What do you think is the most important thing EMS does?

[Akulahawk]

We have a similar arrangement at our university. We did A&P, legal, health sociology and communications subjects with the nurses, OTs, midwives, physios etc. Then we trot off to the paramedics building for field specific stuff in 2 and 3rd year. I understand they now have an inter-professional education subject in first year as well which sounds like a good idea. I would like to have done more with the nurses

The more we understand about other fields, the better we can work together, especially when it comes to things like falls referral.



True. We don't really have a culture here of doing absolutely every assessment we have on every patient. But then it could be argued that we have enough education to start choosing tests depending on whats going on. I laugh hard when someone comes into the St John's first aid tent at an event for a bandaid for a blistered heel and we have to take medical histories and repeat vitals.

A band-aid for a blistered heel? Just put some Skin Lube on a gauze pad and tape in place... If that doesn't work, 2nd Skin under some Moleskin or flexible adhesive tape works wonders. If only more runners knew that...

It only takes a 4 year education to figure out that I don't need to do a full work-up on someone who presents with a blistered heel from running. Though I might want to see their shoes...

 

[DrParasite]

It is like this in many countries, and it should be. In one country i visited, both the paramedics and nurses sat in class together for basic science. After the first 2 years, nurses went to classes specific for nursing and medics went to classes specific for the field. I think that is absolutely ideal. In 21 years now of watching this argument, the US has actually gone backwards.

2 years ago I heard one paramedic instructor tell a class that all that stuff about cell biology in the front of the book was totally useless. I have seen dozens of intructors tell students there is too much information in the single volume text than is needed to be a medic. These instructors are still spouting that crap today, and I am willing to bet my experience is just the tip of the iceberg.

question from a non-paramedic: is all that stuff really needed? I was under the impression that a paramedic program was completely and totally focused on paramedicine. ever lecture was directly related to paramedicine. no well rounded person, no maybe helpful in the future, everything was all about prehospital EMS. Take Cell biology. is knowing about mitochondrial DNA, or what a vacuole is used for really all that helpful in the street? Does it benefit the patient? Yes, a smarter medic is a better medic, education is good, no arguments, but have studies been done to show that a well educated medic like in Australia or New Zealand have better patient out comes than us dumb USA EMS personnel? remember, evidence based medicine is the key, not what individual feelings are. show me that London EMS has a 4 years EMT program, and that patient outcomes increased 60% over when they had a 2 years program. Explain to us dumb BLS providers how a 2 years EMT program will help the patients better than a 120 hour course. Not just "well a smarter EMT is better" show actual facts to support your claim

oh and for our brothers from down under who can't seem to grasp ALS vs BLS: if you have a stomach ache, do you go to a cardiothoracic surgeon? If you break your arm, do you go to a GI specialist? of course, not, you go to a general MD, who fixes you up, and refers you to a specialist when can't manage you properly. A specialist only sees sick people or people who have issues with their specialty, so they are experts in that area. For the majority of people in the US, their emergencies can be handled by a BLS provider. Not that a medic couldn't treat them, but rather a medic wouldn't do anything different than a BLS provider would. This means the medic only treats sick people, and BLS treats non-life threatening people, and when they need help, they call for help.

I know it's hard to understand, but just like Koalas, dingos, and fosters beer, sometimes you need to try something new to understand how it works.

 

[Veneficus]

I think it is a question of not knowing what you don't know. As was stated several times in this thread, you cannot know whether you even need an ED, BLS, etc. So I'll say it again, if you never heard of thyroid storm, you don't know the patient is really sick. Which a paramedic can help with since cardiac arrythmia is a symptom.

Talking about a stomach ache is not an emergency is just ignorant. Can you determine a surgical abdomen from say, crohn's? Not much to do about a surgical abd, other than recognize it. But crohns causes malabsorbtion and therefore dehydration which can be helped with paramedics.

But deny if you must, economically the US system is failing and cannot continue. So if you are not educating and planning for the future, you might be at unemployment.

Cell biology. How is knowing about mitochondria going to make a difference prehospital? How about a patient that has MELAS, when they go into crisis what is ALS going to do for that? Bicarb is the treatment of choice for an acute attack. These patients are children. "this kid suffers and dies because I didn't feel the need to learn about the cell." outstanding.


It also important to remember that there is more to healthcare than the outcome of a hospitalization. There is the prevention of hospitalization and disposition to a more appropriate facility which can better care for a patient or provide the same care for less money. The measurement of that isn't outcome, it is in dollars.

