What would happen if the NREMT required a degree?

Rialaigh

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The AHA did not mean for "BLS" to mean an EMT when referring to survival rates. BLS in this sense mean early and quality CPR along with access to an AED. This is "BLS" whether it is done by an EMT, Paramedic, Doctor or a layperson. The study in Seattle involved Paramedics coming along after bystanders initiate "BLS" care. AEDs are also now very much for public access in many areas.

But, if ROSC is achieved by BLS, it can quickly turn to dead again if proper post ROSC care is not followed.

http://circ.ahajournals.org/content/122/18_suppl_3/S768.full

But, this is also a weak area in some places which could be why outcomes are not great. Some just don't want to do more because they don't know there is more or can't due to protocol limitations.

Sepsis treatment can be initiated in prehospital even without antibiotics.

Pain can be treated.

We also know that supraglottic tubes have limitations especially when a patient with ROSC regains their gag.

Now let us look at the 95% of the patients you come into contact with who are not dead or going to die right now? What about the patient care aspect? Do you think some of those who have only focused on skills and a few algorithms to get by are going to read the journals or take an interest in EBM to improve the care given? The BSN advocates used this in their favor to get past the old guard who said their "skills" were best and bull to the new ways stated in the journals. The BSNs were more willing to trial new things and accept now ideas. Learning things through education rather than just memorization makes change easier. The BSN advocates did their own studies for patient satisfaction and implementation of new protocols, guidelines and quality control. The ADN were still focused on tasks in some situations just like it seems some Paramedics are.

If your talking about treating pain and improving patient satisfaction scores then absolutely more education will improve this. But lets not confuse patient satisfaction scores with patients medical outcomes. It all comes down to the goal or purpose of doing this.

Again, I am not against more education. I just want our profession as a whole to make realistic goals about what education to require and the purpose of the additional education. To say that we want to be better educated paramedics so we can "Save more lives" is just the epitome of ignorance. To say that we want to be better educated paramedics so we can provide better service to our patients is completely reasonable.
 

Clipper1

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If your talking about treating pain and improving patient satisfaction scores then absolutely more education will improve this. But lets not confuse patient satisfaction scores with patients medical outcomes. It all comes down to the goal or purpose of doing this.

Again, I am not against more education. I just want our profession as a whole to make realistic goals about what education to require and the purpose of the additional education. To say that we want to be better educated paramedics so we can "Save more lives" is just the epitome of ignorance. To say that we want to be better educated paramedics so we can provide better service to our patients is completely reasonable.

I can not think of any profession which has used "save more lives" as a primary argument for increasing education. CMS is one group which will recognize a profession based on education and patient care. Dead people are really not their concern for the long haul unless the person is dead or injured at the hands of the healthcare provider. However, the recognition that layperson BLS saved lives was researched by those with education.

Also don't confuse treating patients' pain with just making them "satisfied" Controlling pain is a vital step in improving outcomes. But, that comes with education.
 
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Rialaigh

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I can not think of any profession which has used "save more lives" as a primary argument for increasing education. CMS is one group which will recognize a profession based on education and patient care. Dead people are really not their concern for the long haul unless the person is dead or injured at the hands of the healthcare provider.

Also don't confuse treating patients' pain with just making them "satisfied" Controlling pain is a vital step in improving outcomes. But, that comes with education.

I would be shocked if there is a study showing prehospital pain management that coordinated with improved long term outcomes for the patient.

I think EMS needs to move in the direction of becoming more educated to become an extension of the hospital system. We shouldn't be a separate enterprise, we should be an extending arm of the hospital system that provides smooth continuity of care to patients that utilize prehospital services. I think more integration into the hospital system would be beneficial. I would not be opposed to some ideas of the director of the ER (or directors) ultimately being over the EMS system.
 

Clipper1

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I would be shocked if there is a study showing prehospital pain management that coordinated with improved long term outcomes for the patient.

I think EMS needs to move in the direction of becoming more educated to become an extension of the hospital system. We shouldn't be a separate enterprise, we should be an extending arm of the hospital system that provides smooth continuity of care to patients that utilize prehospital services. I think more integration into the hospital system would be beneficial. I would not be opposed to some ideas of the director of the ER (or directors) ultimately being over the EMS system.


Why do you think pain management outside of the hospital would not improve outcomes? Chest pain?

Pain management is a big part of the hospital and long term care. If you want to be part of that you need to get used to the concept of patient care and not just the save lives stuff. ADLs in comfort or relatively pain free are an extension of the hospital. This does improve outcomes.

