What would happen if the NREMT required a degree?

[ExpatMedic0]

Hey guys, the thread was reopned by admin. Lets try and keep it on track and civil to avoid another lock of the thread. I will post some EMS advocacy information and ideas later concerning the main topic.

 

[Clipper1]

So that begs the question, what can we as individual providers do to move this process along. Lobby with the NAEMT? Obviously we can all start with becoming more educated, better providers ourselves, but what is the next step? Everyone has great questions and suggestions regarding what the end game should look like, but what we need is a plan. We need a blueprint of tangible things we can actually do in order to see the coming changes in healthcare provide a positive impact on EMS, even though we obviously missed the boat regarding the ACA, what with our almost nonexistent contribution to it.

Basically what I'm saying is that Med school is a long and difficult road to follow just because you are passionate about EMS, which will be a small part of a physician's job. Change in EMS will have to come from the inside. If the people that do the job don't want change, no physician will force it on them. For the most part I do agree. I'm just asking for disussion's sake what we as paramedics can do to move us forward outside of increased personal standards and education. Things such as lobbying, teaching, etc.

You first need to learn who your advocates are.

National Association of EMS Educators
http://www.naemse.org/

National Association of EMS State Officials
http://www.nasemso.org/

National Association of EMS Physicians
http://www.naemsp.org/Pages/default.aspx

American College of Emergency Physicians
http://www.acep.org/

American College of Surgeons
http://www.facs.org/ahp/trauma/index.html

American Trauma Society
http://www.amtrauma.org/

Emergency Services for Children
http://mchb.hrsa.gov/programs/emergencymedical/

American Academy of Pediatrics
http://www.aap.org/en-us/Pages/Default.aspx

American Ambulance Assoication
http://www.the-aaa.org/

Also, every state EMS office has a listing of bills pending and support provided.

The above are just a few.
Some may not believe these associations support EMS because "no more money was mentioned for EMTs". But, in health care everything is a process and advocacy for the patient must take precedence especially since many raises or funding must be supported by the tax payers. Other professionals also support each other on common goals which provides a bond for future endeavors. Unfortunately EMS tends to alienate itself with strong vocal disproval of nurses, ambulance services and anyone in management or who might have supported higher education.

The Associate degrees have been around for a long time. But with less than 20% of EMS holding a degree and probably a lot less holding an EMS degree, this speaks volumes especially since EMS has been around longer than some of the professions now requiring degrees and have also been low paid or continue to be low paid at this time. But the degrees may represent a personal and professional satisfaction.

However, EMS as to start with its educators to become better educated and serve as mentors for the future of education.

 

[unleashedfury]

However, EMS as to start with its educators to become better educated and serve as mentors for the future of education.

To start the process todays providers need to start focusing on the degree, Most of the providers that are instructors today that are Paramedics hold only a certificate completion, and certification card, with *X* number years experience in the field.

I know of only 2 Programs in my area that require that the program be completed as a part of a A.A.S. a third program is aiming more towards eliminating their certificate program and requiring everyone to take the Associates program,

Problem #1 is competition if there is 5 paramedic programs within a hour distance of the student, 3 of the programs require the completion of an associates, 2 are certificate programs, cost of the degree vs. the certificate is significantly higher at least 6 grand difference. and the equivalence in pay and oppurtunitiy remains the same.

If the NREMT required at minimum a Associates to be elgible to test the states that use NREMT as their procotored exam would have to be on board with the intentions. If they weren't States would offer their own exam and no longer have the NREMT requirement.

In Pa there is no Paramedic State Certifcation exam its either NREMT or nothing, they are pushing towards the Basics to become NREMT exams also. Now everyone got on board with the Accrediation of their programs requirement which was a push in the right direction, now if they can increase the requirements slowly but truly without resistance a degree program would be in the works

 

[Rockies]

I would probably earn more money.

