UMSTUDENT

I think there is a huge difference between Iraq and the streets of America. Those of you who keep uttering the comparison are showing significant ignorance, especially when most of America's youth will never experience the horrible thing which is combat. Also, before you start chatting the army up as some wonderful organization out for the better of humanity, lets not forget that they accept young "18 year-old kids" into their ranks, promise them a non-existent job skill (blowing crap up), and unfortunately sometimes a fruitless future filled with PTSD. Sending young kids to die in an unpopular, questionable war bares no resemblance to letting them participate in the life and death events which is domestic life. Now, let me clarify that I have the utmost respect for our veterans and support their cause, but I'm sure most of them would laugh at you if you tried to compare their hell with American EMS. As a provider in the United States I have felt that I was in danger maybe 3 times while on the job, and trust me the erector pili muscles on the back of my neck took care of getting me the fu*K out of that situation. See, in the real world of EMS there is generally a door between yourself and a bad situation. In Iraq, you have an entire country full of sectarian violence and a culture who generally hates us. HUGE difference! Stop putting the profession on this bad-boy, hyper-dangerous plateau. On most days, our job is no more dangerous than that of a UPS driver or pizza delivery "boy." When it is dangerous, 95% of the time police are there kicking the sh*t out of some idiot anyway. There is some acceptable risk in our profession. If a 16 y/o kid wants to do a ride along, let him. And if you're worried about psychological trauma let me say this: I started when I was 16 and lead a functional life and so has everyone else I know who started young. People who have respect and empathy for the human condition are generally able to accept that death, sometimes violent, is just part of life. No one is immune to it. We all fall under the category of mortal. I think if anything, seeing "real" humanity is an amazing thing.

http://www.time.com/time/generations/artic...38630-1,00.html Read that article in TIME and see if it doesn't make you want to vomit. You'd swear that home examinations, blood draws, glucose sticks, and portable 12-leads were brand-new inventions. The reasons physicians make the big bucks is because they're smarter. They recognized a trend in medicine and adapted to it, while simultaneously having the brains to market it as a "new" type of technologically advanced health care. Be it the ignorance of TIME magazine, or simply deceitful or ignorant physicians, they fail to mention that the paramedics in the 911 system they briefly mention have providing these services for years. It doesn't take a rocket scientist, or a physician for that matter, to walk over to grandma's pill box and make sure she's been taking the prescribed dose. We've been doing preventive medicine for years. Moving rugs, positioning beds in new locations, watching patient medication dosing (frequent flyers)... Does anyone else find it interesting that the Medicare billing practices regarding at home visits were changed in 1998? Does anyone else find it interesting that the advanced practice scope of practice for paramedics was primarily put down by physician consultants? MONEY MONEY, M-O-N-E-Y! Medical Doctors---The Advanced Practice Paramedics of the future! See the English aren't stupid. Socialized medicine quickly realized that we can train "Enhanced Practioner Paramedics" to do the same job with significantly less BS and cost to the healthcare system. True capitalism is great.

