Bledsoe article: The Vanity of EMS

[VentMedic]

http://www.ems1.com/columnists/bryan-bleds...e-Vanity-of-EMS

The Vanity of EMS

by Bryan E. Bledsoe

Here, in the Republic of Texas, there are five levels of EMS providers: Emergency Care Attendant (ECA), Emergency Medical Technician (EMT), Emergency Medical Technician-Intermediate (EMT-I), Emergency Medical Technician-Paramedic (EMT-P), and Licensed Paramedic (LP). The ECA is the same as a first responder in most states. The LP is something unique to Texas. Let me digress.

In Texas, as in most states, EMS personnel are not truly licensed like physicians, nurses, plumbers, barbers and so on. There is no state statute that defines the profession and details licensing requirements. Instead, EMS personnel are “registered” with the Texas Department of State Health Services (TDSHS). Several years ago there was a push for licensure. Licensure, in Texas, would require that a new law be established by our legislature, which only meets biannually. EMS has never been on the legislature’s radar screen and the bill never went anywhere.

In a gesture of good will, TDSHS established a provider level called “licensed paramedic.” To become an LP, you needed either a two- or four-year degree in any field. While the intentions were good, I considered this to be a step backwards.

From a functional and legal standpoint, there is absolutely no difference between an LP and an EMT-P. Some systems will pay a little more for LPs as an incentive — some don’t. While the LP level does recognize those with a degree — and I don’t mean to downplay education — it does not really benefit the profession. LPs are not truly licensed and are not allowed to perform any additional skills or have any responsibilities above an EMT-P, despite their increased education. That is wrong. Instead of having a higher level that providers would actually want to strive to reach, an LP is simply an empty moniker that serves to bolster our vanity.

But, as has been the history of EMS, the slogan, “Give them a patch and they will shut up,” seems to have worked again.

If the state does not give you a patch, you can simply make your own. I have recently seen Texas EMS patches for “Tactical EMT” and “Tactical Paramedic” (whatever the hell that is). Recently, I saw one that read “Dive Medical Technician.” These patches are simply knock-offs of bona fide EMS patches and create an adverse effect on the industry’s image. The motivation to make these and wear these is beyond me.

Another vanity favorite in EMS is the self-assigned title of CCEMT-P, which is the acronym for Critical Care EMT-Paramedic. Most people self-assign this title after completing a CCEMT-P course or a similar course. And while some states have started to recognize this level (i.e. Tennessee, Louisiana, West Virginia), most have not. This became a point of contention in a legal case not too long ago where I was an expert witness. The paramedics called themselves CCEMT-Ps, yet there was no evidence they passed any sort of certification examination. The plaintiff’s attorneys had a field day with that and the paramedics looked foolish.

In many countries, critical care certification is available for EMS. Generally, you need four to six years of field experience and a year of critical care education — similar to nursing. Then you take an amazingly difficult certification exam. That is quite different than in the United States, where people take a 120-hour EMT class, go immediately to an 800-hour EMT-P class, then take the 80-hour CCEMT-P class – after which they feel really competent to take care of complicated ICU cases. We are only fooling ourselves here. I am very pro critical care paramedic; I wrote a textbook on the subject (heavily based upon the Canadian, nursing and flight nursing curricula). You cannot master 1,160 pages of complex material in two weeks or 80 hours! Imagine if we all used the initials from each class we took (e.g. Bryan Bledsoe, TCHGC, CTOP [Texas Concealed Hand Gun Course, Case Tractor Owners Program]).

http://www.ems1.com/columnists/bryan-bleds...e-Vanity-of-EMS

And finally, there is mental health care. Virtually anybody can call themselves a “mental health care provider” in the United States and this term can be found sprinkled throughout EMS. There is a significant discrepancy in education in mental health care. Psychiatrists are physicians (MD or DO) who complete a four-year residency after medical school and take certification examinations in psychiatry. Overall, they have 12 or more years of education beyond high school.

Clinical psychologists are health care providers who hold a Doctor of Philosophy degree or Master’s degree in Clinical Psychology and have passed a certification examination in clinical psychology. They often have eight to 12 years of education beyond high school. A PhD in psychology does not automatically make one a psychologist.

Social workers — usually with a bachelor’s or master’s degree — do a great deal of counseling. Then, there are marriage counselors, substance abuse counselors, music therapy counselors, and on and on. Then, there are pastoral counselors — priests, rabbis, ministers — who also provide counseling. Some have received counseling education in their seminary — some have not.

While the standards for psychiatrists, psychologists, social workers and other professional counselors appear standardized, many of the other providers are not. This has given rise to various certifications in mental health care. You can become certified in such areas as Thought Field Therapy (TFT) or Eye Movement Desensitization and Reprocessing (EMDR). With TFT, you repeatedly thump the patient in the head which unblocks Qi (energy flow) and heals various problems. The founder of TFT even reported success at using this method to treat atrial fibrillation. Advanced practitioners can even treat people over the phone using only their voice — no tapping needed. EMDR is similar.

