Rural Updates

[quint]

Alright I am merely taking up the suggestion of starting a new thread for debate! (Dust if this is already covered extensively please point it out and we can move to thtat thread)

If a specific plan sparks debate, please form a new thread. Questions for clarification on specific items are welcome.

Wouldn't this move cause EMS to remain a bastardized service, with no real direction? True, it is probably better than the present, but I can't help but think that it would only keep things the same.

Nationwide, the standards need to be the same for every provider level. The ABEM would be a good place to secure the standards.

Increase the educational requirements. Perhaps an AS level degree for entry level providers, and the BS for all ALS. Of course, pay scales will have to increase accordingly.

Eliminate the Intermediate level altogether. It has outlived it's utility. The rural departments that hold on to this level so adamantly, need to realize the increase to full paramedic is well worth it.

Now I am NOT trying to down play education, which alot of you interpret me as doing, but I do have some questions and concerns.

I do agree with a "nationalized" system instead of state by state regs.

I do have concerns with going to an AS and BS requirement, what would be the bridge to cover the transition, you couldn't just apply it over night.

Intermediate, while it may not be practical in an urban setting is still viable in rural settings IMHO.

As far as rural departments "holding" on to stuff, how would you propose they obtain the higher education? They would have to quit their family supporting job to obtain the proposed education. I know to urban personnel it is not that big of a deal, but most rural providors do the job as a volunteer whether fully or paid on call/paid by call, and their is no second option due to travel times from urban areas.

Pre-response request, don't turn this thread into a shooting match just because you disagree with what I have said on education.

[AZCEP]

To cover the transition, most could be run out with simple attrition. We will be around long after those that have not entered the field recently get tired of all of the young, higher educated providers telling them how things should be done.

The intermediate level was created to allow the rural departments that wanted ALS to get it for less capital outlay than would be required by paramedics. The time has come to eliminate the level altogether. These same rural departments are now using the intermediate as an excuse why they should not be required to upgrade. Of course, this only applies to the few areas that still use this level.

This would force these smaller areas to upgrade to paid services, as has already been discussed in great detail. Volunteer services are not helping anyone, and I will leave it at that.

How exactly is it not a big deal for the urban providers? They still have to pay for their education, most don't get paid to attend classes, and even fewer get paid time off to attend. They also have to make the decision between educating themselves and providing for the "family".

Yes, there are problems to be worked out, but the system must elevate itself before we can realistically expect to be treated as a profession.

[quint]

This would force these smaller areas to upgrade to paid services, as has already been discussed in great detail. Volunteer services are not helping anyone, and I will leave it at that.

I don't understand where you are coming from with this statement. I am talking of ambulance districts with 10,000 or less people, that are still too far out for "paid" city providors to cover. If they are gone who covers these areas?

How exactly is it not a big deal for the urban providers? They still have to pay for their education, most don't get paid to attend classes, and even fewer get paid time off to attend. They also have to make the decision between educating themselves and providing for the "family".

In a "urban" environment you have short commuting distances to class which makes time management a lot easier, and a bigger pool of students, in rural settings you have to deal with items such as calving, harvesting, planting of crops, and that is just spring/summer, plus lower population.

Yes, there are problems to be worked out, but the system must elevate itself before we can realistically expect to be treated as a profession.

I agree whole heartedly, but I disagree with "cutting the fat" before you have an organized effort and a solid plan.

[AZCEP]

http://www.emtcity.com/phpBB2/viewtopic.php?t=3934

http://www.emtcity.com/phpBB2/viewtopic.php?t=4653

http://www.emtcity.com/phpBB2/viewtopic.php?t=4441

Just a few that have already discussed this at length.

[quint]

Alright, so maybe we need to back up and cover this again, this is a thread about education! Not whether or not to eliminate volunteers, but how would you expand their education. It is also not a thread about some made up fantasy certification level of a basic who wants the glory of ALS without the time invested. And I have yet to post ANYTHING about the public!

So, if anyone would like to respond to my questions without diversion, please do so.

[Medic26]

It doesn't make a difference whether you are a volunteer or paid when it comes to training and industry standards. If a training/education standard is set for all agencies, then all agencies would have to abide by it. Lets just remember that just because you had 10 million hours of training, doesn't mean you are a better provider unless you actually learned something. We need to keep it practical and keep in mind that small towns USA outnumber by far those "urban" area's you all think should be modeled after. The rural citizens deserve the best care their own communities can offer.