How do you want to argue for integration into the hospital? Many "techs" at entry level have at least an Associates degree.

ER doctors don't treat for long term. They refer for follow up. But when used as a primary physician you get repeaters because the care is not meant for maintenance.
 
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Rialaigh

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Why do you think pain management outside of the hospital would not improve outcomes? Chest pain?

Pain management is a big part of the hospital and long term care. If you want to be part of that you need to get used to the concept of patient care and not just the save lives stuff. ADLs in comfort or relatively pain free are an extension of the hospital. This does improve outcomes.

How do you want to argue for integration into the hospital? Many "techs" at entry level have at least an Associates degree.

ER doctors don't treat for long term. They refer for follow up. But when used as a primary physician you get repeaters because the care is not meant for maintenance.

Which getting way off topic is why Vene would advocate to get rid of them all together..but that is a whole other discussion.


How are we measuring outcomes. Are we using patient satisfaction scores? hospital length of stay? mortality? Are we talking medical outcomes purely or measuring outcomes in another way?
 

Clipper1

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Which getting way off topic is why Vene would advocate to get rid of them all together..but that is a whole other discussion.


How are we measuring outcomes. Are we using patient satisfaction scores? hospital length of stay? mortality? Are we talking medical outcomes purely or measuring outcomes in another way?

Getting rid of doctors? Vene?

With all of the articles available in the professional journals including emergency medicine I am surprised at your questions. Pain management is not new. This is something you really need to start learning about by reading professional journals espcially if your medical director does not want to approach the topic. That also leaves a big why facor? Don't let a negativity against doctors hinder progress even if you want rid of them.

This whole argument for and against education is not new either. All the other professions have gone through it in their process for professional recognition. But, they were able to better see the differences since they did take note of the changes occurring around them. RNs noticed they were the one of the least educated in the multidisciplinary rounds. RNs were also being supervised by allied health professionals in some units. RNs in the US also got a wake up call for more education when nurses from other countries took them to be only PNs due to lesser education. RTs got left out for reimbursement in alot of things because they have not advanced to the level of the other therapies and nursing is now in a better position at the magnet hospitals.

You would think EMS would have taken a few lessens from others if they wanted to be part of the bigger picture in health care. Expanding into different ares like home care poorly prepared will not go well in the long run. Eventually the grants for the trial runs will go away.
 
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Rialaigh

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Getting rid of doctors? Vene?

With all of the articles available in the professional journals including emergency medicine I am surprised at your questions. Pain management is not new. This is something you really need to start learning about by reading professional journals espcially if your medical director does not want to approach the topic. That also leaves a big why facor? Don't let a negativity against doctors hinder progress even if you want rid of them.

This whole argument for and against education is not new either. All the other professions have gone through it in their process for professional recognition. But, they were able to better see the differences since they did take note of the changes occurring around them. RNs noticed they were the one of the least educated in the multidisciplinary rounds. RNs were also being supervised by allied health professionals in some units. RNs in the US also got a wake up call for more education when nurses from other countries took them to be only PNs due to lesser education. RTs got left out for reimbursement in alot of things because they have not advanced to the level of the other therapies and nursing is now in a better position at the magnet hospitals.

You would think EMS would have taken a few lessens from others if they wanted to be part of the bigger picture in health care. Expanding into different ares like home care poorly prepared will not go well in the long run. Eventually the grants for the trial runs will go away.

Getting ride of ER physicians, yes, and replacing them with internist.



I think you are missing my point. If we are educating further to get more professional recognition, fine. If we are educating further to improve patient satisfaction scores, fine. If we are educating further to raise our pay, fine. If we are educating further so that we can better understand patient complaints and disease process, fine.

But if you think educating further by EMS (in the role that we play CURRENTLY) will reduce mortality or the length of hospital stays, I highly highly doubt it.

I'm not saying we won't be better providers, I'm not saying our patient care won't be better. I am saying that mortality and hospital length of stays aren't going to decrease because we furthered our education.


Frankly if your transport time is less then 30 minutes I highly doubt putting a physician on our ambulances with the same scope that we hold currently would really make much a difference honestly.
 
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Clipper1

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Getting ride of ER physicians, yes, and replacing them with internist. .

There are reasons why we have specialists. An ER should not be used as a primary physician's office.



I think you are missing my point. If we are educating further to get more professional recognition, fine. If we are educating further to improve patient satisfaction scores, fine. If we are educating further to raise our pay, fine. If we are educating further so that we can better understand patient complaints and disease process, fine.

