"What's in a name?" Dr. Bledsoe's article

[VentMedic]

Vent and Sasha, this time, you are 180 degrees off. I said that even doctors have hissy fits over their titles. Did I say that I agreed with them?

In fact, Sasha will tell you that I have moved on from the DNP thing and have adopted a policy of live and let live. I have far to many things to worry about right now other than who is getting called doctor and who is not. As long as DNP schools push for more than 4 units of pathophysiology, fine.

However, to back up my statement that doctors are indeed fighting over the use of the word doctor, here is the American Medical Association statement on the issue. Like I have said, I have no opinion.
http://www.ama-assn.org/ama1/pub/upload/mm/471/303.doc

Where I live and work, you will be hard pressed to find a 20 week paramedic school. Questa College, NCTI Santa Barbara, and Ventura College are all year long programs and all three have transferrable college units recognized by the community college system. There is no comparison between an AS degreed paramedic and a two week first aid cert EMT. Sorry.

The doctorate degree has been awarded for a couple of centuries to many professions. Yes it can get confusing but do you restrict the education of an entire profession to accomondate a handful of complainers that can't keep up with the advancements? BTW, did you read the links to the AANP which also contains the letters to the AMA telling them NPs are still moving on with their education plans? And, the 4 units of Pathophysiology is at a doctorate level. NPs will have had pathophys in undergrad and grad schools prior to entrance into a doctorate program just like the other healthcare professions.

In California, it only takes 1090 hours to be a Paramedic with only 40 ALS patient contacts. Some schools are able to cram those hours within a few months especially if ALS engine sleepovers are allowed.

 

[VentMedic]

VentMedic is certainly entitled to use the title doctor, because in academia, a PhD is generally considered a higher doctorate than a first professional degree like an MD or DNP. It is a huge accomplishment and I would be the first to congratulate her.

Thank you.

And yes, I have had a few semesters of pathophysiology to get to this point.

 

[daedalus]

The doctorate degree has been awarded for a couple of centuries to many professions. Yes it can get confusing but do you restrict the education of an entire profession to accomondate a handful of complainers that can't keep up with the advancements? BTW, did you read the links to the AANP which also contains the letters to the AMA telling them NPs are still moving on with their education plans? And, the 4 units of Pathophysiology is at a doctorate level. NPs will have had pathophys in undergrad and grad schools prior to entrance into a doctorate program just like the other healthcare professions.

In California, it only takes 1090 hours to be a Paramedic with only 40 ALS patient contacts. Some schools are able to cram those hours within a few months especially if ALS engine sleepovers are allowed.

I have read their position statement. The AMA can whine all they want, but it seems that the nursing profession has made up their minds. Like I have said, I am in no place to criticize anyone because I simply do not have enough health care exposure to do so at this point, and fighting other people's battles is too much when I have my own education to worry about.

I will continue to criticize programs in California that can be equated to medic mills. However, at least California law required all of our programs to be accredited long before the Nation Registry decided it was needed, which is much more than a lot of other states can say for themselves.

I will not however back down from my statement that an EMT can be equated to a Paramedic. I will fight that to my grave.

 

[daedalus]

All good ALS begins with BLS, Is not the maintenence of Airway, Assistance of Breathing & Assistance in Circulation BLS BEFORE it becomes ALS? Airwaymaintenance through a simple jaw thrust, or an OPA can be effective, BVM is not an ALS skill, but is effective, CPR is not an ALS skill.





I think that the US needs to look at the definition of the term Paramedic in order to answer this bit. The Cambridge dictionary defines it as



This is a universal name & just about every country other than the US has no difficulty with it.



There is also an option to further distinguish internally using these numbers. We have ICP, as well as ECP here, Intensive Care & Extended Care, but to the public, we are all the same.



Use car numbers that are unique. Who really cares?

There is no BLS before ALS. There is only medicine.

 

[Ridryder911]

Brian must be having a hard time of coming up with articles to write. Same old stuff to stir the pot. I respect and admire Bledsoe for his contributions and usual "dig" to get us in EMS thinking but alike discussed, most M.D.'s and even D.O.'s are the first to dismiss the title "Dr" to anyone without a license as a medical physician. I remember, it was not that long ago even D.O.'s were not really considered "real doctors". About two decades or so, I remember the first D.O. that was allowed to work in one of our major city ER's. Gasp!

In regards to nurses, very few introduce themselves as "nurse" if they are RN.'s. That is one of the running jokes is when someone tells you they are a nurse, chances are they are a LPN or CNA, etc....

Please, please can we stop the B.S. of BLS before ALS, it really does demonstrate the reason separation and need for titles.