The way we teach EMS doesn't allow for any type of critical thinking. EMTs are taught a specific way to accomplish something and are expected to replicate it verbatim during practical skills evaluation. Plenty of things I've seen students do during in-class evaluations are perfectly acceptable, but unfortunately many times I have to correct them. I spend a significant amount of time giving praise to students for "thinking outside of the box" only to then correct them so they don't fail the state practical. Much of it is utter BS. Buckling one strap before the other, always securing distal to proximal...I understand many of these procedures are meant to develop good assessment and treatment skills, but many times they hinder a student's ability to truly treat the patient's unique situation. I know one student who has failed the state practical 3 times for extremely picky reasons. Now, he doesn't even "think" when he does the station he’s so scared. He just goes through a memorized procedure. I'm willing to bet almost none of the nit-picky procedures a BLS provider performs are based in scientific medicine. When was the last time a physicist analyzed the efficacy of "middle, bottom, top" when applying the abdominal straps of a KED board? If it works, and is efficient in its application, who cares how it is applied? EMS needs to move into the realm of residency-like training. Written examinations followed by oral boards for certification/licensure. The student completes X number of hours with certified preceptors in the field and hospital where he/she is deemed "competent." How does this affect overall critical thinking skills in the profession? Very simply. If a young EMT is continuously told that EVERY TIME something MUST be done this way, he'll develop complacency towards thinking on his/her own. This is reinforced by jurisdictions that hold a constant threat of taking your license away should you deviate from a very limited, specific set of protocols. The examples are everywhere in EMS. Here is just one: Over the summer I was working a 911 job and was called to a house about 5 minutes outside of my first due. The call initially goes out as a routine fall call. The other medic units in the area are unavailable and our unit was started to first respond. En route I begin to hear chatter about the patient. I wasn't able to ascertain specifics because the engine crew on scene was constantly talking over each other. I hear one provider get on the radio and frantically request a medic unit to the scene, but the reason was unclear. So I'm thinking "whatever," probably nothing. I get on scene and jump out to be bombarded by a member of the fire company. I was told that they had the patient boarded and that a helio was on the way for a flyout... At this point I'm thinking, "Wait, we're 15 minutes from 3 trauma centers, one of which is a Level 0 adult specialty center." I'm told I have a crew of EMTs in the house attending to the patient. I walk into this dimly lit room to find the patient propped-up against, her face planted into a wall. She's a heavy lady and a wheelchair is found directly behind her. CLUE: She must have slid out. She isn't back boarded like I was told, and the EMTs from the engine company are just kind of standing there staring at her. The daughter, a woman in her mid-forties, looks at the mess confused. She explains to me that she found her mother like this when she arrived home today and presumes she could have been like that for as much as 8-11 hours. I notice that her neck is in an awkward position and inquire about any previous history. She explains that the neck positioning is normal because of set of fused cervical vertebrae approximately 4 years prior. In a very brief discussion it appears that her mother's neck has served as a fulcrum that has enabled her to remain in this position all day... So, I tell the guys to board and collar her taking C-spine precautions. The patient is semi-responsive, occasionally letting out screams of pain. She was no-doubtly in severe pain from the whole ordeal. A quick look reveals some peripheral edema in the arms and legs and her obesity, age, and race (African American) suggest that she is probably a diabetic of some kind. Quick rapid assessment reveals no obvious trauma to the head or body...Differential: Probably hypoglycemia from not eating for 11 hours. Mechanism doesn't suggest traumatic injury. So after having the EMTs board her twice (first time they used pediatric spider straps), we begin to move her to the ambulance. So as the engine crew carries her to the ambulance I ask the officer on the engine exactly what happened. "Well man, we were thinking neurotrauma...so we started the helicopter.” At about this time I'm freaking out. I said, "You did what!?!?" "We called the trooper man...why?" About this time I walk outside to hear the signature whirl of a Dauphin N2 spinning above me. Trooper spins around, about 200 feet off the ground, and moves over the treetops. I had assumed (my mistake) that after our arrival they had canceled the helicopter out of common sense. "Hurry-up man, don't you need to get an IV before he lands?" All-in-all, this patient ends up being flown out of pure idiocy. The flight medic jumps in the back and during assessment begins to ask the EMTs from the engine company the same questions. He leaves with a look of disgust and looks at me in disbelief. Critical thinking fallacies? Crew fails to determine the cause and mechanism of the call and immediately assumes the LLOC is due to trauma. They also fail to recognize that the nearest trauma center is a mere 10-15 minutes away.

