What to Expect in Paramedic Classes?

[rock_shoes]

Another study with weak evidence that suggests certification and undergrad education improves outcomes:

http://ebn.bmj.com/content/early/2011/12/20/ebnurs.2011.100228.short

Again, I am not sure how well this translates to paramedics.

The paper I posted a link to specifically compares Paramedics to Emergency Care Practitioners. ECPs are UK Paramedics with additional education. Evidence is steadily mounting that demonstrates ECP attendance improves both patient outcomes and system cost effectiveness.

Its a direct example of increasing educational standards improving outcomes.

[Kiwiology]

Well said Bill, unfortunately one of the patch factory medic programs of minimum weeks duration is located in the Great Nation of Indiana, unfortunate too is the fact it is an "accredited" program which doesn't really make CAAHEP/COAEMSP seem all that great now does it?

Chris, never would I claim you to be a smart arse, you are one of the most well educated, worldly and eloquent people I know, I will stop by next time I an in New Arizomexas and say hi (reinforce your mailbox, do it now, don't ask why, just do it, I have a habit of backing into the driveway to allow for an expedient escape and um yah ... not quite perfected it yet)

Generally outside the US we Commonwealth nations do not have the same "two and four year" education system as you do; we have university and then we have technical or polytechnic training for those who ... I don't want to say "not suited" to university but for things like hairdressers, plumbers, electricians, mechanics etc i.e. the sorts of things you cannot reasonably expect a Bachelors Degree for entry into. There are some courses which have a bit of overlap for example you can get a Certificate or Diploma in Business and then move onto a Degree but the "2+2" thing is foreign to us. You leave high school with the expectation you will go to uni, you are taught at school that the minimum standard for any sort of professional career is a Bachelors Degree (and I use the term "professional" loosely to define things like doctor, lawyer, dentist, accountant, paramedic or any sort of professional business or management role as the sparky who fixed my stove is a professional but he only has a Certificate education).

The Bachelors Degree is the minimum standard for any sort of professional career in AU, UK, NZ etc, Canada and SA I am not sure. In New Zealand every health professional requires a Degree of three years or more, some are four or five and medicine is six, well five in reality but it is just dressed up to look like six. I am talking everything from doctor, dentist, osteopath, pharmacist, radiographer, dentist, dental therapist, dental technician, dental hygienist, vet, dietician, medical lab scientist, midwife, occupational therapist and the list goes on, all require a degree and it's the same in Australia generally maybe one or two slight differences because we have a trans-Tasman dual recognition thing.

Both Nursing and Ambulance here (and along similar lines in AU and UK) have slowly evolved from Certificate to Diploma to Degree or higher as the field has grown and become more complex, as the knowledge and outcomes expected has increased and as the profession has strengthened. Back in the bad old days it might have taken five years to become an Advanced Care Officer (Paramedic) but your education in total if done all together was only about eighteen months long and was a bit slim on the finer biomedical principles but such was the state of evolution at the time.

Maybe we have it a bit easier outside of the US because we only require three years to complete a Degree, have near universal student loans which are garnished from taxes once one earns enough to pay them back (Studylink in NZ, HECS-HELP in AU and the Bursary system in the UK) and because our "lesser than university" education system (National Certificate/Diploma in NZ, TAFE in AU and the NVA/NVQ in UK) is not suitable for any sort of regulated health professional who can provide independent treatment because they do not encourage the high level cognitive critical thinking required which can only come from a well laid and nurtured foundation of research based knowledge.

Over the three years of the Paramedic degree you learn a little bit, practice it, learn a little bit more, practice it, form a foundation of that first bit then repeat so that it is a long slow organic process until your third year when you are reasonably confident and capable but still need a guiding hand for the more complex stuff and have a good grasp of the wider picture of health systems, ethics, law, planning etc outside of the "clinical stuff". I couldn't teach the Commonwealth Paramedic/ECT level stuff in two years let alone the Intensive Care stuff.

Again, such a system will not work in the US simply because of the "2+2" model sor an acceptable alternative is a two year degree for an ILS level person like we have and a four year degree for the ALS person.

Outside the US where Paramedics require a very high level of education they are well respected, have a well defined career path, are paid very well and have what any of us would consider nothing less than the appropriate level of professional autonomy.

[chbare]

The paper I posted a link to specifically compares Paramedics to Emergency Care Practitioners. ECPs are UK Paramedics with additional education. Evidence is steadily mounting that demonstrates ECP attendance improves both patient outcomes and system cost effectiveness.

Its a direct example of increasing educational standards improving outcomes.

I did not appreciate much beyond how they plan to gather evidence and areas where there will probably be improvement. However, I must admit some of the terminology is not as intuitive to me probably because of a slight language barrier.

[BillKaneEMT]

Kiwi, I was told that they've phased out the paramedic license in our state now. Unless medics were grandfathered in due to having their EMT-P cert prior to 2010 or 2011 you have to pass the NREMT-P written and practical to work in Indiana now. Some of our Illinois medics were grumbling about it just last week due to the fact that some IL programs run about 6 months and have fewer practical stations than the nremt-p and also have a much easier written. Or perhaps that only applies to medics from out of state. I dunno, I'm so damn tired and I can't sleep and I have to work in 5 hours:( Grahgh. So ridiculous.

