What's it mean?

VentMonkey said:
I agree with education for many reasons beaten to death by myself and others on the forum repeatedly.
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You've been asking all the questions time for me to turn the tables. How do you think we can realistically bridge the gap??
I remember i asked a while back if anybody had anything EMS related they wanted to be brought to governmental attention, was going to post as a reference but can't seem to find it.
 
NysEms2117 said:
You've been asking all the questions time for me to turn the tables. How do you think we can realistically bridge the gap?
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Honestly, I don't have the answer. Legislation moves at a glacial pace, but would clearly yield change on a grander scale. It would also require a nationally unified approach by EMS providers coast to coast.

Do I want to effect change that way, or am I content continuing to provide care at the field provider level, effecting change one patient at a time? I'm still undecided, TBCH.

I honestly don't have the answer, but just wonder how others feel about the matter. I think ultimately there are several ways to "make a difference", but you have to be able to accept and understand this as such.

I think labeling our services as emergency services, at least in the prehospital setting, is a misnomer. I think education beyond basic vocational courses reflects a "profession".

I think making entry requirements more than just a way to "make a quick buck, use it as a stepping stone, or see cool stuff" is a start. Sure there may always be a need for the patients in the textbook definition of an emergency, but I don't think we should focus primarily on these limited encounters anymore.

In order to enhance our profession, we need to understand our worth as a public entity, otherwise we'll just continue to deliver false notions to the masses who are then partnered up with that seasoned provider one more tool away from becoming the "hack" at their service.

If you don't believe me, or don't see it at your service, that's fine, but just look at all of the new comers that join this site with catch phrases for names yet lack experience, or display a grim reaper Star Of Life as their avatar.

I'm not knocking them for it per se, I'm just saddened and at times embarrassed that 5 decades later that is still where we are. Is that really how we're still seen to the newer providers? And if so, shouldn't we educate them, and shouldn't they (in theory) embrace it instead of scoffing at it, or getting their "feels" hurt?; it epitomizes stagnation.
 
VentMonkey said:
Legislation moves at a glacial pace, but would clearly yield change on a grander scale. It would also require a nationally unified approach by EMS providers coast to coast.
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I think this is a very important point to emphasize. EMS desperately needs something like the NCLEX. Where it is MANDATORY your become a NREMT before getting a job as an EMT somewhere. I get the NREMT is there, but it's completely optional especially out here on the east coast. I know if your a NYS EMT, your reciprocity goes out to 80%+ of states, but nothing comes in. So what would the benefit of me taking extra tests and what not be? I think there needs to be a national standard, where every single state must oblige by the requirements.
I'm not going to lie, part of the reason why I'm in EMS is because it's a decent side gig, it gets some extra money coming in. However, the other part I really enjoy as well is I can really make a difference in my community, rather then having to be the bad guy(parole), I can truly help people.

I think something else i forgot to mention before is community involvement is critical in any civil service field application. EMS, Fire, LE, the community needs to know they can rely on you, and the only way to do that is to communicate with them. Most municipalities frown on it because it's extra money going out, but in the long run it pays off. Again this may be because i'm young(ish) and too sanguine still.
 
If we made paramedic a 2 year degree(minimum), we'd have plenty of class time to teach both the emergency stuff and the community paramedicine type stuff; and more to the point, we could incorporate more clinical time in more fields to thoroughly assess the total provider. If someone can't manage to pass the soft, emotional stuff(two week inpatient psych rotation?, two weeks doing adl's in a nursing home?), then labeling them a reaper racer only in it for the sexy calls is fair.

Those are just examples. I agree with the idea that we need to demphasize the hero stuff and spend some time talking about the every day things that actually help our patients; but we still need to teach the stuff that makes us EMERGENCY medical technicians. The only way I see that working is a longer course with infinitely more structure and evaluation, like you might find in a college setting.
 
hometownmedic5 said:
If we made paramedic a 2 year degree(minimum), we'd have plenty of class time to teach both the emergency stuff and the community paramedicine type stuff; and more to the point, we could incorporate more clinical time in more fields to thoroughly assess the total provider. If someone can't manage to pass the soft, emotional stuff(two week inpatient psych rotation?, two weeks doing adl's in a nursing home?), then labeling them a reaper racer only in it for the sexy calls is fair.