And as a side note.........the paid vs. volunteer thing is nothing but a bunch of crap. There are good/great and bad/terrible providers on both sides......so stop puffing up your chest just because you do it for a living. I do this for a living, but routinely interface or work with volunteers who are just as good as the paid folks. So grow up, move on and discuss a practical standard that would provide good care to all of our country not just urban area's.

This is a profession regardless of pay.

[quint]

It doesn't make a difference whether you are a volunteer or paid when it comes to training and industry standards. If a training/education standard is set for all agencies, then all agencies would have to abide by it. Lets just remember that just because you had 10 million hours of training, doesn't mean you are a better provider unless you actually learned something. We need to keep it practical and keep in mind that small towns USA outnumber by far those "urban" area's you all think should be modeled after. The rural citizens deserve the best care their own communities can offer.

And as a side note.........the paid vs. volunteer thing is nothing but a bunch of crap. There are good/great and bad/terrible providers on both sides......so stop puffing up your chest just because you do it for a living. I do this for a living, but routinely interface or work with volunteers who are just as good as the paid folks. So grow up, move on and discuss a practical standard that would provide good care to all of our country not just urban area's.

This is a profession regardless of pay.

=D>

Here is my point.. For the most part we agree that education should be brought up, but my concern is not for the rural basics and medics, it is for the people who live in rural areas that at some point will be patients. Now with that said how do we come up with a solution to the education problem?

Can we take it to an actual national system, and have rural agencies cetified to a certain level to get the patient close enough for a more advanced medic unit from an urban area to intercept?

[akflightmedic]

As far as rural departments "holding" on to stuff, how would you propose they obtain the higher education? They would have to quit their family supporting job to obtain the proposed education. I know to urban personnel it is not that big of a deal, but most rural providors do the job as a volunteer whether fully or paid on call/paid by call, and their is no second option due to travel times from urban areas.

Teachers are required to have a degree whether they are rural or urban. Teachers are required to have so many CEUs every year or on a 2 year rotation or they can lose thier certification or ability to teach within certain districts. Rural or urban, they seem to be able to maintain this despite their location and LOW PAY. We as parents, community leaders, or community members would expect nothing less, so why do we tolerate it in EMS?

Its simple, you implement higher education now and phase it in. The majority of people are grandfathered into the system. There will be no huge drain on resources available as EMS will now be viewed as a degreed career instead of somthing to pass the time. The state of Oregon has been doing this since 1998 and it has caused very few if any problems at all. Instead, more rounded, more educated students are on the streets providing higher levels of care.

[quint]

AK, I agree with you, but I want to fix the problem without causing others. When schools do career days, you rarely see EMS or hell even fire involved in the event. It is usually after schooling before anyone considers going into EMS. I agree in the degreed program, but how are students supposed to select it without it being known to get an education in EMS before you head back to the family ranch.

I am not pointing fingers to anyone in this post, but I see a lot of "we should get rid of this" without weighing the consequences, much less putting an effort in to anything off the computer.

[Scaramedic]

Oh my God!!!! I am agreeing with Quint on this one. :banghead: :puke:

Ok, first a little local geography. Grays River, Wa population like 300. The kids living in Grays River have to catch a bus about twenty five miles to a school in Nasselle, pop 400. The town is too small to have a school, yet they do have a volly fire department that does transport. The nearest hospital is about an hour away, east or west, nearest ALS service minimum 30 minutes. Were talking rural here, well as rural as you can get in Washington.

So what are we to tell the residents of Grays River? You need to divide the cost of an ALS service between the 300 of you, ambulance, supplies, quarters, about 8 full time AAS degreed Paramedics. Ummm little math, carry the 2, yeah that is going to equal a buttload of money. I agree with Quint the rural providers cannot afford to run at the levels of urban areas. Yes teachers have to have degrees but podunk America doesn't even have schools, so that analogy is not valid.

So what is the answer? I believe that in urban areas transport units should be staffed with Paramedics. Those Paramedics should have an AAS or above. Urban areas have the tax base to support ALS staff levels. Rural areas do not have the tax base to support ALS staff levels. It comes down to money, so unless we go to a socialized medical system we are stuck with it. Most of rural America relies on Basic level care, it is not possible to cover all of the rural areas with ALS without an increase in taxes, and we know people love to vote for new taxes. Rural providers are an important asset in BFE, even providing Red Cross first aid is something until an ALS intercept or ALS arrival can happen. It is better than the folks of Grays River, Wa having to wait 30+ minutes for an ambulance.

In a perfect world ALS would be everywhere, we don't live in perfect, at least that's what the Walgreen's commercial says.

Peace,

Marty

:joker: