New Standards/Levels

[Kiwiology]

As for talking to a doctor- we call AFTER care has been provided and only get advice in unusual situations- rare. It's a courtesy call to the receiving hospital- which is often not the one at the other end of the radio- to allow them to prepare for a critical patient, to simply free up a bed (vast majority of the time), or to gauge what resources they may need for your patient when you arrive.

I think we're discussing two seperate issues here mate; we give radio reports (called an R40) to the hospital if the patient is critical or unstable but this is as you say, an advisory of what to expect.

Now don't you have to auctually seek permission from a physician to provide some care in your systems? I know that some people may only be allowed to give say, 10mg of analgesia and then must ask permission for more; or to perform RSI they must seek permission from medical control.

I am unsure if it's a legal liability issue or a symptom of the education you recieve or for some other reason but it suprises me.

[VentMedic]

I'm not sure what you mean by "911 medic" here. Nurses have tons of specializations and extended credentials- critical care, mobile intensive care nurse, Trauma Nurse specialist, surgical nurse, critical care nurse, etc- all beyond the scope of their initial nursing training. Nobody would think it was odd that an RN or even a BSN could not function in any nursing capacity or think the RN curriculum was somehow deficient because they could not. Same for a doc- they receive even more training, yet nobody would think a cardiologist should be able to function as a neurosurgeon. Why not the same for paramedics?

But for EMS, the 911 medic is the entry level. Many go straight to that position after a few hundred hours of training. Since services vary, their overall experience may be rather limited. They may never advance in protocols or take additional education. They may never do a CCT or see many drips. California Paramedics are a good example of this. Thus, it might be the equivalent of a nursing working med-surg in a very "slow" hospital that ships anything but "clinic" patients to another facility. Nurses with CCRN or whatever have advanced beyond their basic training.

For choosing a flight team Paramedic, which do you think would be better? Someone who works many calls each shift for a busy service but with limited protocols and nothing but the basic Paramedic training? Or, someone working in a rural area who has taken college classes as well as extra certs to gain knowledge and has expanded protocols to do ALS CCT to the city hospitals?

[spenac]

I think we're discussing two seperate issues here mate; we give radio reports (called an R40) to the hospital if the patient is critical or unstable but this is as you say, an advisory of what to expect.

Now don't you have to auctually seek permission from a physician to provide some care in your systems? I know that some people may only be allowed to give say, 10mg of analgesia and then must ask permission for more; or to perform RSI they must seek permission from medical control.

I am unsure if it's a legal liability issue or a symptom of the education you recieve or for some other reason but it suprises me.

Kiwi not all services in the USA are mother may I systems. If I want to RSI, I RSI. If the first 10 don't relieve the pain I continue to titrate to relief. I interpret 12 lead and treat patients symptoms as needed. I do not have to call to use any of the 50 or so drugs in my bag.

Now there are some systems make you call for O2 I have been told.

[HERBIE1]

But for EMS, the 911 medic is the entry level. Many go straight to that position after a few hundred hours of training. Since services vary, their overall experience may be rather limited. They may never advance in protocols or take additional education. They may never do a CCT or see many drips. California Paramedics are a good example of this. Thus, it might be the equivalent of a nursing working med-surg in a very "slow" hospital that ships anything but "clinic" patients to another facility. Nurses with CCRN or whatever have advanced beyond their basic training.

For choosing a flight team Paramedic, which do you think would be better? Someone who works many calls each shift for a busy service but with limited protocols and nothing but the basic Paramedic training? Or, someone working in a rural area who has taken college classes as well as extra certs to gain knowledge and has expanded protocols to do ALS CCT to the city hospitals?

You are not addressing the issue here. A basic RN is essentially the same as an "entry level" paramedic. They can function just fine within their realm, but need extra training and certification if they choose a venue that requires that additional training. Why no outrage for the plain ole RN who chooses NOT to obtain advanced education beyond their RN license?

Should a medic be certified to deal with decompression sickness when they work in the middle of North Dakota or some other landlocked area with little chance of seeing diving injuries?