Those are just examples. I agree with the idea that we need to demphasize the hero stuff and spend some time talking about the every day things that actually help our patients; but we still need to teach the stuff that makes us EMERGENCY medical technicians. The only way I see that working is a longer course with infinitely more structure and evaluation, like you might find in a college setting.
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Sadly you wouldnt have time because for a college degree you need a speech class, a money management class, 3 english classes, a foreign language, calculus, PE, and 37 electives.



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GMCmedic said:
Sadly you wouldnt have time because for a college degree you need a speech class, a money management class, 3 english classes, a foreign language, calculus, PE, and 37 electives.
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Not sure if you full or half kidding, but that's kind of the point; exit: vocation, enter: profession.
 
VentMonkey said:
Not sure if you full or half kidding, but that's kind of the point; exit: vocation, enter: profession.
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Only half kidding. My point is a two year degree is not long enough.

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VentMonkey said:
Interesting, why not?
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In reference to the post above teaching emergency stuff and community paramedicine, 2 years isnt enough.

Now, just basing this off of my area but in the last 7 years something has happened. Students are starting medic class that haven't even passed their EMT exam. They're not working in EMS till they graduate or right before. The majority of students have 3 months or less experience before they're handed a narc box and likely an equally new EMT partner.

Nearly all of these students are going to county services for clinicals up until internship when they finally go to the busy AMR shop, but only because internship is a number of runs and not hours. Some of these students make great medics, most of them are gone within a year because they weren't prepared, THEY have no one to blame but themselves, but I put part of the blame on the education system.

Though I dont agree with the practice, it seems protocols cater to the lowest common denominator so why not education?

I think we can all agree that education provides a good baseline, but experience with education MOSTLY makes for a better provider. If students are not going to put forth the personal effort to gain experience than the only other option is more education or make experience a prereq to program entry (which a state funded college will never do)

I personally went through a hybrid accelerated course that was a year long (I have all prereqs for the associates except Anatomy II).
That type of class certainly isnt for everyone but it worked well for me and the entry requirements were much more strict than our local community college. That really isnt relevant other than I learn better by doing than by reading. I had 2 years experience in a very busy system before I started class. Experience is the only reason any of us were successful in that class. In subsequent classes every single student s experience was measured in months.

There wasnt a student that ever passed that program again after my class, at least not locally.


ETA: on the topic of the thread.

I left a bachelors program 6 classes shy of a degree to work in EMS. It was the best decision I ever made. From the start ive told myself that its not my emergency to judge, there have been some hiccups along the way but I havent lost sight of that.

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Around 40 years ago, you became a nurse by taking a (usually) hospital run on the job training course that covered some theory and many donkey skills; then you learned how to actually do your job while doing it. Wages weren't great, but you could scratch out a living. You weren't well respected in the medical community, but it couldn't function without you; so more than anything you were tolerated more than appreciated.

Fast forward some time and you have the introduction of the associates degree in nursing as the minimum requirement. Education went up, wages were hauled up the hill along with the increase in education(knowledge, skills, and clinical experience). Nurses were begrudgingly accepted and respected as an integral part of the medical team.

All aboard the time machine again to the 90's/00's when the BSN became the standard. Perhaps not nationwide, and certainly not at the say nursing home level; but for example you cant hardly get a job in the mailroom at a boston hospital without a bachelors.

So, does that sound familiar?
 
hometownmedic5 said:
Around 40 years ago, you became a nurse by taking a (usually) hospital run on the job training course that covered some theory and many donkey skills; then you learned how to actually do your job while doing it. Wages weren't great, but you could scratch out a living. You weren't well respected in the medical community, but it couldn't function without you; so more than anything you were tolerated more than appreciated.

Fast forward some time and you have the introduction of the associates degree in nursing as the minimum requirement. Education went up, wages were hauled up the hill along with the increase in education(knowledge, skills, and clinical experience). Nurses were begrudgingly accepted and respected as an integral part of the medical team.

