freethinker

Judging by the information on them, they are similar in some ways to a PA or NP in the US. Except Europe does not have PAs and NPs, and the US versions are not geared for the prehospital environment. Emergency practitioners can work outside the EMS framework, such as in clinics, and in some cases order diagnostic tests. Maybe we need to have PAs or NPs riding on our ambulances. Certainly having the smartest provider possible benefits patients in all settings, limited or controlled. Oh, woops, they wouldn't need us anymore then. That would really suck. Maybe we should all go to medical school.

"Its all about semantics and turf protection. The docs dont want you stealing their thunder, but EMS is no different. I do not know why so many are so afraid to admit that we must make a diagnosis of some sort if we are to do any more than be taxi drivers. I hope you have a diagnosis in mind before you start shoving tubes, needles, and medicines into patients, but with that being said, we can not make a true diagnosis on many patients due to our inability to do labs and xrays." Assessment is different from diagnosis in two distinct, important ways: the content and the process. In terms of the content, assessment is treating the symptoms, whereas diagnosis is figuring out the true extent and mechanisms of the presenting pathology. In terms of the process, assessment is performed and thought about differently than the way in which a doctor would perform a differential diagnosis. A doctor's thought process might assume, for instance, that the patient's respiratory distress has already been treated with what they consider 'basic' procedures- oxygen, IV, etc. Notice that to them almost all procedures will seem basic since by necessity a doctor approaches medicine from a more broader vantage point. The doctor thinks foremost about the root cause of the respiratory distress and the accompanying definitive treatments. It is absolutely essential to do a good pre-hospital assessment and provide the appropriate treatments, but we should remember that, no matter what, we are not doctors without going to medical school. If at some point in the future higher-ups decided to allow field decisions to be made regarding denial of transport and/or field treatment alone, that would require a true-blue differential diagnosis. That would require a doctor, not a pre-hospital allied health provider, and thus would spell the end of all of us. So we should be careful what we wish for.

Yes, that article seemed confusing. To my knowledge, paramedic programs are accredited, not EMT courses. Maybe National Registry wants to make an accreditation program for EMT classes as well, and then demand that no one can become certified as a paramedic through National Registry without taking accredited EMT and paramedic classes. It basically comes down to this: Access vs quality. A paramedic service can do both BLS and ALS, obviously. That's Cadillac coverage. But not everyone needs paramedic-level care. True, sometimes what sounds like a BLS call turns out to be serious, but that's a calculated gamble the system takes. The reason is that not everyone can afford to pay for Cadillac coverage, or wants to pay for it. In suburban areas, people might be willing to vote tax increases on themselves to provide "the best of everything," be it schools, EMS, whatever. They'd probably even be willing to pay for European-style physician EMS, the true Rolls Royce coverage if there ever was one. However, in rural and urban areas, there's no money tree to shake. If the property taxes go up, the rent goes up, and some people can barely get by as it is. That's why volunteers do BLS in some areas. That's also why, incidentally, nurse practitioners and PAs often do more primary care than doctors in those types of places- increase accessibility and reduce the cost.

If I were that partner, I'd say 'You expect me to babysit you? That puts me, the squad, and worst of all, our patients at risk. Healthcare is not for cowboys.' I think what matters most is attitude. I've seen some really smart people who still think EMS is cowboy medicine.

I know that some paramedic programs are run out of hospitals, while others are done through community colleges. What are the relative strengths and weaknesses of each type of program? Also, why do fire academies usually offer EMT-B classes but not paramedic training?

Many different kinds of places offer the EMT-B course to the general public. They range from hospitals, community colleges, fire academies, private ambulance company training centers, etc. What are generally the strengths and weaknesses of each type of location?