Maryland, as an entire state, allows EMTs to become certified and act as primary providers at the age of 16. So, if you're looking for a state that allows it to be done, there you go. I think there is also a common misunderstanding of what "age of consent" truly means. For the purposes of EMS, we are primarily talking about where liability rest. In most situations, an EMS provider works under the medical license of his/her medical director, and as such, the medical director assumes the shared liability of the provider. In states like Maryland, the parent signs an affiliation form that allows that person to function as an EMS provider. This effectively waves the liability of the state should that person be hurt while performing his/her job. I doubt it really has much to do with liability in regards to a lawsuit in the case of malpractice. It is important to remember how insulated an EMS provider is from personal liability in many cases. I would believe very few EMS providers have ever been placed on a stand in a civil case against themselves. Someone's insurance ussually ponys up before it gets that far. EMS provider operates under several layers of financial protection, which include, but are not limited to, the medical liability insurance of his jurisdictional and state medical director. This essentially affords him liability protection by the state should he "mess-up" doing otherwise normal duties. Gross negligence is a different story, and in almost every circumstance, usually borders on criminal. All of this of course assumes you are functioning in the capacity of an EMT, while on the job or volunteering. Our state also has fairly insulating Good Samaritan Laws to my understanding. Much of EMS law is based in good faith. It generally assumes that the person signing the document believes it to be true. I think it is important to truly understand an individual's state laws before you start harassing them regarding "age of consent." It is fairly easy for a legislative body to write in a clause that emancipates an individual in certain circumstances.