All aboard the time machine again to the 90's/00's when the BSN became the standard. Perhaps not nationwide, and certainly not at the say nursing home level; but for example you cant hardly get a job in the mailroom at a boston hospital without a bachelors.

So, does that sound familiar?
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Ironically enough my wife and I were discussing this exact topic this morning over breakfast.

She echoed, almost to a tee, what you've just stated regarding nursing and it's transformation from a vocation to a profession.
 
hometownmedic5 said:
All aboard the time machine again to the 90's/00's when the BSN became the standard. Perhaps not nationwide, and certainly not at the say nursing home level; but for example you cant hardly get a job in the mailroom at a boston hospital without a bachelors.
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just to echo this.... This applies anywhere in the northeast mainly. (aside from your "mom and pop" hospitals)
 
Having done the college thing, I would like to see a lot of what I had to do. Emerson and old literature is a waste of time. However classes like basic math, english, A&P I&II, and EMS specific classes whether they delve into critical care or management principles would be good to have.

Edit: what I had to do and then a lot of modification to the degree path. I would like to see a lot more science and EMS stuff built in.
 
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Sorry, at work and i left that last post without finishing my thought.

So the parallel is that EMS is where nursing was 40 years ago. The future is bright, but a ways off. Some day, you will need a degree to be a paramedic. When that happens, we will get to make the argument that we're educated professional and deserve more money. Right now, we're technicians with a mostly skill based training program. We don't get paid more than we do because, and don't get triggered here, we're not worth it. When you work in a job that people will do for free, you cant demand top tier wages.

Some day, it will be different. It's happening now. It's going to take a long time, but the changes are starting. The first big step is making a college affiliation a requirement for accreditation. That lays the tracks. The next big development will be a universally accepted conversion factor for current paramedic cert to college credit. Once that can be done, the idea of requiring a degree can be birthed.

Once we live in a world where we take paramedicine seriously, as educated professionals, we can demand and will receive higher wages and respect as competent PROFESSIONALS, not reaper racing clowns.
 
hometownmedic5 said:
Once we live in a world where we take paramedicine seriously, as educated professionals, we can demand and will receive higher wages and respect as competent PROFESSIONALS, not reaper racing clowns.
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I'd be interested to see that day. Wages would be nice (like anyone, who doesn't like more money?), but I do ok.

With the parallels to a nursing degree, and its requirements, yielding more mature-minded providers seems like it would boost a vocation into a profession; that would be nice.
 
I think realistically we're looking at a generation. If sweeping changes were made in the entrance requirements to make this a true profession tomorrow, there would still need to be provisions made for everybody currently certified to continue working for at least long enough to meet the new requirements. In my area, the fire union would negotiate something like ten years to accomplish an associates, with almost endless extensions for this reason or that.

So to clean sweep through and have most field providers playing at at least the associates level, about 20 years. I'm 31 with 12 years in. In some abstract manner I might still be in EMS in 20 years, but I won't be humping calls on the street. I might just be around to see it happen though....
 
A transition schedule is going to be awfully important. You can also just grandfather in people who were certified before a certain date.

In general, to align ourselves with other allied health professions, associates then a bachelors is the way to go...but that seems far from today's case (only like 10% of EMS educational credentials across all provider levels are an associates degree or higher) That said, the most recent data I've seen is 2008.
 
I bet it's no farther away than it would have been for a nurse circa 1970.

It all starts somewhere and I think we've seen the spark. As I said, I think CoAEMSP requiring paramedic programs to be affiliated with a college to be accredited is the first step.

I don't think too many years will pass before the NREMT is truly the national standard for paramedics. Once we have a unified certification, the skids are greased and things will start to happen fast(relatively speaking).
 
So many great comments here. Going back to the original question, I think EMS is mostly about being a good citizen -- looking out for others, setting good examples, being kind even when it's hard, sharing knowledge and experience, trying to do better -- things like that. Given the modest pay and day-to-day risks, I had to start looking at it that way, but it took me 20 years to do so.
 
Interesting note: as recently as 1980, a majority of nurses were diploma prepared...but by 2008, collegiate prepared nurses were the bulk of the RN workforce. No reason EMS couldn't do that.
 
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