R/r 911

 

[ResTech]

How can anyone call the statement BLS before ALS improper? That statement serves to illustrate the critical importance of providing basic modalities first and foremost which will be of a great, life saving benefit to the pt. I believe very much in that statement and it offers a lot of truth.

EMS isn't nursing or any other health profession... EMS is EMS!! period... and they're is a heritage to EMS like it or not which is where the BLS before ALS comes from. Yes, EMS needs some improvement in certain areas but it isn't as broken as some of you like to portray. Have we really been doing it that wrong from so long?? Call me a traditionalist when it comes to EMS... but I love EMS and what it stands for and where its come from. I'm all for progression and change for the better don't mistake me for that.... but I also believe that EMS is a realm of itself and needs to be regarded as such.

 

[Sasha]

EMS isn't nursing or any other health profession... EMS is EMS!!

EMS includes nursing and other health professions. EMS doesn't stop at the ER threshold and the body functions the same inside and outside of an ER. EMS is medicine, just like all those other health professions.

 

[daedalus]

How can anyone call the statement BLS before ALS improper? That statement serves to illustrate the critical importance of providing basic modalities first and foremost which will be of a great, life saving benefit to the pt. I believe very much in that statement and it offers a lot of truth.

EMS isn't nursing or any other health profession... EMS is EMS!! period... and they're is a heritage to EMS like it or not which is where the BLS before ALS comes from. Yes, EMS needs some improvement in certain areas but it isn't as broken as some of you like to portray. Have we really been doing it that wrong from so long?? Call me a traditionalist when it comes to EMS... but I love EMS and what it stands for and where its come from. I'm all for progression and change for the better don't mistake me for that.... but I also believe that EMS is a realm of itself and needs to be regarded as such.

When an Emergency Medicine PA inserts a nasal airway and bags a patient, it is medicine. We are no different. No other medical field separates BLS and ALS. There is no such thing as basic medicine and advanced medicine, and VentMedic can tell you there is miles of pages on respiratory physiology that go into bagging a patient.

 

[VentMedic]

Call me a traditionalist when it comes to EMS... but I love EMS and what it stands for and where its come from. I'm all for progression and change for the better don't mistake me for that.... but I also believe that EMS is a realm of itself and needs to be regarded as such.

EMS isn't nursing or any other health profession... EMS is EMS!!

So tell us about your EMS tradition, what EMS stands for and where EMS comes from as you see it. Tell us why you don't believe EMS is a healthcare profession. Why is EMS so different from your point of view except for the environment it is performed in?

 

[ResTech]

Its obvious your not able to speak from experience. In EMS, as of today, there are BASIC and ADVANCED level treatment modalities that providers perform. They are categorized that way for a reason based on the several different provider levels and distinguishment for legal and billing purposes based on how the EMS system is CURRENTLY set up.

Like I said earlier... EMS is EMS!!! its not respiratory therapy and its not nursing. Many of the dynamics present within EMS are NOT present in respiratory therapy or nursing.

And yes, I'm very aware of the physiology and pathophysiology of the respiratory system and what constitutes effective ventilations. I don't need "miles and miles of pages of respiratory physiology" to be able to ventilate my patients effectively. I'm also well aware of the role of a Paramedic and am not out to make it into something it isn't. If I want to dive deep into the respiratory system then after Paramedic school I will go on to become a RRT. I take my education as a Paramedic very seriously and continually read and learn all that I can beyond the minimum required. But at the same time I am very humble and acknowledge the role of the Paramedic.

It sounds like being a Paramedic isn't for you Daedalus.... I think you would be better suited for a PA program or med school... seeing how everything in EMS is wrong and were all under educated and can't ever do ne thing right like those nurses, PA's, and Docs.

 

[ResTech]

I didn't say EMS isn't a health profession because it is. But EMS is served up with dynamics not present in other health professions which makes it vastly different. EMS is of a very unique nature. When speaking clinically, the bar for care is at the very top.

There are certain elements to EMS that cannot be learned in a class room or in an ED. They are only appreciated, learned, and that clinical intuition developed while working in the street. That is all I am saying. Quite a few talk like they are so much better then the rest of us and heaven forbid we hang onto any bit of the EMS heritage or "tradition".

 

[VentMedic]

Its obvious your not able to speak from experience.

Yeah I guess 30 years working as a Paramedic in one of the areas where "EMS" got some of its roots doesn't count.

In EMS, as of today, there are BASIC and ADVANCED level treatment modalities that providers perform. They are categorized that way for a reason based on the several different provider levels and distingusment for legal and billing purposed based on how the EMS system is CURRENTLY set up.