 

[ExpatMedic0]

from my understanding the NREMT now requires your to graduate from a CAAHEP and CoAEMSP accredited program, which requires the EMS instructor (or program director, cant remember) to posses at least a bachelors degree.
If you dont go to an accredited program your not eligible for NREMT testing. Its a small step but its a step in the right direction. National EMS Educator Credentialing/certification is also becoming mainstream.

 

[Clipper1]

from my understanding the NREMT now requires your to graduate from a CAAHEP and CoAEMSP accredited program, which requires the EMS instructor (or program director, cant remember) to posses at least a bachelors degree.
If you dont go to an accredited program your not eligible for NREMT testing. Its a small step but its a step in the right direction. National EMS Educator Credentialing/certification is also becoming mainstream.

The Bachelors degree is a requirement for the Program Director. This is also what I was leading to in my earlier comment about Paramedics being in charge of their own academic departments. Many of the colleges already teaching accredited Paramedic programs have RNs with advanced degrees overseeing them because of this requirement.

http://coaemsp.org/Documents/Standards_Interpretations_2_2013.pdf

The program director must:
1) possess a minimum of an Associate’s degree for
Emergency Medical Technician-Intermediate and a
minimum of a Bachelor’s degree for Emergency
Medical Technician-Paramedic from a regionally
accredited institution of higher education,

For instructors nothing has changed:

Qualifications
The faculty must be knowledgeable in course content and effective in teaching their assigned subjects, and capable through academic preparation, training and experience to teach the courses or topics to which they are assigned.

For most programs, there should be a faculty member to assist in teaching and/or clinical coordination in addition to the program director. The faculty member should be certified by a nationally recognized certifying organization at an equal or higher level of professional training than the Emergency Medical Services Profession(s) for which training is being offered.

 

[Rialaigh]

Someone tell me what the end, and I mean the very end, goal is for furthering the education of paramedics. I don't mean this in a sarcastic way, I just want to know what the individual reasoning (or community reasons) is for furthering our education. What is the end goal in mind.

 

[Rockies]

Someone tell me what the end, and I mean the very end, goal is for furthering the education of paramedics. I don't mean this in a sarcastic way, I just want to know what the individual reasoning (or community reasons) is for furthering our education. What is the end goal in mind.

Other than the CE credits, continuous eduction in a field where there is abundant red tape and a ever evolving treatment plan is almost necessary to keep you on your toes.

 

[Wheel]

You first need to learn who your advocates are.

National Association of EMS Educators
http://www.naemse.org/

National Association of EMS State Officials
http://www.nasemso.org/

National Association of EMS Physicians
http://www.naemsp.org/Pages/default.aspx

American College of Emergency Physicians
http://www.acep.org/

American College of Surgeons
http://www.facs.org/ahp/trauma/index.html

American Trauma Society
http://www.amtrauma.org/

Emergency Services for Children
http://mchb.hrsa.gov/programs/emergencymedical/

American Academy of Pediatrics
http://www.aap.org/en-us/Pages/Default.aspx

American Ambulance Assoication
http://www.the-aaa.org/

Also, every state EMS office has a listing of bills pending and support provided.

The above are just a few.
Some may not believe these associations support EMS because "no more money was mentioned for EMTs". But, in health care everything is a process and advocacy for the patient must take precedence especially since many raises or funding must be supported by the tax payers. Other professionals also support each other on common goals which provides a bond for future endeavors. Unfortunately EMS tends to alienate itself with strong vocal disproval of nurses, ambulance services and anyone in management or who might have supported higher education.

The Associate degrees have been around for a long time. But with less than 20% of EMS holding a degree and probably a lot less holding an EMS degree, this speaks volumes especially since EMS has been around longer than some of the professions now requiring degrees and have also been low paid or continue to be low paid at this time. But the degrees may represent a personal and professional satisfaction.

However, EMS as to start with its educators to become better educated and serve as mentors for the future of education.

Thanks for a well thought out answer and a little direction. I'm about to start finishing my bachelor's degree this coming semester, and my eventual goal is education or advanced practice.

 

[Jon]

You first need to learn who your advocates are.

