Would you like to be a Primary Care Paramedic?

[bigbaldguy]

Another devils advocate question. Let's assume that a patient does understand the difference between ALS and BLS and is given a choice, they can ride with ALS and be comfy with lovely drugs delivered through an IV for 1400 dollars or they can ride with BLS and gut it out for an hour or so and take a 700 dollar hit. Now assuming the patient actually cared about paying the bill himself, wasn't rich, and doesn't have insurance what do you think people would choose ALS or BLS.

 

[Tommerag]

Another devils advocate question. Let's assume that a patient does understand the difference between ALS and BLS and is given a choice, they can ride with ALS and be comfy with lovely drugs delivered through an IV for 1400 dollars or they can ride with BLS and gut it out for an hour or so and take a 700 dollar hit. Now assuming the patient actually cared about paying the bill himself, wasn't rich, and doesn't have insurance what do you think people would choose ALS or BLS.

Valid point, assuming nothing changes from what it is now for transporting, the patient wouldn't get that choice. The ALS would be there and would have the higher level of training, they can't release to someone else with a lower level of care.

If that were to happen you would have to have more forms for patients to sign, to cover your rear end.

 

[Veneficus]

I'm curious to hear your basis for thinking that Paramedic's will be in less demand.

Communities will always need and desire the ALS level of care. People are not going to stop experiencing medical and traumatic emergencies. People will continue to have MI's, COPD, Seizures, hypoglycemia, crash their cars, etc. The US population has a high number of elderly and that population group is still rising.

I would not worry about Paramedic jobs being in short supply.

Just to point out, why pay a paramedic $20/hour when you could pay a Basic with an extended scope $8/hour?

As for the OP.

If I was still working as a paramedic, I would be all for this type of career description.

MedicRob is exactly right. More education= more ability for diversification= more compelling argument for higher wages.

I am convinced there is no need for a paramedic in an urban environment with less than 15 minute transport times. Any treatment performed short of pain releif can be done by a basic.

Train them how to transmit a 12 lead, start an IV, and write a protocol for pain management and there is no longer any purpose for an urban paramedic.

 

[medicRob]

Cool. So why did you become a paramedic then?

Requirement for my position in flight.

 

[medicRob]

If it's a chronic disease then all you can do is make patients comfortable and make them as symptom free as possible. Until cures are found what more can you do for chronic disease suffers?

I am speaking with regard to the individuals responsible for finding cures, not EMS.

 

[18G]

I am convinced there is no need for a paramedic in an urban environment with less than 15 minute transport times. Any treatment performed short of pain releif can be done by a basic.

Train them how to transmit a 12 lead, start an IV, and write a protocol for pain management and there is no longer any purpose for an urban paramedic.

You can't (or shouldn't) build an EMS system based on minimal requirements.

And I disagree that a basic (even with an expanded scope) can replace a Paramedic in an urban environment. There are too many variables when looked at on a deeper level. Again, its a contradiction. The same people who advocate increased standards now advocate for minimal standards. Regardless of system type people need to be in the field that can handle the typical day to day calls in addition to the complex calls without using short hospital transport times as an excuse to stay minimal.

I've been involved in several EMS systems and EMT's are not suitable for giving drugs, injections, and managing a patients total care pre-hospital. It's not that they don't have the ability, it's that the EMT programs do not allow for it and are way too minimal. Even with expanded scope we all know the educational foundation is gonna be severely lacking and the focus is gonna be on skill delivery only.

 

[medicRob]

You can't (or shouldn't) build an EMS system based on minimal requirements.

And I disagree that a basic (even with an expanded scope) can replace a Paramedic in an urban environment. There are too many variables when looked at on a deeper level. Again, its a contradiction. The same people who advocate increased standards now advocate for minimal standards. Regardless of system type people need to be in the field that can handle the typical day to day calls in addition to the complex calls without using short hospital transport times as an excuse to stay minimal.

I've been involved in several EMS systems and EMT's are not suitable for giving drugs, injections, and managing a patients total care pre-hospital. It's not that they don't have the ability, it's that the EMT programs do not allow for it and are way too minimal. Even with expanded scope we all know the educational foundation is gonna be severely lacking and the focus is gonna be on skill delivery only.

A basic can most certainly replace a paramedic in any environment if we up their education, send them to school for 2 years, and give them the proper training in their program + a general education. After all, people seem to forget, Paramedic is just a continuation of basic, and only a year at that. Of course we can teach that in 2 years, that is how every other paramedic is trained.