Like I said earlier... EMS is EMS!!! its not respiratory therapy and its not nursing. Many of the dynamics present within EMS are NOT present in respiratory therapy or nursing.

And yes, I'm very aware of the physiology and pathophysiology of the respiratory system and what constitutes effective ventilations. I don't need "miles and miles of pages of respiratory physiology" to be able to ventilate my patients effectively. I'm also well aware of the role of a Paramedic and am not out to make it into something it isn't. If I want to dive deep into the respiratory system then after Paramedic school I will go on to become a RRT. I take my education as a Paramedic very seriously and continually read and learn all that I can beyond the minimum require. But at the same time I am very humble and acknowledge the role of the Paramedic.

So again I ask you why EMS is not a healthcare profession from your point of view?

In my world which is the state of Florida, we only provide ALS to the citizens of this state because we believe everyone deserves a medical assessment at that level and any treatment associated with it.

I didn't say EMS isn't a health profession because it is. But EMS is served up with dynamics not present in other health professions which makes it vastly different. EMS is of a very unique nature. When speaking clinically, the bar for care is at the very top.

There are certain elements to EMS that cannot be learned in a class room or in an ED. They are only appreciated, learned, and that clinical intuition developed while working in the street. That is all I am saying. Quite a few talk like they are so much better then the rest of us and heaven forbid we hang onto any bit of the EMS heritage or "tradition".

My question still stands.

Why is it so different?

In all areas of medicine experience helps to perfect what has been learned in the classroom.

Are you a FF?

 

[daedalus]

Med School application is about 2 years away, actually.

I am not using paramedic as a stepping stone, but it actually solidified my desire to go to med school because I feel like I am just not getting enough in medic school. I want to know more than just autonomic nervous system pharmacology, I want more than 10 pages on the immune response, etc.

I plan on becoming a medical director if I go the med school route, and pushing my system to new heights.

EDIT: BTW, the EM PA comment was just to show that we are all providing the same medicine. It was not to show that paramedics are undereducated buffoons.

 

[ResTech]

I'm really not out for an argument... just sat down to post a quick opinion... but I'll bite once more...

Vent, the experience comment was not directed at you. I know your a well seasoned and experienced provider well beyond myself.

In my world which is the state of Florida, we only provide ALS to the citizens of this state because we believe everyone deserves a medical assessment at that level and any treatment associated with it.

Awww... we're onto something... you make a great point! Florida residents have it great then... 24/7 all ALS coverage on the ambulance... must be nice... let me guess... mostly all County funded systems and residents pay for it through taxes... am I right???? Have you ever resided anywhere other then Florida where that type of system isn't the model????

Not all States are fortunate enough to have a system like that... In Pennsylvania... it is primarily VOLUNTEER... granted EMS was forced to be paid because of call volume increases and lack of volunteers to keep up with the demand. But do you know how these salaries and operations are paid??? Not by local government... they are paid by each department having Bingo, fundraisers, and through services provided which in some cases just break even or leaves little profit for investment.

So you see... the equation isn't near as simple as some of you like to think. Great, pass the laws for 24/7 all ALS coverage with Paramedics... do away with EMT-Intermediates, and even EMT's.... now come up with the funding plan to pay for it because Bingo isn't gonna cover it and the majority of local government in small communities isn't going to either, and residents are gonna be a bit pissed off when taxes greatly increase too.

Maybe you can tell the residents that their taxes need to be greatly increased so the EMS staff can read those "miles and miles of pages of physiology" on how to properly ventilate them because over the past 30 years we have been doing it so wrong and killing their loved ones with each response.

This is why we have "BLS before ALS" as a teaching point. You structure your educational programs and teaching methodology around the systems in which the providers are gonna be providing care and try to do it the best way that you can with the most optimum result which is what EMS has been exerting a good faith effort to do over the past 30 years. Not saying I totally agree with the approach... but its how it is. I am glad to see on a National level their is work being done to change this approach and have a more unified and systems wide approach to EMS delivery and not so much on a micro level.

Vent, I have my State Firefighter cert but would never consider myself a Firefighter... I am strictly an EMS provider.

 

[Ridryder911]

How can anyone call the statement BLS before ALS improper? That statement serves to illustrate the critical importance of providing basic modalities first and foremost which will be of a great, life saving benefit to the pt. I believe very much in that statement and it offers a lot of truth.

EMS isn't nursing or any other health profession... EMS is EMS!! period... and they're is a heritage to EMS like it or not which is where the BLS before ALS comes from. Yes, EMS needs some improvement in certain areas but it isn't as broken as some of you like to portray. Have we really been doing it that wrong from so long?? Call me a traditionalist when it comes to EMS... but I love EMS and what it stands for and where its come from. I'm all for progression and change for the better don't mistake me for that.... but I also believe that EMS is a realm of itself and needs to be regarded as such.