National Association of EMS Educators
http://www.naemse.org/

National Association of EMS State Officials
http://www.nasemso.org/

National Association of EMS Physicians
http://www.naemsp.org/Pages/default.aspx

American College of Emergency Physicians
http://www.acep.org/

American College of Surgeons
http://www.facs.org/ahp/trauma/index.html

American Trauma Society
http://www.amtrauma.org/

Emergency Services for Children
http://mchb.hrsa.gov/programs/emergencymedical/

American Academy of Pediatrics
http://www.aap.org/en-us/Pages/Default.aspx

American Ambulance Assoication
http://www.the-aaa.org/

Also, every state EMS office has a listing of bills pending and support provided.

The above are just a few.
Some may not believe these associations support EMS because "no more money was mentioned for EMTs". But, in health care everything is a process and advocacy for the patient must take precedence especially since many raises or funding must be supported by the tax payers. Other professionals also support each other on common goals which provides a bond for future endeavors. Unfortunately EMS tends to alienate itself with strong vocal disproval of nurses, ambulance services and anyone in management or who might have supported higher education.

The Associate degrees have been around for a long time. But with less than 20% of EMS holding a degree and probably a lot less holding an EMS degree, this speaks volumes especially since EMS has been around longer than some of the professions now requiring degrees and have also been low paid or continue to be low paid at this time. But the degrees may represent a personal and professional satisfaction.

However, EMS as to start with its educators to become better educated and serve as mentors for the future of education.

Clipper,

You missed two big ones:

NAEMT
http://www.naemt.org/advocacy/advocacy_home.aspx

And

Advocates for EMS
http://www.advocatesforems.org/

 

[Clipper1]

Wheel had already mentioned NAEMT which I quoted earlier.

Advocates for EMS has not had much activity on their website since 2011. They need to keep people interested and updated. They also link back to NAEMT.

 

[Angel]

Personally I'm all for making an Associates the minimum for Paramedics, not so much EMTs.
Reason being is "we" demand to be paid more and respected as more than just ambulance drivers but many refuse to get some solid education under their belt. Taking GE classes at a CC isn't HARD, it will expand general knowledge (reading, math, basic English ect) and possibly even help. (How many people actually take an in depth anat and phys class?)

A lot of people are just lazy and want to do the absolute minimum to get by and I think that's a terrible attribute for a paramedic to have.

 

[Handsome Robb]

Someone tell me what the end, and I mean the very end, goal is for furthering the education of paramedics. I don't mean this in a sarcastic way, I just want to know what the individual reasoning (or community reasons) is for furthering our education. What is the end goal in mind.

I think that's kind of been stated already.

Beyond the common pay and professional respect aspect there's the education related things such as paramedics being the director if a paramedic program, professional advancement and the potential for different areas if specialization (flight/critical care, education, community Paramedicine/advanced practice Paramedicine).

EMS is changing. It already has internationally. It's not you call we haul anymore, that system doesn't work. We can't be a gateway to the healthcare system without having more education than just recognize, stabilize/treat life thread/symptoms, transport. Doing things like triage to urgent cares or treat-and-release with a referral to a PCP isn't going to work properly with the current education models.

 

[ExpatMedic0]

You guys beat me to the links and info!

I would also like to point out when you go to the NAEMT website you can click on advocacy, there is a list of resources from that link such as "how to advocate" and many more, here http://www.naemt.org/advocacy/advocate/howtoadvocate.aspx The framework on the NAEMT website does provide a good blueprint for ways to advocate and advance if your unfamiliar.

Now, I am probably setting myself up to be flamed on this, and the following statements are my own ideas/opinions.

However, one big problem I have with the NAEMT themselves, is that they claim to be the nations main EMS advocacy entity, yet what have they done for us? Keep in mind they have been around since the 1970's.