In the perfect world, there would be:

Paramedic (Associates), Paramedic Specialist (Bachelors), and maybe even Paramedic Practitioner (Masters).

Paramedic would be the basic of this system, Specialist would have more education to deviate into specialty areas such as doctors offices, ICUs, ERs, Trauma Units, Community Health, etc. Paramedic practitioner would have an emphasis on research and education as well as clinical practice (continuing development of scopes of practice from evidence based findings in the literature, expanded skill set to include certificate of fitness to prescribe)

However, this will never happen til the current EMS Mindset and EMS as a whole dies. It needs rebirth, stop putting a bandaid on it and come up with a whole new system, one that emphasizes education, not skill set. Then, you have your bargaining chips for a salary like Registered Nurses.

 

[18G]

A basic can most certainly replace a paramedic in any environment if we up their education, send them to school for 2 years, and give them the proper training in their program + a general education. After all, people seem to forget, Paramedic is just a continuation of basic, and only a year at that. Of course we can teach that in 2 years, that is how every other paramedic is trained.

If we send them to school for two years then they are not a Basic.

I agree the minimum level EMS provider on an ambulance should be a two year, degreed Paramedic and then have levels on top of that. 140hrs is just not enough to serve as a primary care provider on an ambulance. Over many years I have witnessed many EMT's and maybe one or two in almost 20yrs really knew the why behind what they were doing. In short, they were scary and I would not trust them taking care of my kids so I would not be in favor of giving them more of an arsenal to actually do harm.

If you want to provide medical care on a professional level then it is a requirement to go to College for at least two years and put in the work. If you don't want to do that then find something else to do.

And also along the lines of substituting urban Paramedic's with EMT's due to short transport times, then why not substitute RN's with LPN's in a hospital setting and just give them expanded scope? There are physicians present to give their orders and within arms reach so why pay an RN $30/hr when you can pay an LPN much less? It's all about standards and having people in the position that can adjust to the demand and not fizzle out when the system throws in a roadblock.

 

[medicRob]

If we send them to school for two years then they are not a Basic.

I agree the minimum level EMS provider on an ambulance should be a two year, degreed Paramedic and then have levels on top of that. 140hrs is just not enough to serve as a primary care provider on an ambulance. Over many years I have witnessed many EMT's and maybe one or two in almost 20yrs really knew the why behind what they were doing. In short, they were scary and I would not trust them taking care of my kids so I would not be in favor of giving them more of an arsenal to actually do harm.

If you want to provide medical care on a professional level then it is a requirement to go to College for at least two years and put in the work. If you don't want to do that then find something else to do.

And also along the lines of substituting urban Paramedic's with EMT's due to short transport times, then why not substitute RN's with LPN's in a hospital setting and just give them expanded scope? There are physicians present to give their orders and within arms reach so why pay an RN $30/hr when you can pay an LPN much less? It's all about standards and having people in the position that can adjust to the demand and not fizzle out when the system throws in a roadblock.

Because LPN is a technical level provider, RN is has a general education background along with an advanced skill set. EMT's are technical trades, and for the time being, so is Paramedicine.

 

[Veneficus]

You can't (or shouldn't) build an EMS system based on minimal requirements.

We've been doing it for 40 years! What's changed?

Even many paramedics on this forum revolve around a skilled trade mentality. Why not just give them what they want?

The fire service, which is the largest provider of EMS in the US actually lobbies for this.

And I disagree that a basic (even with an expanded scope) can replace a Paramedic in an urban environment. There are too many variables when looked at on a deeper level.

I could say the same thing about paramedics.

its a contradiction. The same people who advocate increased standards now advocate for minimal standards.

I don't see it as a contradiction. I agrue that increased standards is to the benefit of all.

If people don't want to make things better, then it is only reasonable to make the current system as efficent and inexpensive as possible. The people who pay the price will be the EMS workers who thought they would get no benefit from increased education.

They will receive all that they wished for. In abundance. Because most are too lazy, greedy, or stubborn to look 10 years down the road is not my problem.

Regardless of system type people need to be in the ield that can handle the typical day to day calls in addition to the complex calls without using short hospital transport times as an excuse to stay minimal.

Why?

As EMS stands right now they cannot handle the typical day to day patient care and just bring the people to the hospital anyway.

When was the last time any EMS provider in the US administered childrens' tylenol to a kid with a fever, gave them some pedialyte and left them at home?

When was the last time a US paramedic decided somebody "just had heart burn" told them to take some antacids and left them to die of a MI?

You see the point? Starting an IV, hooking up a heart monitor, and driving every patient to the hospital whether they need it or not is just as useless as just driving them to the hospital and doing nothing. Except it is more expensive.

