What would happen if the NREMT required a degree?

[ExpatMedic0]

I don't feel nursing is the best answer to EMS, or to every other healthcare occupation. I am not saying it can't be done (because some countries do follow this).

I think the idea and concept of Paramedicine is great, it just needs to progress like we have seen it do in every other English speaking 1st world country in the world. It can be frustrating at times to always be the underdog and redheaded stepchild of both healthcare, and public safety in the USA, but I think one day in the not so distant future, America will catch up with the rest of the world.

I know I would not have dedicated 4 years of university and soon to start post graduate work while remaining in EMS if I did not have some passion for it and hopefully can help advocate for furthering it one day. Having been in it for 10 years now, I know the giant **** sandwich I have signed up for, but I don't think nursing is know all cure all answer to all things health related.

 

[Summit]

I don't think nursing is THE answer. It could be AN answer. It depends on what EMS is going to be. I really like what I hear and see in the NZ, Canadian, and Australian systems. I doubt the answer will be that... or nursing. I don't think answer will be a good answer. The green tinted glasses folks love disposable technicians.

 

[EpiEMS]

The green tinted glasses folks love disposable technicians.

From a cost perspective I don't see the "disposable technician" side having a large advantage, at least, it's revenue model dependent. If the revenue model is going to be transport based, yes, it may make sense. However, if the "revenue" model is based on municipal tax receipts, just as it is for FD and PD, then "disposable" isn't good -- if you have the broad tax base supporting it, you can afford to have professionals, people with advanced training, degrees, you name it.

 

[SandpitMedic]

-- if you have the broad tax base supporting it, you can afford to have professionals, people with advanced training, degrees, you name it.

Indeed!

 

[SandpitMedic]

I know I would not have dedicated 4 years of university and soon to start post graduate work while remaining in EMS if I did not have some passion for it and hopefully can help advocate for furthering it one day. Having been in it for 10 years now, I know the giant **** sandwich I have signed up for, but I don't think nursing is know all cure all answer to all things health related.

This made my day!!!! Someone thinking outside the box! Going the extra mile to further the cause! This is what I'm talking about.. we need more "yous!"

 

[Summit]

From a cost perspective I don't see the "disposable technician" side having a large advantage, at least, it's revenue model dependent. If the revenue model is going to be transport based, yes, it may make sense. However, if the "revenue" model is based on municipal tax receipts, just as it is for FD and PD, then "disposable" isn't good -- if you have the broad tax base supporting it, you can afford to have professionals, people with advanced training, degrees, you name it.

Municipal tax base green tinted glasses folks love disposable technicians if the EMS disposable technicians are simple add-ons to FFs and the goal is to support engines, ladders, pumpers, first.

 

[CFal]

Municipal tax base green tinted glasses folks love disposable technicians if the EMS disposable technicians are simple add-ons to FFs and the goal is to support engines, ladders, pumpers, first.

Municipalities put a lot of money into training their people, especially dual role training. They sure don't treat employees as disposable like privates do.

 

[Carlos Danger]

Might as well eliminate every kind of healthcare occupation and make it some kind of nursing specialty or have it fall under nursing in some kind of way. Or at least that is what some nurses seem to think that post on this forum. Apparently this trusty holistic sidekick of the doctor complements all realms of healthcare.

Well, the reality is that nurses DO already exist in all realms of healthcare....CCT, acute inpatient care, long-term care, home care, and everything in between.....but I don't think anyone here (or anywhere else) is advocating eliminating other healthcare professions.

The thing about community health is not that nurses should "take it over", it's that nurses already do it. Many of the early influential nurses (Nightingale, Lillian Wald, etc) were focused on public health, and today there are probably 10's of thousands of full-time home healthcare nurses.

I do think that community health can/should/will be a big part of improving access to primary care and reigning in healthcare costs in the future, which means there is a lot of room for expansion. And I do think that there is plenty of room for paramedicine to be involved in that.

What I don't see is any demand or justification for going to all the trouble and expense of inventing a completely new profession at the mid-level provider for paramedics who want to do primary care in the community. I just do not see that ever happening, and I think it is too bad that so many see a complete re-invention of their profession as the only salvation for paramedicine.

Here is something I wrote in another thread on this topic:

If the government decides to increase funding for community health initiatives, it makes more sense to simply expand the existing infrastructure than it does to invent a whole new provider. We already have NP's, PA's, and CHRN's. The existing entities all have more political pull than EMS, and will quickly snatch up any funding made available. And as a taxpayer who would rather see his tax dollars go towards the actual delivery of care rather than towards funding redundant educational programs, I wouldn't necessarily disagree with that.

