentMedic]

In fact, the majority of Paramedic's I have worked with over the years... did not have degree's and were great and very knowledgeable Paramedics.

What are you basing this on? Many EMT-Bs think the Paramedics are great because they "look good" or were really nice to them. With the limited medical knowledge you have as an EMT-B are you really able to QA these medics at that level? Have you read their patient reports and found their charting to be in order and that they actually gave the proper meds by a good field diagnosis? Or, are you basing your experience from a couple of cool codes?

I have been in EMS long enough to know what works. I really dont want to get on the education thing.... but I know first hand what it takes to be a good provider and someone not having micro, statistics, or geometry, isn't gonna make a bit of difference when it comes down to the actual clinical care.

Your remarks just show how difficult to stress the importance of education to someone who doesn't have the background. It also shows that the Parmaedics you believe are so knowledgable probably aren't because you have nothing to compare them with.

No, Vent... I'm talking about trauma patients where you have Paramedics who **** off for way too long on the scene...

Frankly I could care less what you were talking about since the same could be applied to many different situations by providers who don't have enough education. But, you and I already had this discussion where you believe the Paramedic doesn't need a bunch of book learnin'. Just a few skills and a recipe book will make you a great Paramedic to the eyes of an EMT-B. But, when compared to even the health care professionals that have only a two year degree, what gives you credibility?

What a shame after 40+ years attitudes like yours still exist.

 

[ResTech]

lol.. laughable at how you try to tear something apart to satisfy your own views.

My college has both a degree option and a non-degree option... there are ppl in my class from both. So because one finishes with a degree and the other doesn't that means they are less able to apply their knowledge and skills in the field? Even though they were right there beside me hearing the same lectures and practicing the same skills? That makes no sense at all.

It's one thing to promote education, just don't be ignorant while doing so... get my point?

 

[VentMedic]

lol.. laughable at how you try to tear something apart to satisfy your own views.

My college has both a degree option and a non-degree option... there are ppl in my class from both. So because one finishes with a degree and the other doesn't that means they are less able to apply their knowledge and skills in the field? Even though they were right there beside me hearing the same lectures and practicing the same skills? That makes no sense at all.

It's one thing to promote education, just don't be ignorant while doing so... get my point?

Your arguments are so ridiculous about education, I am just astounded at what is working in the field sometimes.

Do you not think that those who are in the degree track and who have taken college level A&P and pharmacology don't process the information in Paramedic school differently?

There are reasons why every medical profession from RN to MD require prerequisites.

Many health care professionals can do the exact same skills as the Paramedic and much more. They actually have no problem incorporating the skills later since they have a good educational foundation even if they didn't cover them in their college program. Example: RNs doing intubation and central lines. These are both "skills" that the RN can learn in a very short time as well as have no problem getting the hospital to allow clinical practice. How many hospitals are reluctant to now allow the poorly educated Paramedic students to even do a "stand there and don't touch" clinical.

You again are only for a recipe and a few skills. That does not make a good clinician.

 

[Flight-LP]

lol.. laughable at how you try to tear something apart to satisfy your own views.

My college has both a degree option and a non-degree option... there are ppl in my class from both. So because one finishes with a degree and the other doesn't that means they are less able to apply their knowledge and skills in the field? Even though they were right there beside me hearing the same lectures and practicing the same skills? That makes no sense at all.

It's one thing to promote education, just don't be ignorant while doing so... get my point?

O.k. lets try this from a different angle if you feel Vent is biased. Can you clarify the terminology "****ing off"? What specifically are these medics doing in your mind that is an unacceptable delay for transport?

Please do answer the very valid question she has. What basis of statistical coorelation can you present to back up your belief of these non degreed paramedics being "better" than other degreed paramedics? See, Statistics is a needed class! There is a damn good reason why it is required at the Bachelor's level in health care.

I fail to see how a promotion or acceptance of education can be remotely interpreted as ignorant. Was this a statement made in a moment of heated passion for your position, or do you have a valid argument? If its the latter, please present it, otherwise, lets move on to something productive....................

 

[VentMedic]

Was this a statement made in a moment of heated passion for your position, or do you have a valid argument? If its the latter, please present it, otherwise, lets move on to something productive....................