Overtreatment is a medical error. "What if" is just another way to say "I have no idea."

Just like the difference between "hinding" and "taking cover" one just sounds more heroic.

I've been involved in several EMS systems and EMT's are not suitable for giving drugs, injections, and managing a patients total care pre-hospital.

I can also say the very same thing for many "high performance" ALS only systems. I am just too kind to name and shame them here.

It's not that they don't have the ability, it's that the EMT programs do not allow for it and are way too minimal. Even with expanded scope we all know the educational foundation is gonna be severely lacking and the focus is gonna be on skill delivery only.

How is this any different from the current paramedic programs?


It is not that I don't want paramedics to be more. It is not that they can't be more. They choose not to be. I can't help that. So I think since we are going on the cheap for providers and service we need to start going on the cheap what we are willing to spend for it.

I think it sucks. But it is what it is.

 

[medicRob]

It is not that I don't want paramedics to be more. It is not that they can't be more. They choose not to be. I can't help that.

This is the very reason I have chosen to let my EMT-P go after the next renewal cycle. I only needed it for flight, now that I have completed my Nurse Prac, I will be able to fly as an ACNP in my specific system.

 

[18G]

To hear a few on the forum talk one would get the impression that Paramedics and EMS in general is a sham. And that certainly is not the truth. Yes, there are areas in need of improvement as there are in all fields. Perhaps more so in EMS but you have to look at the original intention of EMS. EMS expectations and delivery has evolved. It's just unfortunate that the "smart" people who have advanced degrees and designed EMS didn't see the need to set the stage for modern day EMS by incorporating a strong educational foundation. They maintained the skills driven mentality. So again, why are the field providers getting the brunt of all the criticism when it was the so-called advanced degree smart people who caused it!

And I strongly disagree that EMS is just an expensive ride to the hospital. So your saying that our treatment of the common day to day medical ailments is useless and has no effect? Your saying we can't save a COPD patient from resp failure and give them relief? Or turn around an asthma patient? Or keep a seizure patient from arresting? Or save an anaphylaxis patient? Or extricate a patient from their vehicle and triage them to appropriate care? Or keep an MI from worsening with early ASA and triage to a PCI center in addition to pain relief? Or fixing a hypoglycemic patient that would otherwise die or have long-term neurological consequence if it wasn't for EMS? Or giving the cardiac arrest victim the best chance of survival? Or managing the patients IV drip medications, cardiac monitor, chest tube monitoring, ETT and ventilation monitoring, and hemodynamic monitoring for a safe transport during inter-facility transfer? How about triaging CVA to primary stroke centers to avoid delay of intervention? How about pre-hospital management of TBI which as shown to decrease mortality? What about the fire victim who can be treated for CO and cyanide toxicity and saved? This is stuff I do as part of my everyday job and I know other Paramedics do as well.

The list is endless.

Yet people want to micro-analyze and portray EMS as a sham and waste of money. BS. Take away 911 and EMS and see how many people actually die and suffer because of its lack. Perhaps someone can do a research study on that. Maybe that is what it would take for certain people to realize the necessity of modern day EMS and the role of the Paramedic. You will always have crappy EMS providers just the same as you have crappy nurses and physicians. But don't label all because of a few. There are many more great Paramedics then there are not.

I've had many patients that have benefited greatly from the care I gave them and who would have been harmed if transported 30mins POV. If you want to advocate for change... fine... that is a great thing... but the slamming of current Paramedic care needs to stop. Improvement can always be made but that is no reason to down effective Paramedicine as it is right now. But if you are, then start with the advanced degree people (including physicians) who set all of this into motion long ago. The blame game starts there, not with the field provider .

 

[Veneficus]

To hear a few on the forum talk one would get the impression that Paramedics and EMS in general is a sham.

That is exactly what I am saying. It is a sham. With its effectiveness measured by response times, "life saving" medications, and other "life saving." If it was moe than a patch to put on one's arm to show you have a few more clinical skills, I would think otherwise.

and that certainly is not the truth.

But what is truth?

Is truth a changing law?

We both have truths, are mine the same as yours?

Perhaps more so in EMS but you have to look at the original intention of EMS.

So the intentions of 50 years ago justify the attitude of a vast majority of EMS providers today?

EMS expectations and delivery has evolved.

As far as I can see only a few skills were added and technology has changed.

It's just unfortunate that the "smart" people who have advanced degrees and designed EMS didn't see the need to set the stage for modern day EMS by incorporating a strong educational foundation. They maintained the skills driven mentality. So again, why are the field providers getting the brunt of all the criticism when it was the so-called advanced degree smart people who caused it!