I hate to say it, but you're all lifting your profession to way too high a standard.A smart, well-adjusted 16 year-old is perfectly able to handle the job of being an EMT. I started when I was 16 and I was probably a better EMT than 80% of my peers by 17. I'd say by 18 I was probably making better operational decisions than 40% of my peers at the ALS level. I think we sometimes forget that the EMT curriculum is meant to be performed by someone with an 8th grade education. We make it as easy as possible, write acronyms to assist with basic patient assessment, and teach the class in vo-tech settings designed to get you to pass the test. Honestly, EMT doesn't need to be any longer that it is now. Given the proper amount of clinical exposure and a well-adjusted, intelligent applicant the course is relatively fine. I'm not neccesarily convinced that we should be adding hours to the EMT curriculum anymore. Sure, the argument that these students should be taught based on scientific medicine is great, but adding 100 hours of simple A&P isn't going to fix the problem. Instead, you'll have EMTs trying to make decisions based on a half-assed knowledge of the body. There is a reason that doctors go to medical school to make decisions that will inevitably effect someone's life. I think western society puts a little too much emphasis on medical education sometimes, and this is coming from a professional student. Granted I've found my education to be invaluable, but at the same time I wonder how much better it would be if we just took out all the BS. The UK is a shining example of this. Physicians in the United Kingdom are taught at the undergraduate level (14 allow an applicant to complete this training in 4 years should they possess a previous degree), eventually specializing in their fields, and by all accounts their system beats ours in almost every statistical marker of quality. What is the difference? I'm not entirely sure, but I imagine it has to do with educational methods. The United States spends so much time creating "scientific doctors of medicine," that I think we often forget the importance of treating a patient. Granted, I believe that our model has its significant advantages, but I think a better cost benefit analysis should be made when determening how we educate all of our medical professionals. This includes paramedics. Don't get me wrong. I'm the first person to say that paramedics need to experience significantly more time in an academic setting. Personally, I wouldn't be opposed to it being lengthened to the Bachelors level. I think the level of medicine we're practicing in the field is too complex to be left to a one year certificate program and some honed "intuition." We're doing RSI in the field now; a skill that was kept from emergency physicians for years by anesthesiologist. Honestly, the difference between an ER physician and a highly skilled paramedic should be minimal at best when it comes to background knowledge. Currently, the largest difference between the two professions is held at a steady constant almost entirely by a technological gap. First, our inability to maintain a steady, safe, sterile environment complicates our ability to do many procedures in the field. Secondly, we lack the most recent advancements in medical diagnostic testing. Both of these gaps will slowly change as time goes on. Holographic viral and bacterial load indicators are coming, iStats are here, and just as your PC's processor decreases in size, so will the ability to change the size of imaging technology. Physicians know this. Why else do they work so diligently to depress our profession? Medicare billing hasn't changed recently and I doubt it'll budge in years to come. What you have is a simple economic equation: As cost increase in the hospital environment, and whereas technology becomes more readily available in the field, a time will come when most, if not all, of the procedures currently performed by ER Physicians will be available in the field with a heavy reduction in cost. This will occur primarily because of EMS' ability to effectively operate within historical budgetary restraints. Reasons this will occur: 1.Hospitals are horribly managed from a purely business perspective. 2.American medicine is extremely wasteful. Physicians, especially newer ducklings, are notorious for running hundreds of exams, costing thousands of dollars to the patient and insurance company. They prescribe drugs with minimal benefits to those of OTC drugs. Purple pill anyone? 3.Inability to adapt. When was the last time you saw a physician do his own CAT scan or run his own ABGs? Hospitals employ thousands of people to perform the "lower" task of basic medical care. Nurses are neccesary solely because of this. Even if physicians themselves learn to adapt to changing technologies, these thousands of workers will be hard to simply "let go" accross the medical spectrum. Nurses, like paramedics, will advance in scope of practice and physicians will be forced to retreat to complicated, non-primary care specialities. This is a trend already being seen in medicine. Residents continually choose increasingly complex specialities out of job security. Why else did you spend 8 years in school? To be a super-duper paramedic or nurse? 4. Greed. Many people go into higher medicine not to save lives, but instead to make money. Pharmaceutical reps exist solely because of this. Basically, while our country as a conscious can sometimes be termed "mentally retarded" or even "slow," when it comes to making healthy decisions for our future, it doesn't take a rocket scientist to see which is a better option. You can either choose to pay doctors to perform simple primary, preventive maintenance, or you can pay a better educated generation of paramedics to perform these procedures in the field or in clinics. You can choose to employ a practice of 5 physicians that can see 50 patients a day or a practice of 100 paramedics and nurses that can see 1000 patients a day. This has an even better chance of occurring simply because of the state of our nation. The US is desperately trying to find a way to create an affordable national healthcare system that can be supported with little additional tax revenue. In 30-40 years, when these technologies will most likely exist, our nation will be at a breaking point in regards to healthcare. So, my suggestions? Fight now to increase the education of paramedics before this time comes. Realize the limitations of the profession in its current state and recognize that younger people are our future. Just as doctors will find themselves extinct in our realm (prehospital medicine) one day, so has the traditional view of adolescents. This newer generation is smarter that we ever were at that age. They have access to vast amounts of knowledge at younger and younger ages with a simple keystroke, and educational methods have improved over the last 60 years. My much younger brother was learning advanced algebra at 12. He'll probably start calculus as a freshmen in high school. Video games, TV, and the times we live in have matured them well beyond their years before they ever reach 16. So my point is, if they have an interest, let them take a dumbed-down EMT class. Get them involved early and they will forever be better than any of us. They will master our profession and seek more. Old paramedics die hard... Many of the best EMTs I've ever dealt with are young kids. They are pliable and much more willing to learn that most adults. They haven't really experienced life yet and as such, sometimes handle death and destruction better than the adults around them. Stress innoculation and appreciation for the human condition are invaluable lessions that modern society has all but taken away from our youth. Strong children make stronger adults. Just my $.02.

My county is approximentally 468 square miles and is covered by 9 EMS stations that are geographically located within incorperated and non-incorperated towns. At any one time there are ~10 medics on in the county, ussually with another 3-4 BLS units that can be staffed at any one time. Population is about ~140,000 people.

Maryland has: 1. First Responder 2. EMT-B (State Licensure. Reciprocity can be obtained with NR) 3. CRT-I (Cardiac Rescue Technician-I'99 level) 4. Paramedic (National Registry) 5 .Speciality Care Paramedic (New this year. Optional program for private/interfacility transport companies. I believe the standard is the CCEMT-P curriculum).

JJ, I think you'll be happy to know that Maryland has just instituted Nitro, Captopril, and CPAP as the treatment of choice in the pre-hospital environment. CPAP is now an optional jurisidictional protocal and will be mandatory on all units by 2008.

