How to improve EMS professionalism

[Eydawn]

Ok, so this thread is intended to be a place to offer suggestions for improving our efficacy and professionalism as EMS providers. You want to crack parafiremonkey jokes, there's a wonderful thread going on in the Funny Stuff area right now.

*waves the traffic onwards*

From either side, ED or field, let's have key problems that are affecting our professionalism and patient care pointed out; be fair, realize that not everyone's going to agree, and I ask that for every problem you point out you offer the glimmer of a solution. The solution doesn't have to be detailed or well thought out, but it does have to be thought about.

*sighs* Like I said in the twin to this thread referring to our ED cousins, I think I give this one about 3-4 days before it descends into complete uselessness and gets locked, but in the meantime, let's try to get some good ideas flowing now that people who actually might be able to help improve things are paying attention.

Wendy

CO EMT-B

MI EMT-B

[Ridryder 911]

Dependent on what your definition of what a professional is. One can display professionalism no matter what level of education, age, or job function.

One of the major problems I see is most are not really aware of what being a professional is really about, or for that matters cares to.

There are several factors that "make-up" professional traits. As on another EMS forum, people have different definitions of what those might be.

For me the ones I can identify are: attitude, knowledge, behavior, appearance, and being able to utilize all those in a manner to perform their position and job with all those traits in a positive manner.

Unfortunately, this profession is full of those that do not meet those criteria or even attempt to ever better themselves off. Most are very satisfied with status quo...

R/r 911

[NREMT-Basic]

What about across the board better education for Basics, including better, more qualified instructors. When I went through my classes, the instructor couldnt pronounce, let alone define elementary medical terminology and hadnt been on a call or in the field in more than 10 years. While bandaging is not THE most critical skill in the field, we never were even taught pressure bandaging, were lectured on but not demonstrated occlusive dressings for, say, neck or chest wounds. When I realized that we werent going to get this stuff, I got a friend of mine to get me a Marine Corps. "corpsmans" manual and taught myself. To a certain extent, I can understand the feeling that Bs are undertrained. We had a girl in my class who, even after being passed through her national practicals, couldnt hear BP sounds through a stethoscope, let along lung sounds, etc. So yeah...at the early on stages, I would say better instructors, better instruction and better training equipment...half of the stuff we were using was either so outdated or beat up that it was barely useable. It was hard for us to train for Combitubes, because the maniquins we were using had cracked "lungs" so you couldnt tell if you were getting any air in or not and we were just old in simulations "ok, assume you got the tube in the trachea." Kind of silly considering how frequently they end up in the esophagus. Still being a Basic myself, I really hope that this doesnt degenerate into the old standby medic vs. basic argument or the arguments that say that Basics are worthless and should be eliminated altogether. I think the author of this thread has that in mind as well. Im hoping for good posts from people with alot of EMS field time under their belts. Thanks and I cant wait to read what you all have to say. Thanks also to the threads author for sticking their neck out to discuss a topic which frequently becomes an argument. Plus 15 points for that.

[Eydawn]

Do you think that a higher level of education for EVERYONE prehospital would help us figure out what it truly means to be a professional? Do you think that education leads to critical thinking skills? Truly an open ended question here.

How about a philosophy of medicine course? Do you think that might lead to a more professional demeanor, and hence, better patient care and utilization of training and skills?

Wendy

CO EMT-B

MI EMT-B

[NREMT-Basic]

Yes, I think better pre-hospital education at all levels of EMS would be an excellant start. I am really an advocate for a more "police academy" style training, where things are most standardized. Even little things, like students, whether they be future basics or medics, wearing uniforms to classes. I have observed classes where students come in in street clothes and where they wear uniforms. I guess its a dress for success thing because the uniformed students seemed to have a better handle on information, took pride in their education and did better on practicals, ie patient assessment, megacodes, etc.

As for the standardization of training, I do believe this would increase the level of professionalism. From physical fitness training to things like CPR training...some use AHA, some use National Safety Council, etc.