When you break your arm you are going to an orthopedic surgeon, because a PCP doesn't have what they need to help that and nobody will possibly accept the liability of it. So when you do have a stomach ache depending on your age and the type of ache, you are better served by a GI doc. Peptic ulcer disease can be a precusor to a cancer. A PCP is certainly not going to scope anyone. Finding it early saves both lives and money. No ED, no ICU.

Not trying to be offensive, but if this is the way BLS providers think, perhaps it is time to stop reimbursing them, they clearly provide no more benefit than taxi.

If you have a specific condition, why would go to an ED doc? They can't help. But ambulances keep driving them there. Can't help a cardiac arrest patient most of the time either. The hospital also doesn't forgo the bill for the lab tests that come back 30 minutes after the patient is in the morgue, nor the emergent fee which is often $1000+ above the normal fee. Nor anyother diagnostic that makes absolutely no difference in the outcome.

I also think you don't understan the "handling" of emergencies. Showing up and giving somebody a ride doesn't handle very much. If it did, a lot of the frequent flyers would stop calling because thier emergency would have been handled the first time.

Do you really believe the stuff you posted here?

 

[Akulahawk]

So... If I encounter a patient that's dehydrated, I'm going to attempt to rehydrate via oral intake method, a method which has an absorption rate of about 800 ml/hr when all is going good, when I can, if necessary, deliver that amount in about 15 min via IV? Umm. Yeah.

Yes, I've heard about Crohn's...

I've also heard about Thyroid Storm...

MELAS? Just looked that one up. Acute attack... of lactic acidosis. Bicarb, well, yeah. I can see how that would attempt to lower the pH. Unfortunately, I have yet to see a prehospital protocol that would allow me to treat for acidosis, let alone without having access to a lab that can give me blood pH.

If I had the ability to refer someone to the appropriate resource rather than send them to the ED, I most certainly would. Then again, I'm not the ordinary medic... I've probably had more education (and I'm not a nurse) than most medics have.

 

[mycrofft]

I'm outta this one.

......................

 

[Akulahawk]

With mycrofft.....

......................

Me too. This thread threatens to degenerate. Hope it doesn't, but comparing Med Student knowledge base to Paramedic (or anyone else) knowledge base is apples/oranges because of the different purposes of each.

 

[46Young]

question from a non-paramedic: is all that stuff really needed? I was under the impression that a paramedic program was completely and totally focused on paramedicine. ever lecture was directly related to paramedicine. no well rounded person, no maybe helpful in the future, everything was all about prehospital EMS. Take Cell biology. is knowing about mitochondrial DNA, or what a vacuole is used for really all that helpful in the street? Does it benefit the patient? Yes, a smarter medic is a better medic, education is good, no arguments, but have studies been done to show that a well educated medic like in Australia or New Zealand have better patient out comes than us dumb USA EMS personnel? remember, evidence based medicine is the key, not what individual feelings are. show me that London EMS has a 4 years EMT program, and that patient outcomes increased 60% over when they had a 2 years program. Explain to us dumb BLS providers how a 2 years EMT program will help the patients better than a 120 hour course. Not just "well a smarter EMT is better" show actual facts to support your claim

oh and for our brothers from down under who can't seem to grasp ALS vs BLS: if you have a stomach ache, do you go to a cardiothoracic surgeon? If you break your arm, do you go to a GI specialist? of course, not, you go to a general MD, who fixes you up, and refers you to a specialist when can't manage you properly. A specialist only sees sick people or people who have issues with their specialty, so they are experts in that area. For the majority of people in the US, their emergencies can be handled by a BLS provider. Not that a medic couldn't treat them, but rather a medic wouldn't do anything different than a BLS provider would. This means the medic only treats sick people, and BLS treats non-life threatening people, and when they need help, they call for help.

I know it's hard to understand, but just like Koalas, dingos, and fosters beer, sometimes you need to try something new to understand how it works.

Early on I understood my limitations with just a BLS cert. I didn't realize how much so until I went to medic school. Anyone could get a phlebotomy cert, intubation cert, read Dubin's Rapid Interpretation of EKG's, and be okay with maybe 90% of their pts. Really, anyone could put every medical pt (and stable traumas as well) on an ECG/12 lead, SpO2, ETCO2 (nasal), do a temp and a BGL, and give O2, memorize the regional protocols, and appear confident and thorough to the ignorant. You could fake a whole career like that in some places. But what about the other 10%? Watching what the medics do with certain pts, and asking them why afterward doesn't make you as knowledgeable as a medic. Just knowing that a Cx pain that's not hypotensive should generally get MONA without the knowledge base isn't the same. Asthmas can get albuterol, mag, solu-medrol, atrovent, maybe CPAP and epi. But do you really know what these meds can do? What's the science behind giving five cycles of CPR before attempting a defib with a VF/PVT? And why do we do another five cycles afterward?