Before you answer that question lets compare the allied health care profession of Paramedicine to Athletic Training, which did not use to require a degree. Both professions are certified allied health personal. Athletic training has been recognized by the American Medical Association as an allied health care profession only since 1990. Today, in order to become a Certified Athletic Trainer you must graduate from a bachelors or masters degree program accredited by the Commission on Accreditation of Athletic Training Education (CAATE). Furthermore Although CAT's fall under allied health, they can be used as physician extenders to complement the same kind of work as mid-levels, see link http://www.nata.org/sites/default/files/using-certified-athletic-trainers-as-physician-extenders.pdf
I use to work special event stand by's with a CAT and he worked as an extension of a DO in the field. He made over $20,000 a year more than I did . At our events he handled any and all care with the athletes other than "Emergency Care" which then became my area. His physical assessments for trauma where superior to anything I have seen aside from a doctor.

Athletic Trainers Salary Survey http://www.nata.org/sites/default/files/SalarySurvey11.pdf
EMS providers Salary Survey http://www.jems.com/sites/default/files/1310-jems-tables-1--5_0.pdf

I am not an expert on Athletic Training, I know very little about it, but it would appear to me that the NAEMT should take some lessons from the NATA (www.nata.org) Possibly part of the reason the NAEMT may not be making any progress is because its in kahoots with to many other special interest groups such as the fire service. Furthermore rather than promote real EMS education, they seem to sell us merit badge alphabet soup courses up the wazoo. If the NAEMT is our advocate, why are they not advocating for not even mandatory associates degrees?

PS: It should be noted, an athletic trainer is not a physical trainer (eg at the gym), some people mix up the names, like a Physician Assistant is not a Medical Assistant.

 

[Rialaigh]

I think that's kind of been stated already.

Beyond the common pay and professional respect aspect there's the education related things such as paramedics being the director if a paramedic program, professional advancement and the potential for different areas if specialization (flight/critical care, education, community Paramedicine/advanced practice Paramedicine).

EMS is changing. It already has internationally. It's not you call we haul anymore, that system doesn't work. We can't be a gateway to the healthcare system without having more education than just recognize, stabilize/treat life thread/symptoms, transport. Doing things like triage to urgent cares or treat-and-release with a referral to a PCP isn't going to work properly with the current education models.

I guess my point is I think some people think that better education standards will somehow make us better paramedics (in the sense that we are paramedics now). I don't for a second believe that higher education will reduce mortality or morbidity one bit for the job and purpose we currently serve. Sure we might get paid more, we might have more respect, but beyond that (in our current system) ....what's the point. Now I do understand the calls to educate better for the purpose of transitioning into a community medicine type system, and doing all those things you stated in your second paragraph.


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.

This is primarily why I am against raising the education standards until we can unite a little better and put some common 5 and 10 year goals in perspective and see how to best achieve those through education.

 

[MrJones]

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.

 

[Clipper1]

I guess my point is I think some people think that better education standards will somehow make us better paramedics (in the sense that we are paramedics now). I don't for a second believe that higher education will reduce mortality or morbidity one bit for the job and purpose we currently serve. Sure we might get paid more, we might have more respect, but beyond that (in our current system) ....what's the point. Now I do understand the calls to educate better for the purpose of transitioning into a community medicine type system, and doing all those things you stated in your second paragraph.

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.

Right now a Paramedic cert is not that difficult to get and is considered an add on for some or something to get so you can be a fire fighter. I just read an article about Memphis FD having all 375 firefighters certified as Paramedics including the 25% who are black which is what the article was actually about. I doubt if all 375 fire fighters wanted to be Paramedics but the department started their own in-house training and got everyone certified. There are many other departments which have almost all of their FFs certified as Paramedic including the large ones in Florida and California. The kicker is you don't have to function as a Paramedic, you just have to have the cert. That is not a "career Paramedic". Others take whatever quick cert program they can to be a FF. Many will keep their regular jobs as something else until they get hired by a fire department.