[Kiwiology]

You always had to pass the National Registry test, Indiana only did not need it for the EMT level. I think what you are referring to is program accreditation through CAAHEP/COAESMP which is an NREMT requirement that from 2013 all programs must be "accredited" but I do not hold a lot of faith in the fact that "accreditation" means anything; a back room firehouse good ole boy paramedik course can still be "accredited". It's better than nothing but I think little above the fox investigating the hen house, esp with two seats on the board going to the Fire Service unions.

[EMS Aficionado]

I contend that the issue with Paramedic education in the United States is that it is a class, rather than a program. In other words, it is a stand alone class that is approved by the state licensing authority.

Paramedic Programs will link with colleges, but it is not the same thing as in the rest of healthcare education. In the vast majority of places, degrees are an "add-on", rather than a requirement for licensure. As a result, many Paramedics lack the knowledge that other allied health practitioners with two year degrees typically have.

If you wanted to become a Respiratory Therapist, CT Technologist, or a Registered Nurse at a two year college, you would need to take college level mathematics and writing. Many nursing programs require a semester of Microbiology and a semester of Life-Span/Developmental Psychology. All of the aforementioned courses are taught by qualified professors that typically possess a graduate degree in their field of expertise.

EMS education is too often centered around the idea that a Paramedic instructor can teach every aspect of knowledge that a Paramedic needs to have. Shouldn't healthcare ethics and medical legal be a semester long course taught by a Lawyer or a healthcare ethicist? We encounter legal and ethical issues on every call, yet more classroom time is typically spent on learning Magnesium Sulfate.

[Kiwiology]

An excellent point sir I forgot that in the US the Paramedic programs outside of the colleges (which are by far the majority) are taught by "Instructors" who generally have no other qualification than a Paramedic patch and X years of experience.

One of the benefits of the university programs required outside the US is that the physiology is taught by physiologists, the psychology by psychologists etc not somebody reading off a PowerPoint slide

[chbare]

Okay, let's see literature that looks at outcomes with degree paramedics versus Bob's firehouse medic mill medics.

[Kiwiology]

You're asking for the impossible, what does not exist, I have long wanted to make my Masters degree thesis some sort of trial where we pit ambo's from various nations against each other in some sort of test but there are just too many variables

I think we have to look at this empirically

The US is paid the lowest of any of the big six nations we have data on, it has the least professional autonomy and career progression, people jump ship because they are burnt out or want to "upgrade" to being a nurse, the fire department actively seeks to cannibalise EMS to pad its numbers and little is done to stop it and the EMS Agenda for the Future has been in existence longer than their rough equivalents in New Zealand, Australia, Canada (Ontario) and Ireland yet the gains made by it seem paltry and small in comparison.

I draw a causal relationship between these issues and a lack of professional education, if not a direct relationship than at least an indirect one.

Nursing has long required a two year degree in US and I don't see the nurses bitching about how the guy working as a dishwasher at a restaurant makes more than they do or that Occupational Therapy is succeeding at cannibalising them to make OT look good

Edited June 18, 2012 by Kiwiology

[systemet]

I think this is a valid question, but at the same time we have to ask, "What evidence do we have that training of paramedics beyond 6 months or 2.5 hours, or 7 minutes 14 seconds, isn't beneficial?". As the catechsim goes, "Absence of evidence isn't evidence of absence.".

There's also a philsophical issue as to who should bear the burden of proof here. Should it be those who say that additional training doesn't improve paramedic care, or those that say that additional training does improve care? For whom should the onus to produce evidence fall upon?

Not to ad hominem this discussion into irrelevance, but historically a lot of those who have advocated for shorter programs have been associated with fire department EMS systems that would benefit financially and logistically from shorter training times. It would be fallacious to argue that this renders their arguments invalid, but it does suggest they may be more likely to be biased. [Of course, the converse is true, that many arguing for longer educational requirements just want to professionalise EMS and get paid more, and may be similarly biased in the opposite direction.]

It's difficult to prove the benefit of something before it exists. It might be hard to show an incremental benefit of a 4-year degreed paramedic if they're working in a system alongside 6 month-trained paramedics, with the system designed to the lowest common denominator.

It would be similarly difficult to compare, say the New Zealand system, with an area in the US where the majority of paramedics have 6 months of training and be able to be certain that all differences in outcomes were due to the differences in paramedic education. A number of confounders exist, not the least of which, is that most of the potential effects on outcomes will be greatly influenced by the local demographics of disease and the surrounding medical systems.

The US is paid the lowest of any of the big six nations we have data on

Quick question -- Are you sure? Because I remember a time when the UK medics were very excited that some of them were going to start making more than £20,000 / year (at the time, around US$ 42,000, now about US$32,000 due to the utter collapse of the UK financial system). They didn't seem particularly highly paid. But perhaps this has changed?

My impression (from afar) has been that the pay (and quality) of US systems varies greatly across the country, with some places playing twice as much as others.