Like Veneficus said, it's a question of not knowing what you don't know. Without an ALS assessment, you're going to miss some important stuff. Sure, statistically speaking, the medic won't need to do any "ALS interventions" for the majority of pts, but that level of education is vital to make that determination. That's key. Also, formal A&P is important, for the reasons Veneficus already covered. Also, as medicine advances, we'll need that base in order to absorb and implement future advances in prehospital medicine. The program that focuses solely on paramedic content may have been adequate in 1980, but medicine will continue to evolve. A simple inservice on a new procedure is inadequate without the knowledge to actually understand what the procedure is.

 

[46Young]

Me too. This thread threatens to degenerate. Hope it doesn't, but comparing Med Student knowledge base to Paramedic (or anyone else) knowledge base is apples/oranges because of the different purposes of each.

Good point. I've said before that I don't see the need for much if anything past the EMS AAS level of education for prehospital 911 EMS. I don't see how a 4-6 year degree is going to significantly change my assessment and tx. As medicine advances throughout the years this may change, but I don't see the need for additional education at the moment. 4+ years of education for 911 EMS is overkill IMO.

As far as IFT, the "real" IFT is done through teams or RN's with specialties, such as the NICU nurse, PICU nurse, or from whatever floor the pt is going to. Pts going to various ICU's and such need a specialized crew for their condition and age. It would be impossible for the paramedic to gain proficiency in all those specialties like each txp nurse has in their area.

For this reason, I don't see the paramedic having the availability of any formal EMS clinical training past the two year degree. If one wants to do real IFT, they'll just become a nurse. Why do 4-6 years of school on an EMS track for an uncertain future regarding pay, benefits, scope, etc. that ought to accompany such education? It's a longshot at best to hope for that.

 

[Melclin]

Explain to us dumb BLS providers how a 2 years EMT program will help the patients better than a 120 hour course. Not just "well a smarter EMT is better" show actual facts to support your claim

Your desire for evidence is not unreasonable, however, these things can be quite hard to quantify. Also, there is not way to actually prove that better education leads to better outcomes, there are just too many confounding variables to do a study like that. However, it is possible to make educated guesses about the affect of education. I've been interested in looking into the literature to find some evidence for better outcomes etc, a rationale for education. If I do that any time soon, I'll post it here. However some things do come to mind now.

RSI - of the ground based RSI trials done, I understand that the success of the trial has often been commensurate with the level of education of the providers. I believe our MICA paramedics out did any other service in terms of outcomes and ability. So much so that half way through the trial RSI was expanded from neuro injury only to a wide range of indications because it was clear that MICA were more than capable of handling it.

Soon we will be starting a therapeutic hypothermia trial in ICUs and the docs involved have enough confidence in paramedic abilities to extend it into the prehospital arena. Why? MICA know their s**t.

In 1999 the Victorian government released a report on trauma outcomes which was in part responsible for the statewide increase in scope and education requirements for our basics, and it identified areas where people really were dying because paramedics could not perform certain procedures without more education. Our extra education allows for all providers to perform chest decompression - certainly life saving. It allows for cannulation and fluid resuscitation at the basic level.

It also allows for 3 kinds of pain relief at the basic level. We know that pain has nasty physiological affects, but more than that, its humane. You can't put a number on that but it matters.

Trauma bypass is a proven life saver. How could that be possible without well educated paramedics? You can't necessarily sit around and wait for ALS back up with a major trauma pt. But you also don't want to take them to East Arse nowhere ED.

oh and for our brothers from down under who can't seem to grasp ALS vs BLS: if you have a stomach ache, do you go to a cardiothoracic surgeon? If you break your arm, do you go to a GI specialist? of course, not, you go to a general MD, who fixes you up, and refers you to a specialist when can't manage you properly. A specialist only sees sick people or people who have issues with their specialty, so they are experts in that area. For the majority of people in the US, their emergencies can be handled by a BLS provider. Not that a medic couldn't treat them, but rather a medic wouldn't do anything different than a BLS provider would. This means the medic only treats sick people, and BLS treats non-life threatening people, and when they need help, they call for help.