Traditionalist? I don't think so. It's not that we have been doing it wrong for so long, we have of yet ever done it right!

Are you sure you know the history of EMS? You do realize that prehospital care is one of the smallest divisions of EMS? Yeah, we are NOT solely the whole part of EMS.

The ONLY reason we ever hear or proclaimed the wording BLS is because of the lack of education to EMT's within EMS in the beginning. Yeah, everyone else that was beginning to be taught resuscitative measures went straight into just that. Resuscitative measures. There was no dividing line of this is BLS and this is ALS. All those divisions were made because of EMS half arse of not doing it right the first time.

Let's change it to BLS before EMS. Since in the real reality, the public can generally perform the same level of care to a cardiac arrest patient as a EMT basic can do. So yeah, I agree BLS first... with the emphasis on public awareness, aware that many times that they should be receiving much better care that available

I am not really picking on you, but as a student, just how much time did you study about EMS as a system? Now, that you acclaim to be traditionalist about EMS, what tradition are you wanting to secure? That many places of the U.S. are still being provided sub par emergency care. Even the t.v. show Emergency that was filmed nearly 30+ years ago, provides more advanced care than those that provide "BLS" today. So is the "tradition" you are so proud of? One text book courses. The ONLY health care professional that does NOT require a degree for entry level. Instructors or educators are not required to have at the least a baccalaureate degree (even kindergarten teachers require that much). Sure let's keep up the tradition, shall we. We have progressed so far......not!



.

 

[Sasha]

Awww... we're onto something... you make a great point! Florida residents have it great then... 24/7 all ALS coverage on the ambulance... must be nice... let me guess... mostly all County funded systems and residents pay for it through taxes... am I right????

Maybe you can tell the residents that their taxes need to be greatly increased so the EMS staff can read those "miles and miles of pages of physiology" on how to properly ventilate them because over the past 30 years we have been doing it so wrong and killing their loved ones with each response.

Negative, sweetheart. We only have federal income tax, no state. We pay less taxes than most states.

 

[ResTech]

Rid.. you do make some valid points I must admit.... I'm in no way saying we shouldn't step up... 'cause we definitely should... but let's be realistic and not so critical and recognize the many different components that exists within EMS that don't exist elsewhere in healthcare. This make it a more difficult and time consuming thing to accomplish.

Sasha.. please share with how the entire State of Florida can provide funding for ALS coverage to all of their residents (as proclaimed) and not have County systems or tax payer funding. Curious as to where they drawl the funds for that.

 

[Shishkabob]

Negative, sweetheart. We only have federal income tax, no state. We pay less taxes than most states.

And crap high property tax.

The Property Tax Oversight Program oversees a local property tax system that in 2006 had more than 9 million parcels of real property and a just value of $2.4 trillion...r.esulting in more than $30.4 billion in property taxes levied by local governments and taxing authorities.

:wacko:

 

[VentMedic]

The rest of my comments are not to be argumentative but rather informative for those who don't know the roots of EMS.

Vent, I have my State Firefighter cert but would never consider myself a Firefighter... I am strictly an EMS provider.

I made that comment because my roots are in a FD as a Paramedic. In the mid 1960s, Dr. Nagel started one of the birthplaces of today's EMS in FD in Miami.

Here's his comments:
http://www.jems.com/news_and_articles/articles/q_and_a_with_dr_eugene_nagel.html

Question: How can the "traditional" fire department better embrace EMS delivery?
Answer: By understanding EMS expectations and limitations. This requires understanding how we got there and where we are going. Not an easy task.
Question: How did you tap into the culture?
Answer: By trying to bring some of hospital medicine to the streets.

Of course, one could look at "today's" EMS but one should also remember today's Paramedics were not the first to perform in an EMS compacity.
On another thread, it physicians on ambulances were discussed. St. Vincent's in NYC did use Physicians starting in 1968 as did a few other cities including Miami and some used them well into the 1980s.

http://www.angelfire.com/co/fantasyfigures/710history.html

If one wants to look at another "tradition" one could look at the Freedom House Ambulance which gave their Paramedic almost 3000 hours of training in 1967. That is over 3 - 4 times what many Paramedics get today. Unfortunately a couple of other "traditions" (not the pleasant ones) helped to end what appeared to be a good model for EMS. It also was centered around medicine.

http://www.freedomhousedoc.com/

 

[VentMedic]

And crap high property tax.

:wacko:

But, do you know our tax base for some areas?