How many so called smart people have to tell EMS providers they need a modern education before they catch on and do it?

Who told Nursing to do it?

Who told other ancillary providers?

Blaming people from the 1960s for not having the ability to look into the future and see what would make a valuable EMS provider in 2011 is a very poor excuse and trying to assign blame for it on somebody other than the providers who inspite of a whole modern world demonstrating what modern EMS is, the US providers are still locked into the laborer mentality and think everyone else should do all the work and take all the responsibility for them. They even want a pay raise for their "efforts" up front. Fat Chance.

And I strongly disagree that EMS is just an expensive ride to the hospital.

Really? How much does your service charge? Where are your service's studies demonstrating their medical effectiveness? Does your service even keep track of that? Nobody is going to take your word you save lives except an ignorant public.

Every other worker in any industry has to prove their worth. Why should others be required to disprove the worth of EMS?

So your saying that our treatment of the common day to day medical ailments is useless and has no effect? Your saying we can't save a COPD patient from resp failure and give them relief?

So can a Basic EMT.

Or turn around an asthma patient?Or save an anaphylaxis patient?

So can a Basic EMT and now even Police officers in some places.

Or keep a seizure patient from arresting?

Or extricate a patient from their vehicle and triage them to appropriate care?

Really? YOu do that? Or do you just spine board them and find the nearest trauma center?

Or keep an MI from worsening with early ASA and triage to a PCI center in addition to pain relief?

So can a basic, but they would need extra training and i mindless protocol for the morphine.

Or fixing a hypoglycemic patient that would otherwise die or have long-term neurological consequence if it wasn't for EMS?

Basic.

Or giving the cardiac arrest victim the best chance of survival?

Oh I'm game for that.

How many free community cpr classes does your organization provide?

Public access AEDs your service monitors?

Or do you just show up in less than 8:59 90% of the time and flog a corpse and pour some useless chemicals into it?

Or managing the patients IV drip medications, cardiac monitor, chest tube monitoring, ETT and ventilation monitoring, and hemodynamic monitoring for a safe transport during inter-facility transfer?

Do nurses not do this? With more knowledge?

How about triaging CVA to primary stroke centers to avoid delay of intervention?

A basic EMT doesn't do this?

How about pre-hospital management of TBI which as shown to decrease mortality?

When they put the tube in the right hole?

What about the fire victim who can be treated for CO and cyanide toxicity and saved? This is stuff I do as part of my everyday job and I know other Paramedics do as well.

Everyday huh? Somehow I doubt you see a fire victim everyday.

The list is endless.

Perhaps in your mind.

Yet people want to micro-analyze and portray EMS as a sham and waste of money. BS.

Yea? Compare yourself to every other First World Nation's EMS. You got nothing.

Take away 911 and EMS and see how many people actually die and suffer because of its lack.

That was a nice strawman attempt, but I don't see what the call for the defense of an EMS system has to do with replacing ALS with more up skilled basics at a cheaper rate.

Perhaps someone can do a research study on that.

Every physician specialty does research on their effectiveness and outcomes.

The same for nursing.

Where is the EMS research demonstrating their effectiveness?

Smoke and mirrors and making others responsible to prove the dogma wrong is not the level of a professional. It is that of a con artist.

Maybe that is what it would take for certain people to realize the necessity of modern day EMS and the role of the Paramedic. You will always have crappy EMS providers just the same as you have crappy nurses and physicians. But don't label all because of a few. There are many more great Paramedics then there are not..

The only thing I have seen is your word an anecdotes that paramedics are necessary. MOdern EMS I agree is required. Capable EMS providers like the British or Austrailians. The Slovaks or the Polish. Ther Germans or the French. Spaniards, Dutch, Even Russians. US paramedics shame the very title of EMS compared to these people.

Not im my experience, most are protocol monkeys incapable of clinical thought, too irresponsible to take credit and consequences for making their own decisions. Overtreating every patient doesn't make a great provider. Any idiot can run every test in the hospital.

I've had many patients that have benefited greatly from the care I gave them and who would have been harmed if transported 30mins POV.

You have proof?

If you want to advocate for change... fine... that is a great thing... but the slamming of current Paramedic care needs to stop.

So does pretending it is anything but a sham.

Improvement can always be made but that is no reason to down effective Paramedicine as it is right now.

Look how pathetic US paramedicine is. Improvement. That is like an alcoholic touting success for cutting down from 5 drinks a day to 4.