Philips MRX all the way...

Dust, As someone who does go to one of these 4-year Bachelors programs, I can enlighten you on some of the problems facing these departments. I've spoken about my education before, but rarely elaborate on the kind of curriculum being taught us. Overall, however, I believe the education I'm receiving is superior in many ways. I'll layout some of the things that encompass it: 1. Prerequisites: At my university, there are two available "tracks" one can decide to take. There is the "paramedic/clinical" and the "management" track. 1.Management students participate in a broad liberal arts education, with specifics on classes in accounting, statistics, public policy, and administrative law. In their senior year they participate in a fairly long internship and finish with classes in research methods and health economics. Students from the management track study, in-depth, several methods of EMS delivery and evaluate their usefulness given specific situations. This degree plan prepares students for many of the aspects of business and public health. 2. The paramedic track is a highly selective, 133 credit program, that focuses on training paramedics with advanced knowledge in both the clinical and management setting. The first two years in school are devoted to obtaining pre-requisites alone. This includes finishing the universities' general requirements while also obtaining classes in several sciences. There are two sub-tracks within the paramedic curriculum. Pre-med students take everything we do, plus they complete all the requirements needed before applying to medical school. This generally adds two semesters of Organic Chemistry and one semester of Physics, Calculus, and Genetics. Before applying to the paramedic program in their sophomore year, all students must have completed the following: 1. Biology 100 with lab, Chem 123 and 124 with lab (substitute this with Chem 101, Chem 102 w/ lab if pre-med), and 2 semesters of Anatomy and Physiology with lab. 2. Most of the student's primary university requirements should be completed by this time. Specific to the major include: Statistics, Basic and Abnormal Psychology (2 classes), Sociology, Concepts in EMS, and an instructor's course in EMS. In the student's sophomore year they must apply and interview for a spot in the paramedic program. This includes both an interview with current students and faculty/medical director. Benefits of this Education Model: 1. Amazing instructors, which include: medical doctors, pharmacologist, seasoned paramedics, psychologist, etc. 2. Broad, comprehensive education. Everything gets a "why" when being taught. Everything is taught with scientific medicine in mind, especially if current controversy surrounds the skill or method. 3. Extensive clinical time. Field and hospital clinicals in a variety of different settings in many world-renowned hospitals. 4. Management classes teach the student the necessary skills needed to be an effective leader and innovator in the field. Problems: 1.The current "standard" curriculum doesn't allow these 4-year programs to deviate from the specific skill-set. Face it, only so much can be taught before you're basically adding "hours for the sake of having more hours." We have a lot of specialist come in and guest lecture on specific skills, or physiological problems, but eventually you've thoroughly covered the topic. Sure, we get in serviced on a lot of advanced skills, but unless we fly or operate in a critical care system, how often are we truly going to be using balloon pumps? More importantly, these are skills that need to be maintained. All of us will admit that learning something like RSI in a classroom is certainly much different than doing it. So while we may be introduced and educated on these practices, it is much harder to guarantee proficiency. 2. Our profession is a mess. Part of any university's goal is to make sure that their students are successful. While we receive an amazing clinical education, the management courses are needed. No current job in the profession will allow a paramedic to make a decent living based solely upon his amazing clinical knowledge (maybe teaching). The student must be able to succeed in the "real-world" situation that is currently EMS. That means supporting a family through upper-level management positions. You don't always "wow" your boss by simply being a go-getter. You have to apply skill-sets and knowledge that he may no be familiar with. You have to increase productivity, maintain continuity of care, and deliver patient care that is better than the next guy. 3. Change isn't made by just screaming very loud. A lot of the people on this forum seem to complain about the sorry state of our profession, but exactly how many of us are truly taking the time to rise above and change it. The goals of many of these programs are simply that. Someone who has completed an undergraduate curriculum is far better prepared to flourish in the real world of business and politics. Its about showing an employer that you took the time and were intelligent enough to put up with all the BS (no pun intended) that is found in universities today. The short and long is that most universities mimic, fairly closely, the types of red-tape that someone will encounter throughout life. More importantly, succeeding in any venture requires a certain amount of complex life skills. EMS needs representation at a truly professional level; people who are going to compete with a knowledgeable physician or nurse manager. These are the people who are the dictators of our profession and we must be capable of carrying on intelligent conversation with them should we hope to rise above. More importantly, we need people are are better than them. People who are smarter, more organized, and better connected should we ever hope to gain autonomy as a true profession. These 4-year programs prepare students for this. 4. Cost of education and type of ideal student. In today's world, education is more expensive that it has ever been before. It becomes harder and harder for someone to justify receiving an "advanced" paramedic education, only to be restricted at the current level. Secondly, our program requires a significant amount of devotion similar to that found in medical school. Working a job is extremely hard to do, so its not uncommon for these students to loan out a significant amount of money, or just stress themselves out to work and go to school. Secondly, finding an ideal student for this type of program seems to be slightly harder. They have to be extremely intelligent, physically capable, and most importantly have an absolute devotion to the profession. They really have to love it enough to want to be the very best. Anyone can go to medical or nursing school and be mediocre, but these guys have to be stellar the rest of their lives. Otherwise, what good was it? In the long run, I think the success of graduates from these types of programs speaks for itself. Dust, I agree that it would be great to have a four year, clinically intensive, paramedic education. I think many of the educators at these institutions feel that same way. The difference is that they also have an obligation to their student to provide a useful, practical education for the amount of money. They could easily create an advanced practice curriculum and teach it to all the students, but what state is going to recognize it?