You don't seem to understand the concept of assessment. How do you know if the person is sick enough for a medic if you have no idea whats wrong with the patient or you don't understand the disease pathology, the medications etc. An EMT is a taxi driver with a CPR card. I would argue that spending money on them is less useful than spending a little extra on a service that is actually worthwhile.

EDIT: LOL, I see Vene also appreciates the future of American EMS: the replacement of EMTs with the much cheaper and equally as useful CPR crosstrained taxi driver with cab companies contracted for EMS.

I think it is a question of not knowing what you don't know.

Exactly.

He who knows most, knows how little he really knows - Socrates (from my extensive classical education...certainly not from Brown's sig )

Cell biology. How is knowing about mitochondria going to make a difference prehospital? How about a patient that has MELAS, when they go into crisis what is ALS going to do for that? Bicarb is the treatment of choice for an acute attack. These patients are children. "this kid suffers and dies because I didn't feel the need to learn about the cell." outstanding.

While this is true, I think the cell bio stuff is more about the necessary underlying understanding. A long chain of knowledge that leads to being a better provider. Where is my understanding of shakespear directly relevant to paramedic practice? Its not, but learning those things in high school makes me better equipped to analyse the world and communicate with people and that is relevant.

Cell biology? When you start learning about nerve conduction, how would you understand any of the terminology/anatomy? When you learn about APO, how are you supposed to understand the upset balance between hydrostatic and oncotic pressure without cell biology? Why does it matter? Because if you don't know the difference then you need to have protocols that say, if crackles give GTN, and you end up with post near drowning patients getting GTN from idiots who didn't think it was necessary to learn about the disease process they are actually treating.

It also important to remember that there is more to healthcare than the outcome of a hospitalization. There is the prevention of hospitalization and disposition to a more appropriate facility which can better care for a patient or provide the same care for less money. The measurement of that isn't outcome, it is in dollars.

These can be difficult to measure. Not because they can't be measured but because it is very difficult to attribute causality. Also, Dr Parasite, one of the reasons why little evidence exists is because paramedics and basics are not educated enough to do the research, and nobody else is interested enough to do it. That is quickly changing here. We built our own evidence base for IN fentanyl for example. Couldn't have done that without being educated, and now thousands of people all over the state have better, quicker pain relief and paramedics have more options.

 

[Melclin]

Without an ALS assessment, you're going to miss some important stuff. Sure, statistically speaking, the medic won't need to do any "ALS interventions" for the majority of pts, but that level of education is vital to make that determination.

Well said.

Also, formal A&P is important, for the reasons Veneficus already covered. Also, as medicine advances, we'll need that base in order to absorb and implement future advances in prehospital medicine.

Another very good point. Its so much easier to introduce, say a new drug or a slight change in procedure when everyone already understand it, because 1, they are familiar with some of the literature and probably saw the change coming, and 2, they had a broad educational base in pharmacology.

EG: We are encouraged to learn basic blood test rages at the basic level because its handy for IFT but also because in 20 years maybe we'll be using a range of different blood chemistry monitors in the PH environment. Won't it be so much easier to introduce lactate monitors for trauma and sepsis here where everyone at the basic level already understands the concept of anerobic metabolism, and related concepts such as the oxyhaemoglobin disassociation curve.

Good point. I've said before that I don't see the need for much if anything past the EMS AAS level of education for prehospital 911 EMS. I don't see how a 4-6 year degree is going to significantly change my assessment and tx. As medicine advances throughout the years this may change, but I don't see the need for additional education at the moment. 4+ years of education for 911 EMS is overkill IMO.

As far as IFT, the "real" IFT is done through teams or RN's with specialties, such as the NICU nurse, PICU nurse, or from whatever floor the pt is going to. Pts going to various ICU's and such need a specialized crew for their condition and age. It would be impossible for the paramedic to gain proficiency in all those specialties like each txp nurse has in their area.

For this reason, I don't see the paramedic having the availability of any formal EMS clinical training past the two year degree. If one wants to do real IFT, they'll just become a nurse. Why do 4-6 years of school on an EMS track for an uncertain future regarding pay, benefits, scope, etc. that ought to accompany such education? It's a longshot at best to hope for that.

Very valid argument. Also it does depend on how you use those years. Our degree is three years, but you could cover the material in two. We also have a lot of primary care type education that will contribute to our ability to institute a great deal of alternative referral pathways in the future. It's not all tubes and cannulas.