[fireflymedic]

You also misconstrue and misinterpret what I said. First, simply getting a degree will NOT change the problems in EMS. You need to understand the underlying reasons why EMS is struggling for respectability and recognition. The vast majority of IAFF members have nothing more than a high school education or a GED. They may have multiple classes in HazMat, technical rescue, but their baseline education is the same. Some places require various levels of college education to advance within their ranks, but in most areas, an entry level FF does not NEED a college education.

Why? Because what they do does not REQUIRE advanced training or education. The vast majority of what they learn is technical instruction in a fire academy, and the rest is on the job training.

So, why are they able to dictate and determine the future of EMS in many areas?

It's about established culture. They, along with LEO's are the dominant force in public safety.

Why? History, numbers, and tradition- NOT the level of their education.

More education will certainly benefit the provider, but not necessarily EMS in general.

A college degree or advanced education is not like a magic wand that will cure what ails EMS. It's far more complicated than that and education is only one piece of the puzzle.

Herbie,

I think you are a bit mislead about certain aspects. Despite the fact that the IAFF is resistant to change on the EMS perspective, many are starting to require at least some college education to get in there, and then usually a degree to advance through the rank. This is why you are seeing so many degree completion programs popping up on the internet and within the technical college system. The vast majority of police departments require at least two years of college and the more you have the better off you are. In this state, hiring for FD's and PD is done on a point system and things like college, veteran status, prior experience, etc help you gain more points in consideration during application. Also, almost any EMS service in the area requires a bachelors degree and 5 years EMS experience with prior supervisory experience to consider moving up into a directors roll.

A degree in EMS will make a huge difference as it did when nurses went from a technical education to degrees. Yes it took them a bit, and agreed it was painful - it weeded out those unwilling to move up to a higher level of education. And I believe that's exactly what would happen with EMS. I don't argue too much with leaving the basic at a technical level of education as a degree shouldn't be required for those who only solely want to volunteer and rarely make calls, or for PD and FD who are cross trained. Let a two year degree be the entrance which would be like an I-85/AMET level but at the same proposed skill set. Then a four year degree be a full paramedic, and post graduate be your critical care medics. I'm not concerned with whether the degree came from a technical college, a degree completion program, or a university. I'm not arguing it would be a bigger output of funds but I believe it would move EMS from the public safety sector to more the healthcare provider area such as hospitals, etc. If we want more skills and responsiblity and to move from the taxi mentality we must increase education. Though as previously stated, a piece of paper will be a start, but it's up to the individual person to learn the content. Just as there are people who slip through the cracks with other professions, there still will be, but much of that will be reduced. For those currently working, degree completion options should be offered.

I don't argue too much with leaving the basic at a technical level of education as a degree shouldn't be required for those who only solely want to volunteer and rarely make calls, or for PD and FD who are cross trained. However, basics complain of not being able to do very many skills beyond basic first aid (heads up guys, that's why it's called a BASIC). They're still useful for taxi rides to doctor's offices, dialysis runs, etc and there is still a market for them or solely as drivers. However, I do feel for any significant IFT's or 911 then you should be a paramedic to give your patient the best possible care. Nursing Assistants complain of being nothing more than a glorified butt wiper and they have comparable education essentially to the basic emt. They aren't entrusted with a large skill set because of that so why should we extend basic's skills for a similar education? I'm not knocking either one - the are important within the role they serve, but would you want a nursing assistant pushing medications without the education and knowledge? They aren't even allowed to distribute medications without additional training. This is the entry level though and a great majority of nursing schools require six months of working as a nursing assistant prior to application (which didn't use to be the case), so are we off to ask basics to do the same? I think basics have seriously over rated themselves in terms of knowledge and what their scope of practice should be.

I know this post will be far from popular, but if we really want to see education progress these are the advances we are going to have to make, as painful as they may be. And to those of you that say well it doesnt make a difference to you - the changes would affect me as well in having to pursue additional education so I'm not exempt. But change and growth are painful and hard, but worth it in the end. EMS moved from nursing homes to the county/private/fire areas to advance, and now it's time to move again. We'll see better pay and a better respect and reputation.