I think this is an entirely stupid argument. People in health professions should be the first to realize that food, basic energy, is required to continue metabolic function. I'm not diabetic and I can tell you that if I don't eat, I'll feel the effects by at least 2-3 PM. Any service that does not allow their employees to eat is just asking for someone to screw up. Its a perfect lawsuit against your organization. All the employee has to do is say, "Well I hadn't eaten in 14 hours."

Been awhile, but life has been busy. The only thing that is going to change EMS for the better is a drastic improvement in the education of paramedics, EMS managers, etc around this entire country. Honestly, I believe that the role of a paramedic physician extender will be seen sometime within the next 10 years...someplace. Something at least similar to what is occurring in the UK in regards to their Enhanced Practitioner Paramedics will need to occur to cope with the ever increasing amount of non-emergent calls being put out by dispatch centers around the country. I know a lot of people don't agree with me here, and while I see their points, I respectively disagree. Some level of provider, be it a better educated paramedic or a new level of provider, needs to be able to say no, or at least write referrals. There is a place for an advanced paramedic, trained in universities at the baccalaureate level. I also believe there is a place for trained EMS managers and clinical specialist at the graduate level. By increasing the education requirement of our newer generation we can begin the process of phasing out those unwilling to succumb to new requirements.

http://www.tnt.tv/title/?oid=2912

A brief search didn't reveal anything on the site related to this so anyway... I was just watching TV when I saw a trailer for the new series Saved!. You can view the trailer online at that link. Not sure what I think of it so far. Apparently the show will focus more on the interpersonal relationships of this medical school dropout turned paramedic. Sounds a lot like a watered-down "Bringing Out the Dead." [web:45ca213ced]http://www.variety.com/article/VR1117936597?categoryid=1300&cs=1[/web:45ca213ced]

As someone else has said, I would suggest Human Anatomy and Physiology by Elaine N. Marieb. Good book... I'm weary of any book that teaches A&P for "paramedics." Anatomy and Physiology is an entire field of biological research and shouldn't be "dumb-down" for a paramedic class. Two semesters at a respectable college would probably be the best bet.