But if you think educating further by EMS (in the role that we play CURRENTLY) will reduce mortality or the length of hospital stays, I highly highly doubt it.

I'm not saying we won't be better providers, I'm not saying our patient care won't be better. I am saying that mortality and hospital length of stays aren't going to decrease because we furthered our education..

You are fixated on the saving lives things. But yes, there are things EMS is researching to improve outcomes. Being more proficient at intubation and recognizing sepsis are two things. Both of which can improve outcomes. TH and recognizing stroke patients are more things. CPAP alone is not always the answer for respiratory failure. Recognition and early intervention as appropriate is key. Just playing by numbers is not always the only way to do things. By your reasoning all EMS should be doing is driving fast to the hospital and that nothing you do matters.

If you can not see in any way how EMS makes a difference, time to find another profession. Unfortunately too many probably think like you or this type of talk is what some want to hear to avoid education which explains probably only 10% of those in EMS holding a degree in EMS as working Paramedics. The other 10% of the 20% probably have obtained other degrees such as in nursing or PA to get away from the downers in EMS who want to justify not getting more education or fearing change.

Frankly if your transport time is less then 30 minutes I highly doubt putting a physician on our ambulances with the same scope that we hold currently would really make much a difference honestly.

A doctor does not have the same scope of practice or the same knowledge base as a Paramedic. A doctor can do more with less in some situations because of their education and experience. A Paramedic has only studied a few indications for the medications and equipment on the ambulances. If a doctor (or PA or NP) was on the ambulance, there might not be a need to transport. That would be doing more.
 

Rialaigh

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There are reasons why we have specialists. An ER should not be used as a primary physician's office.





You are fixated on the saving lives things. But yes, there are things EMS is researching to improve outcomes. Being more proficient at intubation and recognizing sepsis are two things. Both of which can improve outcomes. TH and recognizing stroke patients are more things. CPAP alone is not always the answer for respiratory failure. Recognition and early intervention as appropriate is key. Just playing by numbers is not always the only way to do things. By your reasoning all EMS should be doing is driving fast to the hospital and that nothing you do matters.

If you can not see in any way how EMS makes a difference, time to find another profession. Unfortunately too many probably think like you or this type of talk is what some want to hear to avoid education which explains probably only 10% of those in EMS holding a degree in EMS as working Paramedics. The other 10% of the 20% probably have obtained other degrees such as in nursing or PA to get away from the downers in EMS who want to justify not getting more education or fearing change.



A doctor does not have the same scope of practice or the same knowledge base as a Paramedic. A doctor can do more with less in some situations because of their education and experience. A Paramedic has only studied a few indications for the medications and equipment on the ambulances. If a doctor (or PA or NP) was on the ambulance, there might not be a need to transport. That would be doing more.


Yet people keep preaching the need to formulate protocol after evidenced based research. If the evidence states that frankly, a lot of what we do doesn't make a difference in mortality or morbidity outcomes or length of hospital stays...can you accept that?



I see plenty of ways that EMS makes a difference. We comfort patients who are having "emergencies". We bring calm and reason to scenes and situations in which there was previously panic. We bring comfortable transports to patients in pain. We enable patients to be seen in a timely manner to receive the medication they need to get better and be more comfortable. We give patients peace of mind by assuring them they we are taking them to see a doctor and that it is going to be okay. Furthering our education can help us become better in all those areas to better serve our patients.


Let us fix our education standards based upon things we can actually change. It all goes back to the goals of prehospital EMS services. Evaluate areas in which you can make a difference, set goals based on those areas. Set your education standards based upon those goals.
 

Clipper1

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Let us fix our education standards based upon things we can actually change. It all goes back to the goals of prehospital EMS services. Evaluate areas in which you can make a difference, set goals based on those areas. Set your education standards based upon those goals.

You need a base education to go forth with other education goals. An Associates is barely an education as others have found out but it is a start.

As far as mortality, sometimes dead is dead. There are many life threatening events you can not change even in a major hospital. You are not God or any other object of worship.

If you want to remain a technician with a year or less of training (national average for Paramedic certificates) be happy. Allow other professionals who have a well rounded education do the research for EMS. Be satisfied with other professionals being the program directors of your educational institutions.

If being a tech is good enough, go with it. You are not alone since over 80% of EMS shows support by not advancing to even an Associates degree in EMS.

