How to begin?

[AZCEP]

The question was raised in the "Mandatory 2 year degree..." thread about how to go about implementing the changes that have been suggested.

Due to the large number of different types of providers, there will be much teeth gnashing as this suggestion moves forward.

Would a national standard be useful? Would the local jurisdictional issues eliminate the utility that such a standard would have?

Much room for discussion on this topic. What's your opinion?

[chbare]

I think a comprehensive nationally recognized standard of education is needed. A college would need be accredited to teach the curriculum and the minimal requirements of graduation would be required for every other program. This would ensure that everybody is on the same page and has a common foundation upon graduation. I think scope of practice could be similar to RN scope of practice. The state and institutions would still have the ability to customize scope of practice, much like nursing. However, the foundation of education would still remain standardized.

Take care,

chbare.

[Ridryder 911]

I agree with CHBare. We need to totally revamp the thinking and level of our education before a drastic change occurs (not for the better) I personally feel we are on a slippery slope, with one agenda to produce quality and thoroughly educated medics and the other to crank personnel out as fast and cheap one can to fill the need.

Unfortunately, EMT's educational system was poorly designed. It was formatted to train existing ambulance attendants, the curriculum took in account that ones taking an EMT course already had previous experience and understanding of transport systems. Tragically, the curriculum and educational systems have never corrected or changed this as of yet. We continue to hear the outcry from students, working EMS personnel, managers, physicians, and even now research is pointing the faults of the system.

I personally believe within the next 5-7 years, we will see the pendulum either swing toward to requiring formal education or to the opposite to develop very minimal criteria for economic reasons. It is all dependent upon our actions at this time, what the future holds.

If we (EMS) are smart we would explore and observe what other medical professions have done. Not all other medical professions were established as they are now. Compare what respiratory therapist, radiological technologists, and yes even nurses have changed to enhance their profession. I remember the dilemma that those professions had which were similar to ours. Let's not reinvent the wheel. They wanted to perform better patient care, increase salary and benefits to the members of their community, and have more of a say of the their future.

Ironically we have had it demonstrated by several EMS forums that demonstrated many are well satisfied with the status quo and on some points much rather to "lower" some of the mandates. This is shocking to some of us but over all this does not surprise many of us. Apathy is our number one problem in EMS. Be it pro or con for more education, the lack of concern and involvement will kill the rights of EMT's to change their own profession. I do believe that if we do not take action and show some steering of it, other professions (F.D., EMS Admin., Physicians) will do it for us. Although it might appear to be subtle and in a non-direct manner; it will be done.

As CHBare described a comprehensive curriculum needs to be established with associated formal requirements to accompany the program. There needs to a a clear removal of the Paramedic from a technician status to a practitioner or professional level. Until we change the education, we will not be able to accomplish this. Formally accredited educational institutions should be established as well as requiring EMS instructors to have a minimum of bachelor's or masters prepared. We require those that teach crayon coloring and learning ABC's to have such, but those that perform intubation or crich's, RSI to only have a GED.. there is no logic in this! Once we have a formal educational system of institutions, instructors, then a national examination can be developed as well as potential increasing level of academia.

There should never be a formal national scope of practice or protocols. Practicing medicine is an art with a knowledge of science. Individuality of the local medical community should be considered. Each community needs are different and treatment regime should reflect that. Each state should develop a Board composed of members of the EMS Community to govern those in EMS. This board should be composed of EMT's and Medics with advice from other medical professionals. However only as advisement capabilities. This board should develop individual state scope of practice which could be uniquely developed for that area, these could be added upon and give restrictions and guidelines for violators.

Since we do represent the medical control and we work and perform under the authority of the local medical director we should not have national standardized protocols as well. Having such could enhance or possibility limit some EMS providers. This could as well as tie the hands of the local medical director. We want physician involvement and do not want anything to detract from it. Tying the hands of the local EMS Director will only cause distraction and potentially no advancement or progression in therapy.

So the question returns back to the same statement as been described many times in this forum... What type of EMS do you want? And what are you going to do about it ?

[MTNMANMEDIC]

There should never be a formal national scope of practice or protocols. Practicing medicine is an art with a knowledge of science. Individuality of the local medical community should be considered. Each community needs are different and treatment regime should reflect that. Each state should develop a Board composed of members of the EMS Community to govern those in EMS. This board should be composed of EMT's and Medics with advice from other medical professionals. However only as advisement capabilities. This board should develop individual state scope of practice which could be uniquely developed for that area, these could be added upon and give restrictions and guidelines for violators.

That is what we have now and according to you and a lot of other folks, it does not work.

We have to have National Standards to set the bar, after that bring in the State Officials and the OMD's who are willing to accept the Standards and then improve upon them, have the Board of Review on the National level with strict guidelines set, that say the Standards will be evaluated every 3-5 years.

Let's look at a common occurance call.

Chest Pains :

In my region the EMT-B protocol calls for

ASA 81mg X 2.

Assisted Nitro tabs (no spray) if prescribed.

High Flow O2.

The next county over calls for:

ASA 162mg X2

Assist with Nitro (spray allowed)

High Flow O2

12 lead recorded on scene if time allows, no interuping, transmit to hospital if equipped, med consult if 12 lead software indicates ACS.