If interested, you can obtain “board certification” in a mental health field. For instance, the American Academy of Experts in Traumatic Stress (AAETS), based in New York, offers “certification” in various mental health disciplines. You can become certified in:

Board Certified Expert in Traumatic Stress

Board Certification in Forensic Traumatology

Board Certification in Emergency Crisis Response

Board Certification in Motor Vehicle Trauma

Board Certification in Disability Trauma

Board Certification in Pain Management

Board Certification in Illness Trauma

Board Certification in Bereavement Trauma

Board Certification in Domestic Violence

Board Certification in Sexual Abuse

Board Certification in Rape Trauma

Board Certification in Stress Management

Board Certification in School Crisis Response

Board Certification in University Crisis Response

Later, if you have the time and money, you can obtain a Certificate in Traumatic Stress Management or a Fellowship in the American Association of Experts in Traumatic Stress (FAAETS). I called the following organizations to determine whether AAETS was recognized as a certification body:

American Medical Association

American Osteopathic Association

American Psychiatric Association

American Psychological Association

National Association of Social Workers

Of these organizations, only one had ever heard of AAETS. None recognized their board certification scheme. The term “Board Certified Expert in Traumatic Stress (BCETS)” comes up a lot in EMS, especially related to CISM. Interestingly, you do not even need a college degree in psychology to become a “board-certified expert.” Amazing.

This discussion came to light because I recently had to re-certify my emergency medicine board certification (required every 10 years). The examination was quite intense with both written and oral sections. I bought several books, took a review course, and then turned off the phone for more than a week to study. I flew to Philadelphia and completed the exam. It cost well over $4,000 overall, but it was worth it.

To people who don’t know me, board certification by a nationally-recognized body assures the public that I have met certain national standards. The term NREMT or NREMT-P means the same. You can’t say the same thing for LP, CCEMT-P or BCETS. While these monikers may make us feel important, they actually dilute and degrade our profession.

[WelshMedic]

Well said, that man!

Your title or the letters after your name are totally irrelevant in this job. It's about what you are educated to do to manage your patient and their emergency.

WM

[Just Plain Ruff]

I'll take on the licensure versus registered.

I don't really see a difference. If the licensure and the registered title would have the same background requirements then what difference does it make if you are licensed or registered.

If being registered required that you have X amount of this and x amount of that and then they went a different way and decided to change the naming convention and said you are licensed but you still have to do X amount of this and x amount of that then what difference is there in licensure versus registration?

Just a title.

Now for the CCEMT-P title. I would never put CCEMT-P behind my name and use it in place of my EMT-P. Missouri does not recognize that you are a CCEMT-P. If you say I'm a CCEMT-P not a EMT-P then you are holding yourself out as something you are not and like those paramedics in court were shown(which also out to be a wake up call for us out there) they look like fools.

We have become a title driven society, I have behind my name Michael N. Ruff EMT-P, MPM but those are registered titles. EMT-P we all know and then I am a master of Project Management (which is what my masters degree is).

To hold that you are a CCEMT-P shows vanity like BB says, and it also may be unethical to hold yourself out as a CCEMT-P when in fact, your state does not recognize that certification.

A couple of friends of mine, One being a licensed therapist, the other owns his own business and is a pharmacist and another who is a computer professional all believe that the drive to get as many certifications as possible is a drive for compensating for what we perceive as something in our lives we lack.

If I put all my certs behind my name this is what my business card would look have looked like in my heyday when I had all the certs. (I add CCEMT-P for emphasis)

Michael Ruff, EMT-P, BA, MPM, CPR, ACLS, ACLS-I, Pals, Pals-I, BTLS, BTLS-I, ABLS, ABLS-I, NRP, PHTLS, EMT Instructor, EMT-P Instructor, CPR Instructor

does anyone see the silliness of this. We need to focus on patient care and continuing education and leave the alphabet soup to the makers of Alphabits cereal or Campbells soup.

[Lone Star]

Well said Ruffles!

I've never been one to feel the need to put a ton of letters after my name, and 'impress' anyone.

I know what I've been educated to do, I try to work within the protocols of that given field, and am always looking to further educate myself, so that I can be the best that I can be.

At the risk of pissing off a few people on here, it is my contention that if one is 'patch motivated' or needs the 'flashy things' to impress people; may I suggest that you get involved in the Boy Scouts, Girl Scouts or some 'Happy Sam' organization that collects these 'brag vest patches'!

How many times have we seen the 'old school' bikers...bebopping around on their choppers with the 'ape hanger' handle bars...and their vests with patches and pins covering every square centimeter of material, and simply rolled our eyes? (This patch is from a poker run in Albuquerque , this pin is from one in East Pigeon Asshole, TN [My appologies to the citizens of East Pigeon Asshole, TN])

Why, as a profession, should we subscribe to that same mentality? Have we not progressed past the "Ooh! Shiny/flashy thinggies!!" mentality?