He's had several of these "heated passion moments" as his stance against education has been consistent in several threads.

 

[ResTech]

I swear I feel like I am typing to a wall sometimes... how is spending two years in a degree program and plans to spend even more getting a BS degree not supportive of education? As I have stated all along, now sit down for this one as it may be a shock to some, it is possible to be a great provider without a degree. Acknowledging this and not belittling someone without a degree is not advocating we should remain where we are and not push for increased standards... it's simply that... an acknowledgment. My program has in its basic requirements both A&P I and II... no matter if your a degree or non-degree... you still take A&P I and II.

I can imagine how all the non-degreed Medic's on the forum must feel by now from hearing all the negativity and worthless views on non-degreed providers.

Flight-LP... ****ing off is defined as staying onscene way to long to perform skills that have not been shown to make any difference in clinical outcome of patients... particularity trauma patients and in fact the delay caused by them has been noted in studies to be a cause for not so good outcomes. So yeah, a driver and attendant with some O2 would prob be better in some cases.

And Vent, you have had plenty of "I'm God, your not, your opinion doesn't matter and is wrong" kinda moments in A LOT of other threads with many different people.

Vent, do you even practice as a Paramedic anymore?

 

[rescue99]

I disagree. We need education and training. Education is associated with learning done in a classroom or school, whereas training is usually associated with learning and mastering a skill. In order to be a great EMT you need both a solid education and exceptional training.

MMiz..you are correct. The transition phase has shown us how very vital the combination of training and education are in EMS. Responders who think a patient to death just doesn't work. There has to be both.

 

[Sasha]

Why do all threads that have the potential to be a great debate deteriorate into a peeing match? And it's the same one every single time.

I think training has it's place. You can throw all the education and compassion you want at someone, but if you can't start an IV or draw up a med it's useless. However, I don't think anyones arguing against that, they are arguing against Paramedic courses being soley training on how to do skills and how to read a protocol book and doesn't focus on teaching, or setting up a paramedic to make educated patient care decisions on their own two feet. It also doesn't allow them to think past patient drop off, which I think ultimately will harm a patient.

I once had an instructor tell me to load a patient up with fluid, they'll "pay for it later" but that it wasn't your concern and let the doctors handle it. We need to get away from that kind of thinking, because I think it ultimately it hurts the very patients we care for in the long run, however paramedic "training" and education doesn't allow for that with it's two week a&p course.

 

[rescue99]

Why do all threads that have the potential to be a great debate deteriorate into a peeing match? And it's the same one every single time.

I think training has it's place. You can throw all the education and compassion you want at someone, but if you can't start an IV or draw up a med it's useless. However, I don't think anyones arguing against that, they are arguing against Paramedic courses being soley training on how to do skills and how to read a protocol book and doesn't focus on teaching, or setting up a paramedic to make educated patient care decisions on their own two feet. It also doesn't allow them to think past patient drop off, which I think ultimately will harm a patient.

I once had an instructor tell me to load a patient up with fluid, they'll "pay for it later" but that it wasn't your concern and let the doctors handle it. We need to get away from that kind of thinking, because I think it ultimately it hurts the very patients we care for in the long run, however paramedic "training" and education doesn't allow for that with it's two week a&p course.

"Education and training" includes AP. Med Term and Pharm. I assume it to mean a well rounded classroom / practical experience. Silly me

 

[VentMedic]

I disagree. We need education and training. Education is associated with learning done in a classroom or school, whereas training is usually associated with learning and mastering a skill. In order to be a great EMT you need both a solid education and exceptional training.

Somehow the other health care professions manage to get a lot of education and a lot of training done. RNs and RRTs can log easily over 1000 hours in just clinicals in their 2 year programs. The same for radiology. I've lost track of how many hours PT gets since their entry level program is now a Masters and they now have the Doctorate.

It really shouldn't be that hard for a Paramedic to accomplish education and training in a mere two year degree.

 

[VentMedic]

I swear I feel like I am typing to a wall sometimes... how is spending two years in a degree program and plans to spend even more getting a BS degree not supportive of education?