But then, you need to stop complaining about wages or reimbursement by CMS at a tech status. You need to stop complaining about not getting respect from other professionals as an equal professional. You need to stop complaining about RNs who challenge your certificate because they can due to the loop holes. If you can go on believing you save lives now without more education or improved protocols or guidelines, good for you.


I see plenty of ways that EMS makes a difference. We comfort patients who are having "emergencies". We bring calm and reason to scenes and situations in which there was previously panic. We bring comfortable transports to patients in pain. We enable patients to be seen in a timely manner to receive the medication they need to get better and be more comfortable. We give patients peace of mind by assuring them they we are taking them to see a doctor and that it is going to be okay. Furthering our education can help us become better in all those areas to better serve our patients.

I thought EMS wanted to evolve past just driving people to the hospital. I hope you are doing more than hand holding for someone having an emergency. I also do not tell people "it is going to be okay" since I can not see into their future. Medical bankruptcy can add stress and the patient could die of an MI or suicide.

Overall, I still don't see where you get the idea EMS does not make a difference except for comfort but without the pain management we discussed earlier. Seattle has shown that a combination of educating the layperson for BLS and their ALS knowledge has made a difference. This has also been duplicated in other cities with similar results. TH has had varying outcomes also. The way head trauma and stroke is managed has made a difference.

I can only tell you that there are many journals out there which could provide you with more information. Also, not every EMS system just drives the patients to the hospital. Some have extensive interventions they can do to make a difference. They can do both the hand holding and the interventions while still getting the patient to a doctor.
 

Carlos Danger

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I just hope that people recognize that having 2 or 4 more years of school behind you for the job that we currently do....won't make a damn bit of difference to patient outcomes.

I'd say you're painting with a bit too broad of a brush. Unless, of course, you have something more than your opinion upon which you're basing that statement. And I'd love to see it if you do.

What reason do we have to believe that requiring more education WILL improve patient outcomes?

Remember, it is the intervention (in this case, requiring more education) that must prove itself, not the absence of the intervention.
 

AzValley

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Having a high(er) bar for entry typically weeds out the less serious and committed in most fields.
 

unleashedfury

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Having a high(er) bar for entry typically weeds out the less serious and committed in most fields.

Yes and no,

I am a strong believer we as a field should work harder to become more like a nursing program counterpart.

Nursing programs have their clinical time built into the program where as EMS schools have the student do it on their own time, at their convenience which is nice since you can work with your schedule, but students don't get enough time to "focus" on the current didactic at hand.

In example I just did my airway section of my program. It was 4 classroom lectures and a fred the head sign off. Where as if this were a nursing program after this section of the program if nurses where intubating patients they would have a round with Respiratory and the OR as part of the program.

The education standards of our field our broken its more like a self study if your a paramedic. If you want to become more proficient or knowledgeable within your scope of practice you might as well go out on your own and become a more proficient and knowledgeable provider. But many are just saying well I got the certificate so I can play with needles, and meds, Maintain the minimum standards of continuing education, and merit badge courses to keep their jobs. Which from what I gather not only in my state but other states is pretty minimal.

It goes back from the initial, paramedic training in the united states the idea was to provide the standards to get the program rolling and saturate the states with paramedics basically they found a problem and put a band aid on it. Not a long term solution but we never increased the standards after meeting the initial requirements.
 

bsmsdave

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Show me a State that subscribes to NREMT for licensure & I will show you a State to lazy to run their 0wn program
 

EpiEMS

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Show me a State that subscribes to NREMT for licensure & I will show you a State to lazy to run their 0wn program

Imagine if you said that for the NCLEX or USMLEs (obviously, ≥1 year of extra training required for unrestricted licensure in the latter case). How much repetitive effort is required for each state to run their own licensure exams of EMTs and Medics separately? Strikes me as an efficiency gain to use Registry.
 

Medic Tim

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Yes and no,

I am a strong believer we as a field should work harder to become more like a nursing program counterpart.

Nursing programs have their clinical time built into the program where as EMS schools have the student do it on their own time, at their convenience which is nice since you can work with your schedule, but students don't get enough time to "focus" on the current didactic at hand.

In example I just did my airway section of my program. It was 4 classroom lectures and a fred the head sign off. Where as if this were a nursing program after this section of the program if nurses where intubating patients they would have a round with Respiratory and the OR as part of the program.

The education standards of our field our broken its more like a self study if your a paramedic. If you want to become more proficient or knowledgeable within your scope of practice you might as well go out on your own and become a more proficient and knowledgeable provider. But many are just saying well I got the certificate so I can play with needles, and meds, Maintain the minimum standards of continuing education, and merit badge courses to keep their jobs. Which from what I gather not only in my state but other states is pretty minimal.