One thing I will say though is that having an extra bit of education can be beneficial for the person in many other ways. For example my bachelors degree means I can go on to do post graduate work in many other fields.

If I wanna do a grad dip in health admin and move to managing hospitals, I can.

If I wanna do medicine, well then I already have a pre-med bachelors degree, although I'd prefer to take a chem unit or two before then :blush:

If I want to change fields entirely and say, teach highschool, I need only do a grad dip in education (a bachelors degree in any field is required for teaching + a dip ed if the degree is not teaching related). Or maybe I've had enough and want to float myself on the job market..I'll get much better jobs because I have a bachelors degree. If I had an advanced diploma (our old qualification) it would be of almost zero use in any other field but paramedicine, despite the fact that there was relatively little difference in content.

Making it a bachelors degree also attracts different people. I'm an academic kinda bloke and I never saw myself doing anything but going to a good university. I would have never even considered being a paramedic if it were a lower qualification because I simply would never have looked at literature from those kinds of institutions (to my detriment). Entry to the degree course is quite competitive and a little less than half of us already have degrees. The cut of lower ENTER score (like SATs I spose) was in the 83rd percentile I this year I think. This is for basics. How many EMT programs can say that? Not to say that anyone who doesn't have a degree is an idiot or anything like that, but you know what I mean.

Vene, to return to the actual question you pose, I think that a good way of getting better education requirements is to recruit public opinion. Government here have often made election promises about improving education levels for paramedics. In '99 (or 2000, I forget), the government ran on the notion of statewide ALS. The education of paramedics has always been a selling point for our service, and I would have thought that in America where services are actually selling them selves, education would be a selling point. There are always articles in the paper here about how little jimmy died because paramedics response times were too slow, or ALS couldn't get there in time. Why not encourage media like that regarding poor education?

 

[Aidey]

The education of paramedics has always been a selling point for our service, and I would have thought that in America where services are actually selling them selves, education would be a selling point. There are always articles in the paper here about how little jimmy died because paramedics response times were too slow, or ALS couldn't get there in time. Why not encourage media like that regarding poor education?

There is a huge road block to this, and it is the fire unions. Seriously. Fire departments have regulated themselves out of a job. They have had to branch out their services in order to continue to justify their budgets.

If the education requirements are increased it means more costs to send people to school, more time lost while they are in school, and it makes it harder for them to convince guys to go to paramedic school. In places were costs are already out of control it just isn't worth it to them.

With reimbursement rates from medicare/medicaid/private insurance so low private companies don't want to have to pay higher wages either. With those two groups opposing more education there aren't any large groups left to counter them.

Even if the private companies wanted to lobby for more education they are fighting a major uphill battle. The FFs are America's Heroes while private companies are money-grubbing corrupt scum who only want more money. It would take a lot of money and effort to have any sort of successful campaign against the fire departments. Since many private companies are contracted to fire departments by campaigning against them they risk loosing their contracts (I know we would). It's a messy situation all the way around.

 

[Melclin]

That is a pickle of a cowinkydink. :wacko:

 

[Veneficus]

So... If I encounter a patient that's dehydrated, I'm going to attempt to rehydrate via oral intake method, a method which has an absorption rate of about 800 ml/hr when all is going good, when I can, if necessary, deliver that amount in about 15 min via IV? Umm. Yeah.

Having an IV was my point.

MELAS? Just looked that one up. Acute attack... of lactic acidosis. Bicarb, well, yeah. I can see how that would attempt to lower the pH. Unfortunately, I have yet to see a prehospital protocol that would allow me to treat for acidosis, let alone without having access to a lab that can give me blood pH.

These people may not live to get blood PH in the hospital. In 2 of the of three cases I saw, physician on scene (at his office) as well as at a home (call to online medical direction) Bicarb was adminitered without any lab work. It can be that profound.

My point is that you know about acidosis, and have the potential ability to treat it, because you do understand something about physiology above a basic level.

If I had the ability to refer someone to the appropriate resource rather than send them to the ED, I most certainly would. Then again, I'm not the ordinary medic... I've probably had more education (and I'm not a nurse) than most medics have.

I am not sure what you are arguing about? You seem to just be echoing my point.

 

[DrParasite]

If you have a specific condition, why would go to an ED doc? They can't help. But ambulances keep driving them there. Can't help a cardiac arrest patient most of the time either. The hospital also doesn't forgo the bill for the lab tests that come back 30 minutes after the patient is in the morgue, nor the emergent fee which is often $1000+ above the normal fee. Nor anyother diagnostic that makes absolutely no difference in the outcome.