Now, that said.....

One of the big problems with paramedic education is that it is still focused solely on life-threatening emergencies even though those requests make up a very small percentage of what paramedics actually do. For that reason, it makes good sense to me that paramedic education and mindset would shift from its emergency focus to one where the importance of basic non-emergency care is increased.

I would re-design paramedic education to take a full two years (at least), and the curriculum would spend at least as much time on non-emergency as on emergency care. Paramedics would still learn to do EKG's and ACLS and PALS and airway management, but rather than pretending that's all there is to prehospital care and then having to schlep everyone to the ED whether or not they need it, medics would also be in a much better position to implement protocols that allowed for "treat and release" and for referral to clinics. Asthma attacks, diabetic wake-ups, minor burns, minor lacerations, and drunks would no longer have to receive the same disposition as a STEMI or a stroke.

And I wouldn't call this a "community health paramedic"; I would just call it a paramedic who is better trained to do what we are already called to do most of the time anyway.

I would much rather see the EMS community get behind the idea of increasing and improving basic educational standards and making them reflect the realities of what paramedics actually do. To me that makes a lot more sense and is a lot more realistic than all the push towards the community health or critical care stuff.

And my vision of what paramedicine should and realistically can and should be:

This is exactly why "normal" paramedics need the ability to do non-emergency care, and part of the reason why having dedicated "community health paramedics" is unworkable, IMO:

A patient calls 911 for shortness of breath, just like they do now. A paramedic unit responds emergently, just like they do now.

Once arriving, they do the same assessment they normally would, including an EKG. Their assessment findings point to pneumonia. Their protocol takes into account the assessment findings, age, co-morbidities, etc and indicates that the patient should be triaged to clinic. They make a quick call to med control, who agrees with their plan. They then make a quick call to dispatch, who gives them a time for a clinic appointment the next day (or a followup home visit with a PA or NP from the home-health car agency).

The paramedics give a neb treatment and a course of ABX, tell the patient to drink lots of fluids and call back ASAP if they have worsening SOB, talk for a minute about the importance of smoking cessation, and leave the appointment slip with the patient.

They clear that call and are dispatched to a rollover MVC.

​

 

[MrJones]

...And my vision of what paramedicine should and realistically can and should be:

This is exactly why "normal" paramedics need the ability to do non-emergency care, and part of the reason why having dedicated "community health paramedics" is unworkable, IMO:

A patient calls 911 for shortness of breath, just like they do now. A paramedic unit responds emergently, just like they do now.

Once arriving, they do the same assessment they normally would, including an EKG. Their assessment findings point to pneumonia. Their protocol takes into account the assessment findings, age, co-morbidities, etc and indicates that the patient should be triaged to clinic. They make a quick call to med control, who agrees with their plan. They then make a quick call to dispatch, who gives them a time for a clinic appointment the next day (or a followup home visit with a PA or NP from the home-health car agency).

The paramedics give a neb treatment and a course of ABX, tell the patient to drink lots of fluids and call back ASAP if they have worsening SOB, talk for a minute about the importance of smoking cessation, and leave the appointment slip with the patient.

They clear that call and are dispatched to a rollover MVC.

You left out one key bit of information: How is the ambulance service reimbursed for this call? A sustainable funding model is absolutely imperative for your vision to succeed in the long run.

 

[CriticalCareIFT]

Well, the reality is that nurses DO already exist in all realms of healthcare....CCT, acute inpatient care, long-term care, home care, and everything in between.....but I don't think anyone here (or anywhere else) is advocating eliminating other healthcare professions

I agree that nurses do exists in all realms of health care and function in their respected roles and practice nursing. Yet have a belief that after years of nursing that they can take a 2 week course here, a residency training there, or masters degree and transform to another health care profession with equal competencies and be a paramedic, primary care physician as NP, anesthesiologist as CRNA etc. etc.

What I don't see is any demand or justification for going to all the trouble and expense of inventing a completely new profession at the mid-level provider for paramedics who want to do primary care in the community. I just do not see that ever happening, and I think it is too bad that so many see a complete re-invention of their profession as the only salvation for paramedicine.

You mean line nurses did with NP? And wanted to practice medicine in rural areas where there is need, but really stay in major cities and university hospitals?

 

[EpiEMS]

Municipal tax base green tinted glasses folks love disposable technicians if the EMS disposable technicians are simple add-ons to FFs and the goal is to support engines, ladders, pumpers, first.