[Kiwiology]

You are not addressing the issue here. A basic RN is essentially the same as an "entry level" paramedic.

I beg to differ; your basic Paramedic has about 1,000 hours of education right, may never have taken a University level class in his life and is not required to do so. He is not required to learn the same cellular level A&P, pathophysiology, biochemistry or English as the RN.

Nurses are subject to a greater degree of peer-review and critique founded in science and established medical practice. Paramedic's .... eh whatever the medical director says is cool is cool and Sparky your partner might tell you that his way is better or that you are practicing out your arse but does he really know the ins, outs, whats and whys of it?

Your 1,000 hour Paramedics have less total education than the clinical component of both our Paramedic and Nursing degrees. The American Board of Anaesthesology states to be minimally competent an anaesthesologist must be performing ~200 intubations a year, eh, whatever, we know five during clinicals is cool right?

Very broadly I will say you are unable to speak to your 1,000 hour Paramedic the same as you can speak to a nurse. The nurses have more foundational knolwedge in bioscience and are generally held to a higher education standard both by thier peers and by the licensing system.

If you hand the recieving nurse at ED a list of your patients medications $10 says he or she can tell you what they are, what they do and how they interact a hell of a lot better than your 1,000 hour paramedic can.

Having said that there are some pretty shiity RNs out there and there are some equally piss poor Paramedics.

Oh and just to show you I'm not an arrogant wanker ... I cannot document an old ladys hyperglycemia but have a Bachelors Degree with an 80% average and can turn in 5,000 word research essays; FML.

[46Young]

Herbie,

I think you are a bit mislead about certain aspects. Despite the fact that the IAFF is resistant to change on the EMS perspective, many are starting to require at least some college education to get in there, and then usually a degree to advance through the rank. This is why you are seeing so many degree completion programs popping up on the internet and within the technical college system. The vast majority of police departments require at least two years of college and the more you have the better off you are. In this state, hiring for FD's and PD is done on a point system and things like college, veteran status, prior experience, etc help you gain more points in consideration during application. Also, almost any EMS service in the area requires a bachelors degree and 5 years EMS experience with prior supervisory experience to consider moving up into a directors roll.

A degree in EMS will make a huge difference as it did when nurses went from a technical education to degrees. Yes it took them a bit, and agreed it was painful - it weeded out those unwilling to move up to a higher level of education. And I believe that's exactly what would happen with EMS. I don't argue too much with leaving the basic at a technical level of education as a degree shouldn't be required for those who only solely want to volunteer and rarely make calls, or for PD and FD who are cross trained. Let a two year degree be the entrance which would be like an I-85/AMET level but at the same proposed skill set. Then a four year degree be a full paramedic, and post graduate be your critical care medics. I'm not concerned with whether the degree came from a technical college, a degree completion program, or a university. I'm not arguing it would be a bigger output of funds but I believe it would move EMS from the public safety sector to more the healthcare provider area such as hospitals, etc. If we want more skills and responsiblity and to move from the taxi mentality we must increase education. Though as previously stated, a piece of paper will be a start, but it's up to the individual person to learn the content. Just as there are people who slip through the cracks with other professions, there still will be, but much of that will be reduced. For those currently working, degree completion options should be offered.

I don't argue too much with leaving the basic at a technical level of education as a degree shouldn't be required for those who only solely want to volunteer and rarely make calls, or for PD and FD who are cross trained. However, basics complain of not being able to do very many skills beyond basic first aid (heads up guys, that's why it's called a BASIC). They're still useful for taxi rides to doctor's offices, dialysis runs, etc and there is still a market for them or solely as drivers. However, I do feel for any significant IFT's or 911 then you should be a paramedic to give your patient the best possible care. Nursing Assistants complain of being nothing more than a glorified butt wiper and they have comparable education essentially to the basic emt. They aren't entrusted with a large skill set because of that so why should we extend basic's skills for a similar education? I'm not knocking either one - the are important within the role they serve, but would you want a nursing assistant pushing medications without the education and knowledge? They aren't even allowed to distribute medications without additional training. This is the entry level though and a great majority of nursing schools require six months of working as a nursing assistant prior to application (which didn't use to be the case), so are we off to ask basics to do the same? I think basics have seriously over rated themselves in terms of knowledge and what their scope of practice should be.