I also think that a more "degree" style training would be better suited, in terms of expanding Basic school to 8 months instead of 4 or 5 and medic training to a full 2 years, both basic and medic having the possibility of being dropped if you dont meet performance and skills mastery benchmarks along the way. We are dealing with peoples lives and health here. You cant train too much, or be too educated.

[tniuqs]

Dependent on what your definition of what a professional is. One can display professionalism no matter what level of education, age, or job function.

R/r 911

Well said.

[Ridryder 911]

Do you think that a higher level of education for EVERYONE prehospital would help us figure out what it truly means to be a professional? Do you think that education leads to critical thinking skills? Truly an open ended question here.

How about a philosophy of medicine course? Do you think that might lead to a more professional demeanor, and hence, better patient care and utilization of training and skills?

Wendy

CO EMT-B

MI EMT-B

Wendy, I think you have hit the main point. I am in the middle of writing an article for an EMS magazine on critical thinking skills. Very few EMS instructors are aware of what these are and definitely not how to improve their students upon them.

As more and more medical academia are accepting and promoting critical thinking skills, we will hopefully see a paradigm shift of this in our profession as well.

One does not have to have letters, degrees after their name to be a professional in their career. I know of many with M.D., MSN, etc.. only to be some of the most non-professional persons I know. However, the difference is they choose to be that way. They have been educated and as well expected to become such, it is they chose not to. I cannot say the same about EMS personnel.

We in EMS do not endorse teaching, maintaining professional standards and being a professional. In comparison of my nursing school, with each semester or each class professionalism was re-addressed in some form of another. Expectations of behaving, displaying and presenting one self as a professional was expected by educators, peers, with pressures to maintain it. The higher level of education, the more pressure and expectation is required of having and displaying it, at all times. Where we in EMS will briefly discuss it once in the beginning of EMT school, and again the beginning of Paramedic school... then, that's it! .. One chapter. Most consider being professional is having a nice, crisp, uniform... which is part, but is only a very small part of the picture.

I would like for all to consider this: We require those to teach our 4 year olds (reading, arithmetic-which is crucial) and on up to have at least a baccalaureate degree with hundreds of clinical hours which is very important; but yet, we only require those that truly deal with life and death situations only to have a two week instructor course. Is there something wrong with this picture ? Then of course the course material itself is minimal...

We expect others to treat us as a profession or be to treated as a professional ? ..... Are we asking for too much ?

We can be.. but, it is a long road. We have to have willing participants. This includes administration, educators, state buerocrats, and yes field medics wanting to change and requiring the change.

[Asysin2leads]

Improve hiring standards for paramedics.

Improve education for paramedics.

Make everyone a paramedic.

Banish volunteers.

Pay us more.

That should do it.

[emaxray]

Improve hiring standards for paramedics.

Improve education for paramedics.

Make everyone a paramedic.

Banish volunteers.

Pay us more.

That should do it.

I'm not sure if all of those address the question at hand, but I love it!! :!:

[xlq771]

At the risk of offending my American neighbours, the best way way to increase professionalism in US EMS would be to simply drop your National Standard Curriculum for FR, EMT, EMT-I and EMT-P levels and adopt our Canadian PAC National Occupational Competancy Profiles for EMR, PCP, ACP, and CCP levels.

Before anyone complains that I am wrong, I have trained in Buffalo, NY as an EMT-Basic (NYS and NREMT certified) and in both Ontario and Alberta as a Canadian EMR. Even though my EMR course was only 80 hours, I learned some things that were not covered in the US course (137 hours), such as applying a 3 lead ECG, and setting up an IV set. How many others on this forum can say that they trained in both systems?

The problem with the US EMS education system as far as I can see, is in what material is taught, and how it is taught. Many Canadian EMR courses use US EMT-Basic textbooks (my Alberta course used Mosby's The Basic EMT). Many PCP/EMT courses in Alberta use Mosby's EMT-Intermediate/99 textbook, so the problem can't be the textbook used.

The problem can't be the length of the course, either. Professional Medical Associates, in St. Albert, Alberta runs a CMA accredited PCP/EMT program that consists of only 240 hours of classroom didactic instruction. Yet even with such a short program, this program is rated as one of the best in Alberta. And it is short enough that even volunteers can take the time to take the program.