It goes back from the initial, paramedic training in the united states the idea was to provide the standards to get the program rolling and saturate the states with paramedics basically they found a problem and put a band aid on it. Not a long term solution but we never increased the standards after meeting the initial requirements.

Not all programs are as you describe.

I went through a CC for my AAS in Paramedicine. We had the same pre-reqs and co-reqs as the nursing students. Our program also had more class time and clinical hours than the nursing program. It was common for students to have over 1000 clinical hours between the hospital and ambulance that was all scheduled. All of our instructors had at least an AAS. Our medical director also taught a few classes, he also guest lectured in most others a few times.

I understand that this is not the norm..... but there are good programs out there.
 

Clipper1

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Not all programs are as you describe.

I went through a CC for my AAS in Paramedicine. We had the same pre-reqs and co-reqs as the nursing students. Our program also had more class time and clinical hours than the nursing program. It was common for students to have over 1000 clinical hours between the hospital and ambulance that was all scheduled. All of our instructors had at least an AAS. Our medical director also taught a few classes, he also guest lectured in most others a few times.

I understand that this is not the norm..... but there are good programs out there.

There have been some good Associates programs for Paramedic in the US since the 1970s. But, almost every college also has the cert option to stay competitive with the private votechs. Probably half of all Paramedics in the US are taught at private votechs or by the ambulance companies/fire departments by people who have the same cert level and no college A&P experience. Their A&P courses usually transfer nowhere and are just overview. The students who take the initiative to find a good program will probably do well but move on to higher education such as PA or move to Canada if they meet the higher education requirements and can get through the red tape to work there. Some moved on because they did not like working with those who did the bare minimum and complained about the possibility of more education being required all shift.

The hours of clinicals on an ambulance are not necessarily equal to that of nursing for patient contact. A nursing student has one or two patients for all 8 or 12 hours and will do a variety of procedures. If their patient does not have the procedures needed, there are many other patients who might. They can also observe and talk to doctors or any other health care professional. Paramedic students might spend 12 hours at an ambulance station watching TV or playing on the computer. Some ambulance companies and FDs are popular because they allow for 24 hour shifts with the sleeping hours count towards total hours. Some states have gone to number of ALS patient contacts because of this but then you get patients with unnecessary IVs and ECGs just to get someone their ALS patient contact. Some states even had to define "ambulance" since students in some places were allowed to do ALS engine rides with no transport.
 

Medic Tim

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There have been some good Associates programs for Paramedic in the US since the 1970s. But, almost every college also has the cert option to stay competitive with the private votechs. Probably half of all Paramedics in the US are taught at private votechs or by the ambulance companies/fire departments by people who have the same cert level and no college A&P experience. Their A&P courses usually transfer nowhere and are just overview. The students who take the initiative to find a good program will probably do well but move on to higher education such as PA or move to Canada if they meet the higher education requirements and can get through the red tape to work there. Some moved on because they did not like working with those who did the bare minimum and complained about the possibility of more education being required all shift.

The hours of clinicals on an ambulance are not necessarily equal to that of nursing for patient contact. A nursing student has one or two patients for all 8 or 12 hours and will do a variety of procedures. If their patient does not have the procedures needed, there are many other patients who might. They can also observe and talk to doctors or any other health care professional. Paramedic students might spend 12 hours at an ambulance station watching TV or playing on the computer. Some ambulance companies and FDs are popular because they allow for 24 hour shifts with the sleeping hours count towards total hours. Some states have gone to number of ALS patient contacts because of this but then you get patients with unnecessary IVs and ECGs just to get someone their ALS patient contact. Some states even had to define "ambulance" since students in some places were allowed to do ALS engine rides with no transport.

I don't disagree. I am also familiar with the differences between EMS and nursing clinical activities. I was midway through Junior year in a BSN program before deciding to go the EMS route....I know that sounds crazy to many here
 

Clipper1

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I don't disagree. I am also familiar with the differences between EMS and nursing clinical activities. I was midway through Junior year in a BSN program before deciding to go the EMS route....I know that sounds crazy to many here


But now you are in Canada.
The nursing programs there are also way ahead of the US for requirements and US ADNs barely can be called PNs there.

http://www.senecac.on.ca/fulltime/BSCN.html

1700 hours of clinicals exceeds the US standard.
 
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