But if you are, then start with the advanced degree people (including physicians) who set all of this into motion long ago. The blame game starts there, not with the field provider .

So your solution is blaming the physicians of yesterday despite calls for change from physicians of today and the absolute refusal of the providers to make any effort?

Yea that'll get things done.

This is not specifically directed at you personally. I think every paramedic in the US should take a hard look at this.

 

[18G]

Once more, EMS is not a sham. And a research study is not needed to justify every single action a health care provider takes. Yes, studies are very important but people get carried away.

- When a patient is in pain and a Paramedic reduces it from a 9 to a 1. Is that not benefit? Do we really need research to tell us pain management is effective and necessary?

- A nausea rating from an 8 to a 2 and an obviously more comfortable patient? Do we really need research to tell us antiemetics make people feel better?

-A resp distress patient who is having a severe exacerbation of their disease, an SpO2 of 84%, EtCO2 of 50mmHg, and tachypneic. A Paramedic arrives and on arrival at the ED, the patient now has a normal SpO2, ventilation improved with EtCO2 showing 38mmHg, and resp rate of 20min, and steroids onboard at the very early onset of symptoms. Do we really need research to tell us we made a difference with this patient type?

- A patient is stung by a bee with a severe anaphylactic reaction. Pt. needs IV epi due to circulatory collapse, benedryl, albuterol, solu-medrol, and advanced airway management. Is BLS and an epi-pen really gonna suffice? Do we really need a research study to tell us that these interventions are highly time sensitive, effective, and mandatory?

- A seizure patient is status. Closest hospital is say 15mins away. Do we really need a research study to show that this patient type needs intervention now with benzos and airway and not over 15mins later?

When does intelligence start to become like ignorance and common sense gets left out of the equation. Your honestly going to argue with the above examples and claim that Paramedic care is a sham in those instances and the many more like it? Would ED care not consist of the same thing?

And no the intentions of the leaders 50yrs ago should not solely influence the attitude of providers today. But it does play a strong part. You cant instill a certain mind set and embed it into everyday practice and then all of a sudden turn around and say your all wrong, why are you being a minimalist, etc, etc like it's their fault to begin with. You act like its totally up to us field providers and its not.

Trust me, more then a few skills and technology has been added over the years. I went to school for two years, took A&P, etc... in fact the Paramedic program at my College is almost identical to the RN program. The only difference is the obvious core courses. The general education track is the same except for like two classes.

And please enlighten me how an EMT-Basic is gonna fix a severe COPD exacerbation with only oxygen and a BVM? I guess trying to ventilate lungs with such poor compliance and with such high pressure that it causes gastric distention and aspiration is considered equal care to you? No inhaled or IV bronchodilators, CPAP, or steroids is okay? No way to measure ventilation and response to treatment with EtCO2 is acceptable? And the probable dehydration and fever should be ignored as well? Your argument for substituting ALS with BLS is very weak and very flawed.

I think your getting confused. An EMT-Basic as is standard today is not able to provide ALS. You keep talking about adding this and adding that which eventually leads to an ALS type provider with nothing but skills which I always hear you argue against. So why would you advocate in this debate what you normally argue against?

I don't profess to know everything and health care is a never ending journey with something new to learn and improve everyday. But I am not so jaded as to realize when Paramedic care makes a difference.

I guess if you were the one at this moment who couldn't breathe and a Paramedic showed up in your living room with his jump bag and started to alleviate your dyspnea and lessen your anxiety you would feel a bit different. Would you as a patient not be smart enough to figure out A) hmmmm... I cant breathe, B) Paramedic showed up and gave me medicine and made me breathe better and improved me all around. C) hmmm... did Paramedicine really work or is it just placebo effect? Do we really need research to show that putting black paint on a wall really does make the wall black?

And before you say just give albuterol to Basics problem solved, we both know that is lame and a ignorant approach. I'm all for Basics having albuterol but not to replace a Paramedic response. Patient's on constant nebs especially with age need cardiac monitoring along with EtCO2 monitoring to gauge current resp status and trajectory. A Basic is not able to do this nor do they understand the pathophysiology well enough.

It's obvious your very jaded which I can understand.... but I too, am finding many flaws with your perception and thinking.

 

[18G]

I wanted to say that I am liking the engagement and expression of different views. Hope others join in as well.

 

[Veneficus]

Once more, EMS is not a sham. And a research study is not needed to justify every single action a health care provider takes. Yes, studies are very important but people get carried away.