No, I would not be a paramedic for free. At least not very long. I'm spending too much money getting an education as a paramedic to "give" my services away. As Dust always says, we don't have volunteer cable repair men, nor do we have volunteer plumbers, yet people expect the EMS profession to give the service away for free? We've seen people in my community who will actually bitch because we drive our units to get something to eat. They say I'm "waisting" their tax money. Apparently I'm supposed to give my technical services away AND not eat. People expect us to be supermen and it has to stop. Granted this is a very vocal minority. Why does this happen? Because there are people in the respective companies who actually believe that ho-hah. Volunteer companies rely on donations so much that they're afraid to piss someone off. Until providers start demanding that their services are compensated for, this is going to continue. I started as a volunteer, and I appreciate volunteers, but there will be a time when their existence will have to be limited.

Getting used to dealing with tragedy is something that takes time for some people. Others deal with it easily. Blaming yourself isn't the way to go and seeking professional help is definite must if you continued to be bothered by the incident. Seeking a professional psychologist is a must if one is available to you. While many people here bust on CISM, it is still the standard in many jurisdictions around the country and should have been offered to you upon completion of the call. If you need more information the following is a great resource: http://www.icisf.org/

No, I agree with what your saying. I was never professing that these people would necessarily be working in medicine to any higher level, but instead would focus on research and education. The need for a higher level of provider exist in my opinion, but not one that would require a doctoral level position. It would be similar to how the nursing profession currently operates.

These school's alumni speak for themselves. Doctors, administrators, flight medics, etc. From all corners of the world. You say you question "intent and creditability," yet many of these programs produce very good paramedics and administrators. There is no "intent" beyond that goal, especially since none of these people are making a killing as a university professor. You should know that professors make crap most of the time. Most of the Baccalaureate programs are found in well-respected colleges with a very high level of fiscal responsibility. From what I've seen the goals of these institutions is genuine. As for what education a paramedic student may get at a program like this, I point you to the clinicals, the facilities, the resources, the instructors, the alumni, etc, etc. Finally, your comment about people not taking the research of kids seriously is ridiculous. Research is research, especially if it's useful. A Ph.D from Johns Hopkins or Harvard is the same no matter if you're 27 or 67. People will respect you for the extraordinary individual you are.

There doesn't necessarily have to be a pot-of-gold at the end of the rainbow for someone to pursue an education in a given field. I'll use those that major in philosophy as an example... I know plenty of "kids" who go to school for fun and will never have to rely on earning any type of substantial living. People whose parents are wealthy enough to support and finance their years of research. There are plenty of them out there and plenty of college kids with an interest in EMS. Hundreds of universities have responding services on campus, some with fully functional BLS and ALS transport services. I always wonder how many of these "kids" would have pursued a degree in EMS had the opportunity been presented to them. The people are here now, with the money to invest in such an education, we just need to encourage it.

That reply is exactly what I'd expect to hear from someone with a vested interest in keeping EMS where it is today. Unfortunately for your opinions, I think they come with a little bias. No one here can forget that you're starting a 911 service that will rely on dumb "kids" staying dumb (not so much literally, but at least by maintaing the current job function). Your business relies on the fact that EMS will maintain it's position of transporting the sick and injured. More simply, people getting sick is your bread and butter. There is nothing wrong with this, and like you, I too believe that the majority of our profession will always concentrate its collective efforts on this task. It is of my opinion though that this will only be the simple majority of the field in the future. I think I may have been a little "broad" in my statements about the prevention issue, since having read your first point, I agree whole heartily. Field treatment is exactly what I meant by prevention. Treating grandma's CHF before it becomes an emergency is the best type of preventive medicine I can think of. That is a role I think EMS will play, especially among the poorer populations. Also, let me address your statement about EMS being on the bottom latter of academe. In your state alone there are two universities that provide education at the undergraduate and graduate levels. UPITT (BS in Emergency Medicine) and Drexel (graduate program in Emergency and Public Safety Services). Also, what qualifies you to make such sweeping statements about what is a "realistic" future for EMS. Do you have any formal training in public health? Any formal training beyond that of paramedic? I want to hear about more than Pennsylvania "street cred" and an entrepreneurial spirit. I'm not discrediting your opinions, just saying that they are no more unrealistic than mine.

