First Post - Just graduated and passed the NREMT!

[chbare]

That is the old 1998 curriculum however.

Take care,

chbare.

[paramedicmike]

I don't know if this is meant as a slight or what, but both EMTs and paramedics talk about how BLS should come before ALS. That is because it is true.

It's not meant as a slight at all.

This has come up in different discussions on this site before as well. This very argument, doing away with the ridiculous notion of BLS before ALS, is part of the reason why this site doesn't have a BLS or ALS specific forum anymore. It's called appropriate patient care and it applies to everyone from basics up through physicians.

To follow your argument you would have to require EMT training for physicians before they could even continue with medical school because "BLS comes before ALS". My argument is simply stating that a comprehensive educational program should teach this as an ingrained part of the curriculum. Supporting clinical time should build on lecture based lessons. This is how medical school works. This is how nursing school works. This is how paramedic school works in many places across the country.

Paramedic schools don't have time to teach EMTs to be EMTs before they can become paramedics. If you want to argue that 1600 hours (the NREMT standard) is not enough time then I am all for that, but don't tell me that my school is deficient because it is not cramming in the EMT curriculum as well. The school where I teach does do some targeted BLS refresher stuff, but this is in no way is expected to replace EMT training and experience.

This is exactly my point! You're *not* teaching them to be EMTs. You're teaching them to be *paramedics*. A comprehensive curriculum starts at the very beginning and teaches students what they need to know in order to function as at that level. You're not supposed to be replacing EMT school. You're supposed to be teaching people to be paramedics. Shortchanging them of that knowledge is deficient. Assuming they have that knowledge is dangerous.

Maybe this is true where you work, but not here. An ambulance around here includes one EMT and one paramedic. When that ambulance arrives on scene, that paramedic (and nobody else) is in charge. There is no "reduced leadership" role. My school is aware of this, and has a responsibility to graduate paramedics who are prepared to handle that reality.

Perhaps we are looking at two different levels of leadership here. But to follow the argument you've just put forth with this statement I'll again go back to my argument that a proper educational program will provide enough education AND experience to allow a brand spanking new paramedic to function as necessary during his/her first day on the job.

This is, after all, why there is a clinical component to training... to provide experience.

You can't just ignore the time spent. Physician training takes six years at an absolute minimum (not even counting undergraduate). Of that time, at least four of those years are spent in the clinical environment (and usually even more than that). If paramedic schools want to model their system that way, then the length is going to have to dramatically increase. As it stands today (which is the frame from which we should be talking), paramedic schools cannot hope to achieve such a complete "start to finish" product in the amount of time they have.

Yes, we can ignore time spent. It's the style of education that's important in this comparison. The method of education, didactic and clinical, each building upon the other, is what's at play.

Time is a separate issue entirely.

I'm glad you listed these.

Physicians - 6 years (minimum) graduate level

Nurses - 2 or 4 years undergraduate or associates level

Physician Assistants - 2 years graduate level

Radiology - (?? radiology is a physician specialty. Do you mean rad-tech? That's 2 years undergraduate level)

Physical Therapists - 2 or 3 years graduate level

Social Workers - 4 years undergraduate level, most have graduate degrees

Paramedic training is MUCH, MUCH shorter than all of the professions you listed. Different worlds, really. Not only that, but with the sole exception of physicians (who's training is the longest), not a single graduate from any of these systems will be expected to perform as an independent leader and provider for the sickest, most critical patients.

Please see my above comments. We're not talking time. We are talking style and methodology of instruction.

I also disagree with your assumption that physicians are the only ones dealing with the most critical patients. PAs, NPs and nurses are increasingly seeing, treating and dealing with critical patients before, and often times, depending on location, in place of physicians.

Before you argue that PAs and nurses are dependent practitioners, which they are, they don't always have to have a physician present in order to practice. In many cases they work under the same model that paramedics do with knowledge/education, protocols/guidelines and some form of medical consultation available (phone, radio, internet). They may not necessarily carrying sick CHF-ers downstairs but they're still providing critical care interventions without the benefit of a physician standing over their shoulder telling them what to do much like paramedics do now (who are also, coincidentally, dependent practitioners).

A paramedic is unique in that he/she has the least amount of training among his/her "peers" in healthcare, but one of the highest levels of responsibility. I see that as a dangerous situation, and I want my students to be as experienced and prepared as possible.

Then why not advocate for a more comprehensive educational program that will incorporate sufficient clinical time to teach people how to function at the paramedic level in *all* aspects of their job instead of hoping the remember something from the time spent functioning in a different job altogether?

I think we're both on the same page regarding the change that needs to be seen in terms of paramedic education. I'll take chbare's idea of a three year education requirement for paramedic and raise it to a full bachelor's degree requirement.

My argument, for the sake of this discussion, is simply a comprehensive paramedic program should provide both the didactic knowledge AND the clinical experience necessary to produce paramedics who can competently function as a brand new provider. I think schools that rely on prior experience to fill the gap in their education programs are doing a disservice to their students, the public and health care as a whole. You have no way of verifying knowledge. You also spend a lot of time breaking bad habits/practices in order to get them to do things the right way. So why not take someone that can be molded correctly from the start instead of wasting time trying to break bad habits just to start all over again?

I have seen most major cities seem to be fire/ems integrated, with the exception to (mostly very) rural areas. This may not be true nationwide, but at least it is as far as I have seen. But to answer your question, I have a lease agreement for the next 6 months and I am open to the idea of moving elsewhere after that. I would stay if I can get into a paramedic program, but I am just unsure of which route to go as of yet.

It's not true nationwide. While true that many major urban areas use some sort of fire based EMS system it's not the case everywhere.

Take New York City for example. The FDNY runs EMS (poorly but that's another issue). There are many hospitals that run paramedic level services in NYC to supplement FDNY EMS.

Also, don't limit yourself to big cities. Many suburban areas surrounding big cities run non-fire based EMS. The greater Philadelphia metro area is an example. Philly itself is a fire based system. The surrounding counties, in fact most of the counties in PA, run EMS as non-fire based services. You still get big city feel without the burden of dealing with the FD.

I guess my point is that options are great, and I would rather do paramedic, which can be transferred to other states much easier than minimum standards, and seems to offer a broader range of opportunity.

To follow this line of thinking, and just to give you something else to consider, nursing offers better chances of reciprocity in terms of your license than does paramedic. This is more the case for a traditional nursing school. The Excelsior program that was previously mentioned has had some troubles with this (for example, last I checked California would not allow anyone with a nursing degree from Excelsior licensure within the state no matter if that person was licensed in another state or not).

Keep in mind, too, that at least Oregon now requires a college degree before they will grant state certification to any paramedic. Other states have considered this and may enact something along these lines in the future. But as far as I know Oregon is the only state to have this requirement in place.

These two points would play well with the idea of completing nursing school first and then completing paramedic training.

Also, you have stated a few times that continuing education is your priority. Continuing your education is strongly recommended. However, I'm sure a good number of people who frequent here have either said this themselves, or know people who have said it only to get trapped in EMS and never make it back to school.

DO NOT LET THIS HAPPEN TO YOU! If you choose EMS first do not allow yourself to get trapped in EMS. It is *very* easy to get trapped. You must fight this with everything you have.

Just throwing that out there for your consideration. Ultimately, the decision is yours.

What other questions do you have? There are so many more debates that could spawn from this thread.