I have been wondering that every time people call for a chronic complaints. but it's not like we can refuse to transport people

I also think you don't understan the "handling" of emergencies. Showing up and giving somebody a ride doesn't handle very much. If it did, a lot of the frequent flyers would stop calling because thier emergency would have been handled the first time.

haha, are you serious? do you actually work in EMS? how about in a impoverished urban environment? If you did, you would know the answers to these questions.

Do you really believe the stuff you posted here?

the real question is, do you understand there is a difference between a paramedic and a doctor?

I am glad I am not the only one who had to look up what MELAS was. I can admit it, I had no idea what it was. And after Akulahawk said what it was, I can say that I am not aware of any prehospital protocols that allow for it, esp without any lab work to confirm your diagnosis. Not saying that they don't exist, only that I am not aware of any.

But Vene, you have convinced me of one thing. Every paramedic should have to go through medical school before they step of the ambulance. That means a bachelors degree and 3 years of medical school, so they know of every disease, illness, and potential injury that may occur, and they can both diagnose said illness and injury without the luxury of all those fancy tests that doctors have available to them in the hospitals. That is what you keep pushing for right, more education to better help the patients?

 

[Aidey]

I admit it, I had to look up MELAS too, and here is all I have to say.

We will probably never have protocols to treat it in the field. But at the very least when a family member says "they have MELAS. It's a mitochondrial disease" we should know WTF a mitochondria is and what it does. I bet if I polled my co-workers and the fire medics tomorrow 1/2 would have a hard time explaining what a mitochondria is and what it does. And THAT needs to be fixed.

 

[SeeNoMore]

I see both sides of the discussion, education is essential and I'd rather err on having too much (not that I do now) but from a practical standpoint we should expect Paramedics to have enough education to do their job well. This might not mean knowing every single condition to a T, but certainly would include knowing enough to opt for or rule out interventions, make informed reports to other providers, and decide on where to transport.

 

[Ridryder911]

I believe sometimes we cannot see the forest for the trees in EMS. What is the most important thing we do?

Short and simple we respond to a crisis that the average person cannot handle or know what to do at that time.

Now, with that we can explore what extent and how much education is needed for those responding to emergencies. Futile discussions on what and the extent of education and training will always be debatable. Again, if it was your emergency what extent would you feel be necessary?

R/r 911

 

[46Young]

There is a huge road block to this, and it is the fire unions. Seriously. Fire departments have regulated themselves out of a job. They have had to branch out their services in order to continue to justify their budgets.

If the education requirements are increased it means more costs to send people to school, more time lost while they are in school, and it makes it harder for them to convince guys to go to paramedic school. In places were costs are already out of control it just isn't worth it to them.

With reimbursement rates from medicare/medicaid/private insurance so low private companies don't want to have to pay higher wages either. With those two groups opposing more education there aren't any large groups left to counter them.

Even if the private companies wanted to lobby for more education they are fighting a major uphill battle. The FFs are America's Heroes while private companies are money-grubbing corrupt scum who only want more money. It would take a lot of money and effort to have any sort of successful campaign against the fire departments. Since many private companies are contracted to fire departments by campaigning against them they risk loosing their contracts (I know we would). It's a messy situation all the way around.

I'm not denying that fire unions have opposed raising educational standards, but that's far from the whole picture. To assign most of the blame toward the fire service is innacurate. There are many other players involved.

I've worked for several privates, several hospitals, and a county run third service EMS agency before going fire. None of them asked or cared where I got my medic cert from, just if it was good or not. No one I've ever worked with knew of any place requiring degrees either. What mattered in some cases was relevant experience. You're talking about lobbying for more education, when in reality it's entirely up to the employer. That's right, you can blame the hospitals, the privates, and the muni third services as much as the FD's.

On this forum I frequently hear about all this supposed overabundance of medics. If this is the case, would we not see more and more employers requiring degrees to get hired? It would make sense. However, what I see happening is that these employers still go with "a pulse and a patch" and instead keep salaries low since there's an ample supply to backfill the disgruntled. If these employers were to start requiring degrees, then we would have no choice but to have one. I don't see any stepping up. Maybe a couple here or there, but that's it. Start pointing fingers there. In fact, there's an increasing trend in the fire service to require formal education for promotional purposes. What that has done is cause myself and quite a few others at my FD to return to college and put in work to upgrade our medic tech certs to the EMS AAS. Some recent FFM hires already have their EMS degree since it's well known that the educated ascend the career ladder much more rapidly, and that education is now a necessity to do so. I don't see any hosp based or third service depts requiring degrees for promotion. Again, maybe one or two, but certainly not a trend.