2 counties over allows EMT-B's to admin. Nitro unprescribed.

They also have EMT-IV status.

These protocoals are set by the regions and approved by the state but if I obtain my EMT-B in this county, I can go 2 counties over and sit through a 8 hour class and be able to start IV's, join an agency, go through the preceptor program and bingo I'm allowed to operate under that regions protocols and I still have the same basic education I started with 2 regions over.

Are you willing to tell me that is the right way to do it ?

Rid, I think you are on the right path with the changes you want to see and remember the Law Enforcement Community faced this problem, one man began the Nationally Accredidated Program they have now, it has progressed to the point where if you are a certified police officer but your agency is not Nationally Accredidated and you apply and get hired at a NA Dept., your butt goes back to school to bring you up to the Standard.

The Police Academies recognized this fact and became NA and started turning out NA officers.

The indivual states have their own laws but the foundation is still the US Constitution and until you teach a cop how it applies to every arrest, every arrest can be thrown out of court on one level or another.

[AnthonyM83]

Why do people think there's such a difference in standards across the nation?

First thing that comes to mind is different demographics. What if you have a county full of uneducated hicks...anyone smart who grows up there, moves out...that type of situation. I think a lot of counties would find it a strain to keep up with a national curriculum that's too stringent, so might fight to avoid it...even if it means not requiring National Registry for their EMTs.

Don't know if this is a realistic problem or not...but my point is let's try to get at the roots of resistance to change.

[pinymayu]

Hello Everyone,

Great points, and I agree with many of the ones raised above. It seems though, that we are only addressing pieces of the issues. Here are some of the things that need to happen in a loosely assembled but yet not iron clad order of importance.

1.) Unification of purpose.

We need to cast off the sense of professionalapathy that many EMS clinicians have built into their personalities as away to protect themselves and work in an austere environment. We all need to recognize, accept, and stand up to make the hard choice which are mandatory to effect the desired changes.

2.) Funding.

Everyone is worried about the allmighty dollar, euro, ruble, etc.. Where does it come from? Why should we pay more taxes, more for courses and certs, etc... Fact of the matter is the majority of funding is in placealready. It is just holding up the weak foundations of an ineffective, failing bureaucracy. If we elimeminate this and creat a national level EMS (only) agency which will also oversee and have the 'teeth' to mandate change and education on a national level.

The creation of the federal administration was a crucial step to bringing governmental attention to a long overlooked part of the public safety triad. This ideal of educating providers, both individuals and agencies, to the highest possible levels. The creation and enforcement of this ideal requires the support of a federal agency (cabinet level?) dedicated to similar principles. By bringing this organization's support for the federal administration, we will in effect, help to facilitate the transition of the current system to a new ideal.

3.) Education.

Discussed adnauseaum and there is alot of 'golden' suggestions in the archives of this forum and in recent threads.

This entails that a new group of practicing EMS clinicians should be brought to fruition. The means to do so will be via a shift from the current system to one, which would provide nationwide equality in our profession. This metamorphosis will occur in concert with a progressive, innovative consortium of EMS and non-traditional EMS educators, and related medical professionals. After implementing the new national 'gold' standard education these EMS providers, will become licensed professional EMS clinicians. By establishing a national 'gold' standard EMS licensing board we intend to eliminate the current difficulties of unequal provider education, clinical competency, and hurdles to geographic provider movement and practice. This licensing body would provide a standard time frame for licensing duration, minimum education, and clinical competency standards, on going evaluation of the educational EMS process standards; and still allow for local modifications in the scope of practice for that particular systems needs. These modifications are not to exceed the new National Standards, but set the new minimum levels of continuing education, re-licensure requirements as well as professional development for each level of licensure. It should be noted though that this new body of more effective EMS clinicians will function in environments and roles as yet to be determined. These clinicians will perform functions, roles and procedures beyond the scope of the National standard as it is currently conceived after meeting appropriate training, competency requirements, and oversight in accordance to the new standard.

This benchmarks a fundamental shift from all states meeting the minimum education, and training requirements to all providers nationally being trained to the same ideals of practice and allow for professional development and advancement through out the EMS and medical community. This shift would streamline all education, allow for lateral recognition of licensure between all states and territories, thus elevate the quality of available patient care possible by all EMS clinicians across the EMS horizon. Additionally, as an added measure the national EMS regulatory body recognizes that this shift would also allow for all regions to pick and choose what skills are best suited to each practice environment. This also conversely allows regions to remove those which are not applicable to that practice environment and or system needs. By removing the uneven EMS provider education currently in place this plan allows for greater flexibility in each EMS system to provide maximum efficacy, efficiency and access to rapid, timely well trained capable EMS care for the entire populace.

This standard will be subject to continual review, evaluation, upgrade and progressive change.

4.) Legislation

With the above unity, a clear funding and educational plan standing on the foundation of a small, efficent, autonomous national level organisation at the cabinet level. Legislation should be enacted to allow for continued funding, and the ability to make states fall into line and accept the afore mentioned.

These are just a few of the steps to be taken. There are more.

Pinymayu

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