Yes, there are some synergies with having FF-based EMS. The personnel are already cross-trained (I say trained for a reason) and much of what they do is related (MVAs require FD for rescue, in most communities where EMS doesn't have "organic" rescue expertise, for example), and the stations are already there. However, remember that most of what the FDs do today is superfluous -- the reason why we don't have lots of fires (or lots of folks dying due to fires) has nothing to do with fire departments, but everything to do with engineering and fire protection technologies. Better construction has reduced the need for fire suppression and financial innovation covers the risk from the cost side. Fire departments are -- on the mean -- overstaffed and overfunded.

Some of the cost disadvantages of FD-based EMS:

-- You're pulling out engines and ladder trucks -- it costs more to have the 3 FFs and 1 officer on an engine respond than it does an EMT/Medic ambulance, and the value-added by the FF/EMTs is pretty minimal, other than for lifting. And we can easily substitute capital for labor (think power stretchers), which are much cheaper than (unionized) FFs. If you really feel that we need more personnel at any given call, I'd wager that the costs (fixed and variable) for having a 3 or 4 person-staffed ambulance (or 2 person ambulance with a 1 person fly-car) are dwarfed by a fire engine.

-- FFs don't want to be doing EMS, on the mean. Less motivation can quickly turn to lower quality of care (or, at the very least, not up-to-date care because of a lack of engagement with the literature, etc.)

-- It provides a reason to add staffing to fire departments where the marginal benefits are exceeded by the marginal costs (i.e. the value added of another FF is smaller than the added benefits provided).

I like to think of FF-based EMS as well-intentioned (even though it perpetuates an extent and outdated system) but ill-informed. Firefighters don't fight fires. We are better off having single-role EMS personnel do EMS, not firefighters.

 

[ExpatMedic0]

Definitely a lot of interesting discussion stemming from this thread, even if I don't agree with it all. The fact of the matter is our healthcare system is changing folks, if you like it or not. Some may think I am full of hot air and over-ally optimistic, which may be partly true ;-) but we are getting ready for some big changes in healthcare, especially from a financial standpoint. I don't want to dive to deeply into the vastly expanding realm of Mobile Inter-graded Healthcare, and the amazing emerging trend of community paramedicine, nore the political agenda with the fire department or nursing, as that is best suited for another thread. However, for better or for worse... there are some big changes coming down the EMS pipeline in our career lifetimes. Personally I think it would be in our best interest to shift towards a degree requirement from a national standpoint, even if only an AAS.

 

[Wayfaring Man]

You need to drop you bias and start to understand the profession you've gotten yourself into.

You've missed my point here. My point is not that level of training is unimportant, or that a degree is a problem. I have a degree, incidentally.

I strongly agree that we need to maintain high standards of training. We need to enforce high levels of competency because lives are at stake. A college degree does not do that. It does not accomplish the things you mentioned (a high national standard or requirement, and so on) to require a college degree. There are other accrediting standards that can be used to do that without specifically requiring a college degree, which is absolutely an institution that at this point is extremely exploitative. It's not about my politics, it's about the reality of the situation.

There absolutely should be a national standard. NREMT is not that yet, it is not mandatory, but that's what NREMT does. It does advocacy to that end the same way CACREP advocates for counseling standards, or PTCB advocates for pharmacy technician standards, or Pro-Board accredits NFPA standard courses, and so on.

This doesn't require college. It is a medical field, it certainly requires advanced education. I am a huge fan of the new EMT courses that emphasize psychophysiology, and increasing the competency and knowledge of all EMS professionals from Basics to Medics.

But mandating a college degree is not the way to do that.

 

[ExpatMedic0]

....
But mandating a college degree is not the way to do that.

Everyone is entitled to there opinion, but I think your wrong. Maybe not from a practical standpoint, completely, but lets face it; In today's world, educated professionals need to posses a degree to be taken seriously, to do research in their field, to advocate and change polices, to lead and manage, and even as a whole, to be given higher salaries, rights, and privileges. Vocational training is not cutting it if you ever want to be taken seriously and as a professional. The general public and our predecessors expect professionals to hold degree's in today's society, otherwise we are just stretcher-baring tradesmen or ambulance drivers to them, and that is how we will be treated and paid.

 

[Wayfaring Man]

Edit: What you're saying makes good sense. I don't agree, for the reasons I had written already which follow, but I definitely see your point. Having a "BS in Emergency Medicine" or something like that would definitely improve the image of an EMT to the public. I think EMS degrees should exist and should become a thing. I think they should compete on the marketplace. If the public demands EMTs with college degrees, then the market will bear that out when such degrees are available, without a government mandate for them. Companies will simply prefer to hire people with a degree over people without one. Companies will prefer to hire people with an EMS degree over those without one. That would happen regardless of a strict mandate "have a degree or you can't get an EMS certificate."