Please if you could answer the question why other healthcare providers do studies on their value and effectiveness and all EMS presents is anecdotes and smoke and mirrors. (aka lies and cons)

- When a patient is in pain and a Paramedic reduces it from a 9 to a 1. Is that not benefit? Do we really need research to tell us pain management is effective and necessary?

- A nausea rating from an 8 to a 2 and an obviously more comfortable patient? Do we really need research to tell us antiemetics make people feel better?

-A resp distress patient who is having a severe exacerbation of their disease, an SpO2 of 84%, EtCO2 of 50mmHg, and tachypneic. A Paramedic arrives and on arrival at the ED, the patient now has a normal SpO2, ventilation improved with EtCO2 showing 38mmHg, and resp rate of 20min, and steroids onboard at the very early onset of symptoms. Do we really need research to tell us we made a difference with this patient type?

- A patient is stung by a bee with a severe anaphylactic reaction. Pt. needs IV epi due to circulatory collapse, benedryl, albuterol, solu-medrol, and advanced airway management. Is BLS and an epi-pen really gonna suffice? Do we really need a research study to tell us that these interventions are highly time sensitive, effective, and mandatory?

- A seizure patient is status. Closest hospital is say 15mins away. Do we really need a research study to show that this patient type needs intervention now with benzos and airway and not over 15mins later?

You can type up individual circumstances and what if's until your fingers fall off. But you have not demonstrated any reason why an skills based provider at less than 1/2 the cost of a modern US paramedic cannot follow the same skills based approach as is common in a majority US based paramedics.

You have offered no rebuttal of my inqusition other than to retype your original statement in different words.

I am most interested in hearing my points addressed, not just your reciting of self serving dogma.

-When does intelligence start to become like ignorance and common sense gets left out of the equation. Your honestly going to argue with the above examples and claim that Paramedic care is a sham in those instances and the many more like it? Would ED care not consist of the same thing?

It was once common sense to bleed the bad blood out of wounds. It is still common sense apparently to put people on long spine boards. It was even once common sense to burn witches to avoid offending God.

Common sense is a weak academic argument.

I will argue that those instances are the 5-10% of all emergency calls and that it is not cost effective to maintain ALS services for them. If we are going to pay providers for 5-10% then we should value it accordingly. I also argue that in those same instances, protocol driven medicine allowing the same treatments is likely to provide equal benefit.

After all in every instance you spelled out the exact treatment you thought indicated without regard to any variables and then stated how much it helped as "common sense."

-And no the intentions of the leaders 50yrs ago should not solely influence the attitude of providers today. But it does play a strong part. You cant instill a certain mind set and embed it into everyday practice and then all of a sudden turn around and say your all wrong, why are you being a minimalist, etc, etc like it's their fault to begin with. You act like its totally up to us field providers and its not.

But it is up to providers. LIke it is has been up to all other providers. Nursing etc. did not advance because a group of physicians pushed them. They took responsibility for their own destiny.

You expect physicans to decend from on high and sudenly improve paramedicine like magic or divine power?

Why should an established profession be responsible for helping another?

The only answer is that EMS isn't a profession. Without the high level of knowledge and responsibility, it is a skill. Skills can be taught for less than the cost/benefit of maintaining ALS for the rare instances where they actually make a difference following preset instructions.

-Trust me, more then a few skills and technology has been added over the years. I went to school for two years, took A&P, etc... in fact the Paramedic program at my College is almost identical to the RN program. The only difference is the obvious core courses. The general education track is the same except for like two classes.

Becase you went to a superior program that translates into advancement for all or even a majority of EMS providers in the US?

Does your edcation permit you anymore clinical latitude than that of a 6 week medic mill graduate?

Is the Education you went through a minimm requirement for medics around the country?

You may have went to one of the few exceptional programs, but your program is an outlier, not the norm.

-And please enlighten me how an EMT-Basic is gonna fix a severe COPD exacerbation with only oxygen and a BVM? I guess trying to ventilate lungs with such poor compliance and with such high pressure that it causes gastric distention and aspiration is considered equal care to you? No inhaled or IV bronchodilators, CPAP, or steroids is okay? No way to measure ventilation and response to treatment with EtCO2 is acceptable? And the probable dehydration and fever should be ignored as well? Your argument for substituting ALS with BLS is very weak and very flawed.

Teaching basics to perform the same interventions as an ALS provider is flawed when you just listed everything that needs to be done in an itemized less in less than 30 words?

Doesn't sound that hard. I'll bet I could do it in a few weeks. Trying to exclude providers from rendering treatment based on your current system and not modification of it is where the flaw in argument is.