I know this post will be far from popular, but if we really want to see education progress these are the advances we are going to have to make, as painful as they may be. And to those of you that say well it doesnt make a difference to you - the changes would affect me as well in having to pursue additional education so I'm not exempt. But change and growth are painful and hard, but worth it in the end. EMS moved from nursing homes to the county/private/fire areas to advance, and now it's time to move again. We'll see better pay and a better respect and reputation.

At my dept the first promo to tech (EMS, Hazmat, Trot, Apparatus) gives 10% weight to education. For Lt's it's 20%. For Capt I and above, it's 25%. I'm suprised that more depts in this region don't require 2 years college. The FDNY dropped their requirement from 60 credits previously to now just one year or 6 months FT experience.

FD's, PD's and EMS agencies alike are requiring education nowadays for promos, and rightfully so. The problem is, there's way more opportunity for advancement in a FRD or PD when compared to EMS. We just promoted 31 new Lt's this quarter. This is done through oral boards and objective exams, afterward being placed on a list. In EMS, there seems to be way fewer opportunities for upward mobility in the system. Fewer supervisor positions available, fewer specialty niches to shoot for. Additionally, the promo system may not be a competitive list, but frequently based on favoritism and cronyism. Hospital based systems do offer more of an opportunity for advancement to other areas of the health system, but typically no pension to speak of.

So, take away the likelihood of your degree facilitating upward mobility, there's little motivation for many to go the degree route for the P-card, unless they want to parlay that into another healthcare related degree. But then, they're leaving the EMS field as their source of primary employment anyway. You'll need a large percentage of degreed paramedics to make effective any organization and lobbying. If the money's not there, many will go the path of least resistance, and the one's with degrees will look for a better deal before too long. Catch 22.

The EMS profession started out strong enough, but then stalled out. sure FD's had a large hand in that, but they weren't the sole offenders by far from a political standpoint. As far as the existing workforce, each and every EMT and medic currently employed and not holding a paramedic assosciates is to blame for holding back the profession, myself included, opting for easier alternatives. Start assigning blame there.

Edited October 17, 2009 by 46Young

[VentMedic]

You are not addressing the issue here. A basic RN is essentially the same as an "entry level" paramedic. They can function just fine within their realm, but need extra training and certification if they choose a venue that requires that additional training. Why no outrage for the plain ole RN who chooses NOT to obtain advanced education beyond their RN license?

You actually want to compare a 3 month wonder or even a 6 month wonder Paramedic with an RN who at least did a 2 year college degree? The Paramedic takes a PDQ course with a few hundred hours of training at a tech school without even a college level A&P cours required. That Paramedic may stay at that same "tech level" of entry without ever advancing their education. The RN already had to get at least a 2 year degree with many students now opting to get a BSN without even being made to do so. Does that not say alot about how the Nurse perceives the importance of an education for quality care as well as preparing for the future? Even if that RN stays on a low acuity floor, he/she still has the education to do whatever and understand the care being provided rather than just reading protocols.

Should a medic be certified to deal with decompression sickness when they work in the middle of North Dakota or some other landlocked area with little chance of seeing diving injuries?

There are so many things a Paramedic could learn. I can not believe you would pick something such as decompression sickness and ND. What about Pharmacology? Vasular access devices? Cardiac technology such as VADs? IABP? A&P? Pathophysiology? Hemodynamics? The one little text book used for the Paramedic class does not even begin to address these subjects in any depth. Actually, it barely qualifies as a basic overview for most of these topics. But then, there is just so much you can do in a few hundred hours of training.

Are you only on a 911 service with no opportunity to see IFT patients of high acuity?