I totally agree that we need to be standardizing from a national standpoint, that we need to be moving towards a rigorous, continuously improving program that provides best patient care based on evidence based medicine. I just disagree that a university degree, even an AAS, is the way to do that. It is entirely possible to train people to do emergency medicine, especially at the basic level, to practice without a degree program. FF/EMTs that attend academies or even volunteers that attend basic training programs like those offered from University of Maryland Fire and Rescue Institute (which is done by colleges, but doesn't require a full degree) is certainly sufficient to produce quality EMTs.

An associates degree is usually comprised of 60 credit hours of education. A credit hour is usually 15 contact hours. That's 900 contact hours. Most schools now require a "liberal arts" basis that emphasizes diverse studies. I think it's great and more people who are able should get such an education, because rounded education allows for better problem solving and better education. This produces better practitioners. I like better practitioners. I think I am a better EMT because I have a solid education. But I don't think mandating a degree is the solution to the problem when it's entirely possible to create quality EMTs without the degree. After all, a degree is just a piece of paper. It's the education and training that matters.

 

[ExpatMedic0]

As I said, from a practical standpoint, I do not think your entirely wrong, I just disagree with your degree opinion. Its not what you or I think, its the reality of the world we live in. As I said before, the general public, our other healthcare colleagues, and our predecessors, expect professionals. They expect educated professionals to hold degree's in today's society. Otherwise, we truly are just stretcher-baring tradesmen or ambulance drivers to them, and that is how we will remain and you and I will be treated and compensated for our services. Not because I think so, but because of the reality. Completing 2 semesters of general education (half of which is natural sciences and related to healthcare) ontop of a Paramedic program is not to much to ask.... I don't think.... I think we could grandfather people in who are already paramedics and start making progress like the rest of the world.

On a side note: I got a friend who works critical care transport. He is studying to become a doctor. When he shows up to take a patient on multiple drips and hooked up to invasive lines that need to be monitored and adjusted en route, nurses still refer to him as "the driver." The driver is here to take the patient...

 

[Carlos Danger]

I agree that nurses do exists in all realms of health care and function in their respected roles and practice nursing. Yet have a belief that after years of nursing that they can take a 2 week course here, a residency training there, or masters degree and transform to another health care profession with equal competencies and be a paramedic, primary care physician as NP, anesthesiologist as CRNA etc. etc.




You mean line nurses did with NP? And wanted to practice medicine in rural areas where there is need, but really stay in major cities and university hospitals?

Yep.

Nurses rule the healthcare world.

They are executing a vast conspiracy to control all other healthcare related professions.

They can do whatever they want.

You exist as a paramedic only because nurses allow you to.

Deal with it.

 

[ExpatMedic0]

When your called to a scene, you make a differential diagnosis, and the decision to take that patients ability to breathe away, paralyze them and manually introduce an ET tube into their trachea, without ever looking at protocols or calling a doctor, I think you need to have a degree. Period.

Not only to prove your smart enough to do the math on drug calculations, understand the anatomy and pathophysiology, and academic skills needed to write a proper report, but also because you deserve some kind of professional recognition, and your not going to get that as a vocational technician.

 

[Wayfaring Man]

Fair enough. I don't think those things are too much to ask except that education in general is still difficult for a lot of people. It's still unnecessarily burdensome in my opinion, but yeah, I agree with your assessment regarding the respect it would afford the field. Having a degree would definitely help boost the profession.

And I agree with the need we have to be asserted as a "real medical profession." A lot of people don't see us that way, and the fire side doesn't help it. I like the "community paramedic" model as it was pointed out to me, and I think that probably is best done as a "real education." I am just heavily skeptical of "pricing people out of the field" so to speak. But it's true, the culture we live in values that piece of paper a lot more than it does the actual details of an education or training, I suppose mainly because most people don't know the details of degrees outside their field.

 

[Wayfaring Man]

Not only to prove your smart enough to do the math on drug calculations, understand the anatomy and pathophysiology, and academic skills needed to write a proper report, but also because you deserve some kind of professional recognition, and your not going to get that as a vocational technician.

This right here is the part I absolutely agree with. The part about not needing to prove you're smart enough to slip an ET or an RSI, because the training and ability to perform those skills is enough to justify performing those skills (as avered by a standardized curriculum and accrediting agency), but because a person who has those skills deserves more respect than that of a basic vocational technician.