I have a PA paramedic card too. Without an expiration date. I am also well aware of what constitutes ALS and its requirements in a majority of PA. Just because your service exceeds that and has a specific way of operating does not make it the only way.

-I think your getting confused. An EMT-Basic as is standard today is not able to provide ALS.

Says who? We have had many providers here detail the expanded scope of Basic EMTs in various parts of the US. If it can be done there. It can be done anywhere. It is also much easier to get people to agree to when you show them how few instances all those expensive ALS providers cost to maintain and how much money they would save.

-You keep talking about adding this and adding that which eventually leads to an ALS type provider with nothing but skills which I always hear you argue against. So why would you advocate in this debate what you normally argue against?

Taking the hardline as the Devil's Advocate.

Your argument has been measured and is found wanting.

You provided nothing but unproven EMS dogma in your response. Maybe if you say it enough it will become true.

-I don't profess to know everything and health care is a never ending journey with something new to learn and improve everyday. But I am not so jaded as to realize when Paramedic care makes a difference.

The original argument was that it doesn't make a difference in a short transport environment, not that it doesn't make a difference at all. But when I challenged to idea it made a difference the only reponse I have seen is the party line and "common sense."

-I guess if you were the one at this moment who couldn't breathe and a Paramedic showed up in your living room with his jump bag and started to alleviate your dyspnea and lessen your anxiety you would feel a bit different..

Would I care if that person was a paramedic, a nurse, an EMT-B or a doctor?

I think not.

-Would you as a patient not be smart enough to figure out A) hmmmm... I cant breathe, B) Somebody showed up and gave me medicine and made me breathe better and improved me all around. C) hmmm...The EMS system really works

Where I sit today I am just as likely to get a doctor. Who may even decide after my treatment I don't need an ALS ambulance bill and a Emergency room bill, because he was able to help me without automatically transporting me to the hospital. In many nations a paramedic can do the same thing. What makes you worth more than double the cost of an EMT with the same skills and treatments you possess again?

My point bolded.

-Do we really need research to show that putting black paint on a wall really does make the wall black?

We are not disputing what treatment helps. Only Who is capable of providing it and at what cost.

And before you say just give albuterol to Basics problem solved, we both know that is lame and a ignorant approach.

It sure is. But it is cheaper than having a paramedic do it.

If Paramedics can not or will not diversify their education and practice, why pay more when you could get the same for less?

Patient's on constant nebs especially with age need cardiac monitoring along with EtCO2 monitoring to gauge current resp status and trajectory. A Basic is not able to do this nor do they understand the pathophysiology well enough.

Neither do most paramedics. Anyway the problem is solved by simply calling a medical control physician on a webcam with a wireless internet connection. Which is still cheaper than training and maintaining paramedics.

It's obvious your very jaded which I can understand.... but I too, am finding many flaws with your perception and thinking.

Yes, I am jaded.

Yes, I do support expanding the value of US paramedics.

But if my argument, as the devil's advocate, cannot be refuted, how do you plan to convince the people who truly do see EMS as a waste of money that can be reduced?

Shout dogma at them and tell them they have no common sense?

They will bury your argument with an OPALS study and a host of expert physician opinion. Including with multiple anti-EMS physicians who are former paramedics.

As friendly advice, I would start putting together some studies and gathering some evidence as well as diversifying the value of your service.

"EMS is not a sham" says the guy who makes his living at it and as proof cites "common sense,"
and no other evidence.

 

[thegreypilgrim]

I am convinced there is no need for a paramedic in an urban environment with less than 15 minute transport times. Any treatment performed short of pain releif can be done by a basic.

Train them how to transmit a 12 lead, start an IV, and write a protocol for pain management and there is no longer any purpose for an urban paramedic.

Unless you want to implement something like the Community Paramedicine program that Rob was talking about and work toward deflating local ED census.

Educated paramedics --> Treat and Release & Referral --> reduction in cumulative health expenditures and better career options for paramedics themselves.

Something like that could certainly benefit an urban area and could not be performed by Basics.

 

[medicRob]

Unless you want to implement something like the Community Paramedicine program that Rob was talking about and work toward deflating local ED census.

Educated paramedics --> Treat and Release & Referral --> reduction in cumulative health expenditures and better career options for paramedics themselves.

Something like that could certainly benefit an urban area and could not be performed by Basics.

The community health paramedic that I speak of in my article has a 4 year BS, Paramedicine degree who has chosen in his/her 4th year to specialize in Community Health Paramedicine. He would be one of many specialists paramedics. Just like my previous posts, when I refer to basic level paramedics, I am talking about a situation where education is rebuilt completely making Associates the minimal level where the associate programs themselves are recreated to have more of a clinical component than they currently instead of just a focus on research and management.