Because all of your education plans do little to support you being Paramedic and does little to raise the professional standard. If you fail to see the need for a decent A&P and Pharmacology class to enhance your knowledge as a Paramedic, I seriously doubt if you will ever see your way to getting a BS degree.

BTW, how long have you been an EMT? Didn't it take you many years before deciding to become a Paramedic? Did you not realize it was okay to take college classes as an EMT-B even if the timing wasn't right for the Paramedic program.

If one really feels they must stay working as an EMT-B, they should still feel free to continue their education with classes that should be prerequisites for the Paramedic. One should NEVER be told they "can't do nothing" but work as an EMT until they apply for the Paramedic program.

 

[thegreypilgrim]

I think there has been more than a small measure of misunderstanding in this post. The OP was not intended to declare war on medics who don't have degrees or fall to one's knees in adoration of those who do.

I don't have a degree as of yet, but I'm in the process of completing one. I think I'm a decent medic, however, and certainly would not assent to the proposition that unless one has a degree then one cannot be a good medic.

My whole point was, this notion of building a program for professional licensure around training for skills is unheard of for other medical professions. It is also, I believe, the primary cause of most of the industry-related problems that we who work in EMS have to deal with. There is another side of this story, however, and I actually think a large portion of the blame lies with the physicians and nurses who design and carry out the education and training of future paramedics. They're the ones who created these programs and felt that 700 total hours with dumbed down A&P and little clinical reasoning is sufficient to fill the streets with paramedics.

Some have raised the question of whether or not holding a piece of paper from some pretentious university to be framed on your wall really makes a difference in the nitty gritty reality of the pre-hospital world. I would respond by saying that in some instances it might not, but it certainly can and is therefore worth the effort (I suspect this "well it doesn't make much difference so we shouldn't do XYZ" is guilty of deriving what ought to be from what is - see the Is-Ought Problem). We really ought to be giving our patients the best chance possible, and I think having advanced pre-hospital EMS providers with a university education would be doing just that for our patients. It's also the only real way to fully professionalize the field, solve our deplorable financial reimbursement problems, and gain recognition from other medical professionals as a whole rather than on an individual basis (i.e. the physicians and nurses at the various local hospitals you run into begin to respect you & don't interrogate you with a million questions when you ask for orders because after working with you for so long, they've finally realized you do actually know what you're doing but still view other paramedics with suspicion...).

I would also argue that when education is lacking, patients ultimately do suffer. I'll use the county I work in as an example (I'd rather not name it, hopefully this is understood). The situation we have here is the epitome of what the droves of anonymous posters that haunt EMS forums such as this one rail against. It's a fire-based system with the primary paramedic training center here being widely considered to be a Medic Mill in its purest form. The curriculum there does not extend into National Standards - the students learn the County protocols, the County policies, the County drugs, and that's it. Many of them have a difficult time with the NREMT exam afterward because they simply don't learn about anything that isn't done here. The result is an army of medics with a cook-book mentality and a cowboy bravado. Then everyone wonders why our local scope of practice becomes more and more limited (no RSI, no pediatric intubation, no needle cric, no IO's except on dead people, a drug box that consists of just 16 meds, few procedures allowed prior to base contact, making base contact entails a tediously detailed and point-by-point report as opposed to a chief complaint a destination facility and an ETA, the list goes on). The excuse of "short transport" times is often given as justification for slashing pre-hospital procedures, but everyone knows what the real reason is. Hospitals are tired of having esophageally intubated patients with no capnography used (despite its being both available and mandated) brought into their ED's.

Sure, a non-degreed paramedic can run a megacode or a chest pain or a trauma just as well and competently as a paramedic who does have a degree. This is probably true. It all really comes down to the individual medic's desire to be a medical professional. This is, however, is myopic. Few people realize the impact pre-hospital providers can have on healthcare as a whole. Imagine being able to close simple lacerations in the field with sutures and a tetanus booster, replacing g-tubes in the field, referring/transporting to urgent care facilities, transporting drunks (when this is their only problem) to sobering centers, or any of hundreds of other "treat and release" type procedures which could desaturate ED's and reduce costs of needless ambulance rides and hospital bills. Can you imagine that happening with the current system we have in place? Can you really imagine paramedics functioning as truly independent practitioners with this expanded scope without more education? That was what I was getting at.