Medical directors must also write their protocols to fit the lowest denominator which would be the one who got the cert just because he had to or for the extra pay. This is the difference between writing a protocol for a mother may I system which a recipe is followed or writing a guideline to allow those who have extended themselves to understand A&P and pharmacology to make decisions based on clinical judgment per their assessment.

You might be able to argue that those who follow the just transport to the nearest hospital as quick as possible might have better outcomes but then that also includes transporting the dead in a cardiac arrest. Another medical director might allow the Paramedics to take to the most appropriate facility including clinics and work a code at scene until ROSC or dead is dead. You could also argue continuing to do something the same way because that is how you've always done it is good enough. You could also argue that you can do all the skills of someone in Australia but with 1/4 the education and can put a tube through the vocal cords just as well. I think some see success in form of a "skill" rather than the bigger picture.

Work in a busy hospital with many different EMS ambulances coming in and you will quickly see the difference between those who consider being a Paramedic a career and those who enjoy a patch with extra pay or those aspiring to get a job on the FD for the pay and not the patient care. The latter the private ambulance Paramedics who are just serving their time and just want a FD job.

Replacing the 3 - 6 month programs which can also be accredited with degree programs, could make the cert less of an add on and medical directors might actually write guidelines for professionals.

This is primarily why I am against raising the education standards until we can unite a little better and put some common 5 and 10 year goals in perspective and see how to best achieve those through education.

It took 15 years for EMS to change the titles again without changing the education very much. Nursing has had their plan for the BSN since the 1970s or right after the transition from diploma to Associates. Before they make their next move they would like to see at least 80% of RNs holding a BSN in the work force. Right now they have reached over 50%. Some states are higher and are moving forth with BSN legislation but for the next 10 years. This is no different than all the other health care professions which promoted the degree through long term plans but could not approach it as a legislative issue until they has nearly all members in their profession with that degree. You should also read about the challenges in Oregon on their path to a degree. They still have to make exceptions for reciprocity and grant at least 2 years for someone who passed the NREMT Paramedic exam. They also had to make considerations as to how the very rural and volunteer agencies could meet the requirements with no schools for many miles. But, they did have the support of the fire departments and the state.

 

[ExpatMedic0]

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 don't agree with this statement. Do you honestly believe that providing paramedics with 2-4 more years of education would not increase an entry level paramedics ability to provide better patient care by, recognizing/treating disease processes, illnesses, injuries, ect; any of which could improve patient outcomes?

 

[Rialaigh]

I don't agree with this statement. Do you honestly believe that providing paramedics with 2-4 more years of education would not increase an entry level paramedics ability to provide better patient care by, recognizing/treating disease processes, illnesses, injuries, ect; any of which could improve patient outcomes?

In theory this would improve outcomes. In reality it does not. (again, I am talking about transport times of an average of less then 30 minutes). BLS systems have some of the highest ROSC rates in the nation. Stemi outcomes are only improved by transport to the closest PCI center and asprin. We all know (or should) by now that we don't treat hypertensive crisis in the field. Infection is treated at the hospital by IV antibiotics. Hypotension is treated by fluids, I doubt you could find me a study showing pressors make any difference in long term outcome in transport times of less than 30 minutes. Trauma is a BLS skill. Cpap has eliminated the need to tube everyone having trouble breathing. RSI has been shown not to help outcomes. King airways are just as effective as intubation in the short term.

Knowing A+P better, being able to recognize disease process, being able to understand what is going on with your patient, all these things can make you a "better" paramedic....they just don't improve patient outcomes in our current system.


I'm not arguing that higher education standards won't improve paramedics. I am arguing that higher education standards won't improve patient outcomes in our current system. Depends on what your end goal is...

 

[Clipper1]

In theory this would improve outcomes. In reality it does not. (again, I am talking about transport times of an average of less then 30 minutes). BLS systems have some of the highest ROSC rates in the nation. Stemi outcomes are only improved by transport to the closest PCI center and asprin. We all know (or should) by now that we don't treat hypertensive crisis in the field. Infection is treated at the hospital by IV antibiotics. Hypotension is treated by fluids,

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.