As far as regulating ourselves out of job, nothing could be farther from the truth. From deployment and staffing objectives to the ISO rating, there still needs to be a timely response to suppression incidents. Sprinklers don't put out fires, they just buy time, there will always be arson, mishaps with space heaters, outside fires, malfunctioning dryers, food on the stove, gas leaks, CO leaks, pin jobs, Hazmats, etc. This video clearly explains the validity and necessity of proper staffing and deployment to suppression incidents.

http://www.youtube.com/watch?v=a_K-K6o5cGc

I've posted this several times before, but I continue to do so since it both educates and validates our positions. It's also a great selling point for the FD to do EMS, right or wrong. The suppression staffing clearly needs to be there, so it only makes sense to use their downtime productively to provide EMS as well. I'm not looking to argue the right or wrong of that, I'm just saying that it's a convenient selling point since the suppression positions are easy to justify, regardless of call volume.

 

[Aidey]

I believe sometimes we cannot see the forest for the trees in EMS. What is the most important thing we do?

Short and simple we respond to a crisis that the average person cannot handle or know what to do at that time.

Now, with that we can explore what extent and how much education is needed for those responding to emergencies. Futile discussions on what and the extent of education and training will always be debatable. Again, if it was your emergency what extent would you feel be necessary?

R/r 911

Not trying to shift the topic, but do you really feel that accurately describes the basis for most 911 calls?

The reason I ask is because it seems like more and more we are responding to non-crisis incidents that the person SHOULD know how to handle. We seem to be running into a lot of "911 solves everything, even if it isn't an emergency". Maybe it is because I grew up in a very rural area, but people seem to be less self-sufficient than they used to be.

 

[Veneficus]

Pearls before swine.

but it's not like we can refuse to transport people?

That is the problem! My point is that in every country except the US, somehow manage to keep their healthcare costs under relative control by providing education. Increased education does allow them to decide not to transport. It also allows them to direct the caller to somewhere more appropriate than an ED. It is about value and cost.The fact you cannot make a decision demonstrates your inability and the value education adds. I find it hard to be proud of my ignorance.

The status quo is not economically sustainable.(No matter what type of agency is providing service. That makes it a systemic problem with the way things are done)Agencies all over the US cannot keep pace with their volume. Endlessly throwing transport resources is not the answer. Increasing education for disposition is a solution, if you don't like that, what solution do you offer? Head in the sand?

haha, are you serious?...If you did, you would know the answers to these questions.?

It wasn't a question it was a statement. I don't feel compelled to justify my resume to somebody with a first aid certificate who hasn't evolved from the industrial age mentality of a common laborer. I am not the only one who thinks EMS should not earn a middle class living because they have managed to master a task at the lowest common denominator. I think one of my friends says it best, "the poor creatures, they don't know any better." Demonstrating with pride how simple and mindless your job is doesn't win any points from higher ups.

I hope it occurs to you when discussing national and global EMS issues, regional socioeconomic issues are not the only piece of the puzzle. Some things are common to all systems.

I realize it is not your fault, it is a cultural issue that is grander than your perspective, that of your agency, and probably region. Infact it predates your generation. But in 2010 the value of society isn't based on a labor like it was in the 1800s. It is based on education. Whether you accept it or not, those with education are more valuable to society than those with a skill, who are barely more valuable only than those without. As the knowledge of man increases, so does the minimum education to be worth anything. (Ever notice a highschool diploma no longer gets you jobs it used to? Why a Masters is required for jobs that once only needed a bachelors?) Again demonstrated by the hyperspecializaton of people in modern societies. It was once possible to master the collective knowledge of all mankind. As I recall Descartes was the last. Such a feat is now impossible. It is impossible to even master medical knowledge or engineering, much less everything.

I am not suggesting every person needs to be a Leonardo or a Musashi, but the value of trades are less. That is why you can get the same level of quality from a day laborer, in front of home depot, you can get from tradesmen. Transport payment is being slashed because what we we have been paying isn't worth it and is set by those "edumacated scule people" who use the same hollow BS lines about heroism and protecting the nation the military does to make emergency services feel better and proud (As Napolean said "A soldier will fight long and hard for a bit of colored ribbon") before they slash the budget yet again. The trend is going to continue to cut away the amount payed to EMS and current systems will price themselves out. Local payers are not going to be able to make up the cost and that will mean job losses. Jobs in your field, not mine. SO I dream, I want EMS providers to have value, at least enough to earn a good life without 3 jobs. If EMS providers don't want to amount to anything, I cannot force it. But I keep hoping that by pointing this out, it might benefit somebody reading. Even if you are a lost cause.