 

[46Young]

I think there has been more than a small measure of misunderstanding in this post. The OP was not intended to declare war on medics who don't have degrees or fall to one's knees in adoration of those who do.

I don't have a degree as of yet, but I'm in the process of completing one. I think I'm a decent medic, however, and certainly would not assent to the proposition that unless one has a degree then one cannot be a good medic.

My whole point was, this notion of building a program for professional licensure around training for skills is unheard of for other medical professions. It is also, I believe, the primary cause of most of the industry-related problems that we who work in EMS have to deal with. There is another side of this story, however, and I actually think a large portion of the blame lies with the physicians and nurses who design and carry out the education and training of future paramedics. They're the ones who created these programs and felt that 700 total hours with dumbed down A&P and little clinical reasoning is sufficient to fill the streets with paramedics.

Some have raised the question of whether or not holding a piece of paper from some pretentious university to be framed on your wall really makes a difference in the nitty gritty reality of the pre-hospital world. I would respond by saying that in some instances it might not, but it certainly can and is therefore worth the effort (I suspect this "well it doesn't make much difference so we shouldn't do XYZ" is guilty of deriving what ought to be from what is - see the Is-Ought Problem). We really ought to be giving our patients the best chance possible, and I think having advanced pre-hospital EMS providers with a university education would be doing just that for our patients. It's also the only real way to fully professionalize the field, solve our deplorable financial reimbursement problems, and gain recognition from other medical professionals as a whole rather than on an individual basis (i.e. the physicians and nurses at the various local hospitals you run into begin to respect you & don't interrogate you with a million questions when you ask for orders because after working with you for so long, they've finally realized you do actually know what you're doing but still view other paramedics with suspicion...).

I would also argue that when education is lacking, patients ultimately do suffer. I'll use the county I work in as an example (I'd rather not name it, hopefully this is understood). The situation we have here is the epitome of what the droves of anonymous posters that haunt EMS forums such as this one rail against. It's a fire-based system with the primary paramedic training center here being widely considered to be a Medic Mill in its purest form. The curriculum there does not extend into National Standards - the students learn the County protocols, the County policies, the County drugs, and that's it. Many of them have a difficult time with the NREMT exam afterward because they simply don't learn about anything that isn't done here. The result is an army of medics with a cook-book mentality and a cowboy bravado. Then everyone wonders why our local scope of practice becomes more and more limited (no RSI, no pediatric intubation, no needle cric, no IO's except on dead people, a drug box that consists of just 16 meds, few procedures allowed prior to base contact, making base contact entails a tediously detailed and point-by-point report as opposed to a chief complaint a destination facility and an ETA, the list goes on). The excuse of "short transport" times is often given as justification for slashing pre-hospital procedures, but everyone knows what the real reason is. Hospitals are tired of having esophageally intubated patients with no capnography used (despite its being both available and mandated) brought into their ED's.

Sure, a non-degreed paramedic can run a megacode or a chest pain or a trauma just as well and competently as a paramedic who does have a degree. This is probably true. It all really comes down to the individual medic's desire to be a medical professional. This is, however, is myopic. Few people realize the impact pre-hospital providers can have on healthcare as a whole. Imagine being able to close simple lacerations in the field with sutures and a tetanus booster, replacing g-tubes in the field, referring/transporting to urgent care facilities, transporting drunks (when this is their only problem) to sobering centers, or any of hundreds of other "treat and release" type procedures which could desaturate ED's and reduce costs of needless ambulance rides and hospital bills. Can you imagine that happening with the current system we have in place? Can you really imagine paramedics functioning as truly independent practitioners with this expanded scope without more education? That was what I was getting at.

I understand that a formal degree should produce the best product, and that even a medic mill graduate can bring themselves up to speed if they put in the work. What I can't grasp is medics doing treat and release, due to the high liability potential. It would require the medic to make a definitive Dx in some cases. Perhaps some provisions with tort reform could protect us if this additional scope is realized.