AAS, Clinical Paramedicine would be a term I would not dismiss.

-----
In the ideal world, I would love to see several 4th year Paramedic specialty areas:

1. CCT Transport & Aeromedicine
2. Emergency Care Paramedic (ER Medic)
2. Critical Care (Specialty in ICU, not the current cc-p you are used too)
3. Community Health Paramedic (Works in Docs offices, in community health treat and release programs on ambulances, etc)

4. Trauma Medic (Trauma unit based)

----
The prefix 'para' is a greek term meaning "Alongside, or aside from". Therefore, the Paramedic acts 'aside from, alongside' the medic or physician.

My idea is to no longer limit paramedics to the ambulance. Let's give them the proper training to utilize them in a whole host of situations besides just ERs and Ambulances. This isn't a crazy idea at all, after all.. we train nurses in 4 years to enter into a whole host of specialties. I didn't specialize until my 4th year of BSN school. We will just need to redefine the roles of the paramedic and set into place laws and languages which would allow them to function in these capacities and how medical control is to be addressed (My thought is to ditch the medical control system in hospital for a chain of command system like we have in nursing. The Nurse answers to superiors, charge nurse, ADON, DON, etc..)

Let's use education to build bridges and to negotiate higher salaries.

 

[thegreypilgrim]

The community health paramedic that I speak of in my article has a 4 year BS, Paramedicine degree who has chosen in his/her 4th year to specialize in Community Health Paramedicine. He would be one of many specialists paramedics. Just like my previous posts, when I refer to basic level paramedics, I am talking about a situation where education is rebuilt completely making Associates the minimal level where the associate programs themselves are recreated to have more of a clinical component than they currently instead of just a focus on research and management.

AAS, Clinical Paramedicine would be a term I would not dismiss.

-----
In the ideal world, I would love to see several 4th year Paramedic specialty areas:

1. CCT Transport & Aeromedicine
2. Emergency Care Paramedic (ER Medic)
2. Critical Care (Specialty in ICU, not the current cc-p you are used too)
3. Community Health Paramedic (Works in Docs offices, in community health treat and release programs on ambulances, etc)

4. Trauma Medic (Trauma unit based)

----
The prefix 'para' is a greek term meaning "Alongside, or aside from". Therefore, the Paramedic acts 'aside from, alongside' the medic or physician.

My idea is to no longer limit paramedics to the ambulance. Let's give them the proper training to utilize them in a whole host of situations besides just ERs and Ambulances. This isn't a crazy idea at all, after all.. we train nurses in 4 years to enter into a whole host of specialties. I didn't specialize until my 4th year of BSN school. We will just need to redefine the roles of the paramedic and set into place laws and languages which would allow them to function in these capacities and how medical control is to be addressed (My thought is to ditch the medical control system in hospital for a chain of command system like we have in nursing. The Nurse answers to superiors, charge nurse, ADON, DON, etc..)

Let's use education to build bridges and to negotiate higher salaries.

I would be behind this 100%.

How would paramedics function in an actual ICU environment though? I foresee the ANA expending all political capital they have to prevent something like that from happening. Not against the idea of course, but just want to see how you'd get around carving out a role for paramedics in the ICU that didn't step on nursing's toes.

Interestingly, San Mateo County here in California has instituted what they refer to as the SMART Program which utilizes paramedics to assess and triage patients suffering from behavioral emergencies to appropriate facilities.

Perhaps mental health and substance abuse could be another area for medics to specialize in.

 

[medicRob]

I would be behind this 100%.

How would paramedics function in an actual ICU environment though? I foresee the ANA expending all political capital they have to prevent something like that from happening. Not against the idea of course, but just want to see how you'd get around carving out a role for paramedics in the ICU that didn't step on nursing's toes.

Interestingly, San Mateo County here in California has instituted what they refer to as the SMART Program which utilizes paramedics to assess and triage patients suffering from behavioral emergencies to appropriate facilities.

Perhaps mental health and substance abuse could be another area for medics to specialize in.

Psychiatric is a good idea. Why can't we add things like Pulmonary Artery caths, Intracranial Pressure Monitoring, IV Pumps, and other ICU skills to the specialty part? That is the best part about a 4th year specialty, you have an entire year to train them in a specialty area.

1st and 2nd year = General Education
3rd year = Paramedic Curriculum for NREMT purposes and testing
4th year = Specialty Year and Internship in specialty area