That is why I keep spending my time typing it. Of course when EMTs, later medics, if things don't change have to start living in those impoverished neighborhoods as the day maids and the nonmamagement career fast food workers, it was all preventable.

The fight against education is absolutely absurd. The only groups who do that are extrinsic religions and tyrants. (though it seems like the uneducated are taking up the banner too. Perhaps they just feel insignificant and want to drag everyone down to their level?)

Unrelated to this, it has been my observation that the people with the least amount of education always seem think they know the most. I haven't figured out why yet, but i am thinking the need for mental security. Anyone else have insight on this?

the real question is, do you understand there is a difference between a paramedic and a doctor?

Yes, but I don't see how advocating for the advancement of EMS somehow blurs this. I do try to restrain my comments to that which is valuable to EMS. I have been forced to learn things beyond the minimum as a medic. I have 5 times more experience in EMS than I do in medicine. Does it seem illogical I would know more about EMS than medicine?

What about the idea that since I do understand both, my contributions might be more insightful than a person who only understands one?
(Hate to break it to you Copernicus, but you can master all there is to know about EMS including the administration of it in about 5 years combined education and experience. Mom would be proud.)

It might also seem reasonable given the resistance to education from EMS that the people who most often dictate what EMS needs are physicians, who have more education than EMS providers.

I am glad I am not the only one who had to look up what MELAS was. I can admit it, I had no idea what it was. And after Akulahawk said what it was, I can say that I am not aware of any prehospital protocols that allow for it, esp without any lab work to confirm your diagnosis.

MELAS is not taught in medical school, it is my experience with it as a paramedic that I have learned it. I'll say it again, you don't need a lab for the dx. It is Dx at birth and it is not curable. (you know, genetic mitochondrial defect from cell biology) When the patient is in crisis, the treatment precedes the diagnostics. Just like many acute coronary syndromes. Do you have protocols for every condition conceivable? This affliction demonstrates how raw education can help you make decisions and actually help a patient even if you haven't commited every disease process to memory. (which is impossible, even for pathologists) If you encounter it (I know most people, even physicians, may never see a case in their life) it is likely the family will tell you the treatment and complications, just like many chronic diseases cared for and when the medic hopefully calls med control to get orders for treatment not covered in the protocol, they can point the physician in the direction so that she can look it up faster and make an informed decision. (Imagine that, a paramedic with enough knowledge about an acute emergency to actually guide a physician, sounds almost like a professional team member and not an underling laborer. Something for both the medic and mom to be proud of)

But Vene, you have convinced me of one thing. Every paramedic should have to go through medical school before they step of the ambulance. That means a bachelors degree and 3 years of medical school, so they know of every disease, illness, and potential injury that may occur, and they can both diagnose said illness and injury without the luxury of all those fancy tests that doctors have available to them in the hospitals.?

That is a bit of an embellishment, I am sure some idiot said the same thing about Dx an MI with a 12 lead once. I don't think it is unreasonable to ask for paramedics to go through the same or similar basic science courses as a nurse to have a foundation on which to make educated conclusions. As part of that education I think that biology, general chemistry, anatomy, physiology, and pathology at a depth acceptable to an associate or bachelors' s not asking a lot. Especially if you are proud of the fact you have to make a decision without a doctor standing over your shoulder telling you what to do. (as with all of life, with privilige comes responsibility)

I think the education should be relavent to EMS practice and directly stated as to why. Did you know both the Mosby and Brady paramedic texts have pathology sections that are cut and pasted out of context from advanced pathology texts? Like "pink frothy sputum" which until terminal stage is actually a microscopic finding requiring staining. So go ahead and keep looking for it, you'll need some good eyes, and preaching it is definitive. I am also fond of "tracheal deviation," and the rumor it equates to death. Gross tracheal deviation is late, but diagnostic is 3mm or more. That's aweful small, and the texts don't define it or tell you how to look for it. (more cut and paste out of context)

That is what you keep pushing for right, more education to better help the patients?

More education for EMS providers doesn't benefit me any. (Does that make me altruistic?)