Exactly. A lot of resentment seems to come from the fact that generations of paramedics, already established in their careers, will refuse to allow a younger (in some cases), more educated generation dictate policy in the field because of their "new fangled" research ideas. Paramedicine is definitely a field that is intimidated by education. I think more fear comes from higher medicine too. Many of the upper echelons of medicine with a vested interest in the emergency medical field gain nothing, from their point of view, from a better educated paramedic. A paramedic who can effectively triage, accomplish basic procedures and administer basic routine medications would probably decrease a large amount of ER visits. I think this is one of the reasons the APP curriculum was shot down so quickly. Think too about all the physician assistants and nurse practitioners who populate our nation's ERs. The future of EMS isn't the delivery of emergency care and transport, but the prevention of emergency care and transport. By providing effective preventive medicine to our aging populations we can prevent many of the medical emergencies that we respond to every day. With crowding hospitals, a dwindling social security system, and no national health care I think it will become pertinent to bring medicine back to the home. A reversal of sorts of the last 40 years of medical culture. To say that a doctoral program is premature is self-defeating. We just sit and wait for the right time that will never come.

There is no EMS career ladder. Well at least not one that is lucrative. Let me reword your answer without the attitude (no offense): 1.You believe that there shouldn't be an EMS education at a doctoral level. At least not right now 2.You believe that currently other professions are handling EMS research okie dokie. These are valid beliefs, but let me offer a rebuttal: 1. Most of the country is moving to a requirement of a Associates Level education to be a paramedic. I know you, PRPG, are aware of this. There are several Baccalaureate level programs in the country and a few graduate programs. 2.We don't practice medicine. Doctors do, but we don't. We practice a set of protocols. There isn't a paramedic in this country with the privileges to experiment with treatments or make definitive decisions when it comes to a patent's care. Those decisions have been made for us on pieces of paper. The scientific physician exist for a reason, and there is a reason that the MD and DO are considered professional doctorates. 3. There is plenty of research being done regarding EMS. Most of it seems to be appearing in trade journals instead of peer-reviewed journals. The other aspect of EMS research is coming from the private industry. From companies such like Zoll, Medtronic, etc who are trying to sell a product. I think the lack of written research is because the majority of people in our field lack the training in proper research methods. 4.Just because there are only a few set theories regarding EMS management doesn't mean others don't exist and have yet to be discovered. Just my $.02

So PRPG says we should have a professional masters and Jake simply has a lack of vision. Read. I also feel that there is some misunderstanding of exactly "what" a doctoral degree "gets you." You don't spend years in school (doctoral program) to "get" anything. You spend years doing intense research to "give" some knowledge back to the community. Most people who obtain a doctoral level degree aren't given any type of privileges (not withstanding the ability to obtain tenure in a institution of higher learning). It simply says that you spent a significant amount of time researching something in your particular field and that you've defended said thesis in front of a committee of peers in academia. I'd like to remind everyone that while the practice of prehospital emergency medicine is relatively simple in the grand scheme of things, there is more to our profession that just the skills we do in the back of an ambulance. There is provider safety, patient trends, injury epidemiology, EMS management, and host of other things that can and should be studied. Having a doctoral program just promotes this research. Please, more constructive criticism.

I'm not sure if this is really the appropriate place for this, but I really didn't think it fell into the "student" or "instructor" forums because it requires input from both sides. Basically, I'm interested to see what people here think about a doctoral program focused on EMS. Granted, there are very few university based programs as it is now, but in a perfect world where 4-year EMS programs were found in a decent amount of colleges and universities, would you support a doctoral program? If you do, what type of school or doctoral program do you think it should fall in? Should it be a Ph.D, Dr.P.H, D.H.S, etc? Under what college should it be found? Public Health, Medicine, etc? Would there be a use for such a degree? Now or in the future? Would you prefer a professional masters or doctoral degree? OR, is the use for such a degree already being filled by another set of degrees? What would the research preferably focus on? Would you pursue such a degree?