There are 911 services that also do CCT. What is sad is when the Paramedic must watch the RN set up all the meds on their pumps with hopefully enough medication to last to the distination hospital. The Paramedic can only look at the pumps but NOT touch. If the line gets occludes or beeps air in the line, the patient just won't get their IV med during transport. Of course there are other places like CA where the Paramedic can not even monitor most meds and the RN is told to accompany the patient. But, what medical director would be willing to put his/her license on the line for Paramedics who barely have 6 months of training and don't have the ambition to even take a few college classes that might make them a little better educated.

So I just find it absurd that you would pick such a lame example when there are so many things for the Paramedic to learn.

Maybe we should have left EMS with the embalmers and funeral homes. I believe they have raised their education level without all this fuss. Even for the dead they still believe in providing a quality service with knowledgable providers.

The EMS profession started out strong enough, but then stalled out. sure FD's had a large hand in that, but they weren't the sole offenders by far from a political standpoint. As far as the existing workforce, each and every EMT and medic currently employed and not holding a paramedic assosciates is to blame for holding back the profession, myself included, opting for easier alternatives. Start assigning blame there.

Exactly! Those who are waiting to be told to get at least a college level A&P class are doing this profession a great disservice.

[fireflymedic]

So, take away the likelihood of your degree facilitating upward mobility, there's little motivation for many to go the degree route for the P-card, unless they want to parlay that into another healthcare related degree. But then, they're leaving the EMS field as their source of primary employment anyway. You'll need a large percentage of degreed paramedics to make effective any organization and lobbying. If the money's not there, many will go the path of least resistance, and the one's with degrees will look for a better deal before too long. Catch 22.

As far as the existing workforce, each and every EMT and medic currently employed and not holding a paramedic assosciates is to blame for holding back the profession, myself included, opting for easier alternatives. Start assigning blame there.

There's less room for advancement because there is no demand for it. We increase the pay, benefits, etc of the EMS profession with the improved education standards there will be more options out there. People are more willing to stay if things are good rather than using it as a stepping stone to get out to a better job. As previously said, it's going to be painful, I don't minimize that, and you are stuck in the comment of well what do you do with the people that already have significant time in but no degree? Do you start bringing in degreed medics at a higher pay? Or do you raise their pay with the caveat of having their degree within a certain amount of time? Do you keep them at the same level of pay until they are degreed? Personally I go for the second option, but that's just me. As long as they are progressing towards it, I think that should be rewarded. If they stop though, they are reduced to their prior level of pay until classes resume or they find employment elsewhere. That would soften the blow and encourage them to further their education until we have a fully educated group in place to move forward with. Then you can start demanding the benefits PD and FD have. I think with the improved education, there will be an expansion of EMS possiblities within patient care and we will see better benefits. I'm not cruel and heartless to those already in and I think those who previously chose to go the easy way out should have the option of degree completion. I'm not saying get rid of them - just bring them up to the education level within a reasonable time frame (ie two years or so) to equate with the rest of the medics graduating. We can sit here and debate all day, but until we decide to agree on something we'll not ever get anywhere. Fire and PD learned a long time ago - unite and we get what we want. We're too busy bickering with each other to get what we need !

Oh and guys - you say well I never got that college level a/p class - why don't you go get it now? It's sure not going to hurt you and most schools will let you just sign up for a class or two without pursuing a degree. Why not give it a try and see how much it will help?

Edited October 17, 2009 by fireflymedic

[Kiwiology]

Oh and guys - you say well I never got that college level a/p class - why don't you go get it now? It's sure not going to hurt you and most schools will let you just sign up for a class or two without pursuing a degree. Why not give it a try and see how much it will help?

I could not agree more! I proactively went out and sought out A&P, pharm and patho from our University nursing faculty because I knew I didn't know enough (still don't but I know and understand an immeasurable quantity more and it makes me a better provider).

It's not until you know what you didn't before that you can appreciate how much that was - if that makes sense.

Good thing is now if I want to go pursue my BSN or BHSc(Paramedic) I have 3 less classes to do!