I like any one else am guilty of wanting that medical chopper pin....I've got pins from the AHA, I've got the Fire/Rescue tie tac pins, and at least one caduceus. But unlike alot of my peers, I don't have them pinned to every square inch of the copy of my license clipped to my uniform somewhere.

While some medical control boards require that I clip not only my license to my uniform, but a special card that allows me to practice my skills in that county/township/or area...I only have on my uniforms the things that the company REQUIRES I have.

What I think is funny is watching these paragods we find on sites like this get so stressed out that their heads nearly explode when you 'remind them' that they ARE an EMT-P!

The bottom line remains the same:

We are SUPPOSED to be here for the well-being of the patient, not to stroke our own ego in public! There are different levels of licensure/certification within the EMS system for a reason, and all levels should (in my opinion) stop bashing those levels that are less educated, and all work together for the patient! LEAVE THE EGO AT THE DOOR!

[scott33]

I find myself agreeing with most of what Dr Bledsoe says. I do try and pick faults, but it is difficult to find any of any significance.

I have been a little disappointed with the emphasis my paramedic program placed upon just memorizing protocols. Surely, it would make more sense to become more educated in the reasons why a particular treatment is indicated or recommended. Learning about changes at the cellular level can teach us about what goes on with the tissues, organs, organ systems, and beyond. This is possibly where the difference lies between professional licensure, and vocational certification.

It has been interesting doing clinical time on the ambulances where you occasionally get the smart arse medics, trying to showboat by testing your knowledge of protocols at 3am. Strangely enough, my experience with these individuals is that they have trouble looking outside their protocols, and know only the basics about the biological processes involved in what is going on with the patient. I don't claim to know it all myself, far from it, but nor do I feel the need to brag about being able to memorize a series of simple algorithms, and pass it off as the hallmark of being a competent provider. Again, training vs education and catering for the least knowledgeable. :roll:

I will say though that paramedic schools, good or bad, are only preparing you for your first day on the road. Education should be ongoing throughout ones career. Personally I do intend to take the CCEMTP course, when I am able to (as well as the CTRN). These are primarily for reasons of continuing my prehospital education / resume building etc.

The CCEMTP course is an interesting one, in that many people automatically believe the "P" stands for "paramedic". It does not. In a course which is equally open to RN's, MD's, and RT's, the "Program" caters for more than just paramedics. Personally, I think the patch should be taken out of circulation, as it can be misleading for the above reasons.

Bring on Licensure, bring on degree-level to practice, and get rid of the 30-odd levels of provider.

That would be a start.

[Just Plain Ruff]

Scotty, I agree with you. I hope I didn't give the impression that I didn't think that the alphabet classes were not worth having. Get all of them you can but leave the letters after your name off your name badge and business cards (if you have them)

I intended to take ccemt-p but financial issues kept me from it and it was not offered locally.

I also took a CEN course (audited it), took a ccrn class and also took every course availble to nurses at the hospital I worked at. The state of Missouri recognized these courses.

Did it make me a better provider, sure but not in among themselves. you take all that you learn and put it all together in the huge hard drive that you have which is your mind and you apply what you learned to the task at hand.

[chbare]

Honestly, I do not have a problem with people who display their credentials. I have CEN, CFRN, and CCEMTP after my name; however, these do not change my title which is simply nurse. I do think it is funny when people put CCEMT-P after their name. Since the course is Critical Care Emergency Medical Transport Program, not paramedic. I agree with how it was described above. Paramedics, physicians, registered nurses, and respiratory therapists are all able to take the program. It is not a dedicated critical care certification, it is simply an introductory course that covers the critical care transport environment.

I think it is fine to display credentials; however, do not bend the truth or make up a title when in fact the credential gives you no such ability.

Take care,

chbare.

[spenac]

I agree that all the extra letters and titles mean nothing. They do hurt our profession as they further confuse the public.

Sincerely,

Spenac NREMT-I, soon to be NREMT-P, Current Texas EMT-I, soon to be Texas Paramedic, ACLS, PALS, PHTLS, CPR, former ECA, former EMT-B, according to some JERK, PIMA, etc, etc,

[Just Plain Ruff]

I agree that all the extra letters and titles mean nothing. They do hurt our profession as they further confuse the public.

Sincerely,

Spenac NREMT-I, soon to be NREMT-P, Current Texas EMT-I, soon to be Texas Paramedic, ACLS, PALS, PHTLS, CPR, former ECA, former EMT-B, according to some JERK, PIMA, etc, etc,

Spenac, you need to put PIMA before NREMT-I

[Lone Star]

I agree that all the extra letters and titles mean nothing. They do hurt our profession as they further confuse the public.

Sincerely,

Spenac NREMT-I, soon to be NREMT-P, Current Texas EMT-I, soon to be Texas Paramedic, ACLS, PALS, PHTLS, CPR, former ECA, former EMT-B, according to some JERK, PIMA, etc, etc,

You forgot the most important title: King Taxi Driver!