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100 percent O2 not best treatment anymore....


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Would someone care to comment on the fact that First Responders, EMTs, and Paramedics have regularly scheduled, mandated "refresher" training to keep them current on practices and protocols for the area, county, state/provence, or country, but the nurses, physician's assistants, and doctors get out of their various training schools, and can actually be using training practices and protocols that are 40 or more years old, possibly outdated, due to whatever age the person is? They don't have to keep current on the newest practices and protocols, unless they choose to.

Also, all things medical, no matter what the level and scope of practice, as per the local medical board or Department of Health, are still called MEDICAL PRACTICE!

In order to keep my state license I need to complete 50 hours of CME per year. To keep my board certification I need to complete an additional 150 hours of CME in 3 years. I cannot speak for any other level of provider. I also don't have protocols, we have clinical judgement and EBM.

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Someday Speedy, I pray to the good Lord our God that will find that sentence as funny as I do right now.

How long is a semester in the US? If it were 18 weeks long that only adds up to 108 hours... but I guess if you add on one ambulance shift then you get to 120.

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Yes, BEorP, that is roughly how long they are. Why people continue to hold their clock hours of education as a standard, when they are so woefully inadequate, remains a mystery to me.

I've never liked the idea that a prehospital provider (paramedic specifically) can keep their certification/license with as little as 48 hours of CE. The information being gathered is just too much to allow this to be sufficient. It is impressive that to remain board certified, an ER doctor must have more continuing education than the bulk of prehospital providers get from their initial course.

Maybe, just maybe, this is why EMS is the orphan of medicine. Could it also be why no one really knows who should be administering the rules for us?

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Yes, BEorP, that is roughly how long they are. Why people continue to hold their clock hours of education as a standard, when they are so woefully inadequate, remains a mystery to me.

I've never liked the idea that a prehospital provider (paramedic specifically) can keep their certification/license with as little as 48 hours of CE. The information being gathered is just too much to allow this to be sufficient. It is impressive that to remain board certified, an ER doctor must have more continuing education than the bulk of prehospital providers get from their initial course.

Maybe, just maybe, this is why EMS is the orphan of medicine. Could it also be why no one really knows who should be administering the rules for us?

AZCEP, I think you hit on something big right there. Part of the problem with EMS is knowing who sets the standards and rules. EMS is like the red headed step child that no body wants, but everyone keeps yelling at. Personally (I admit I have some bias), I think EMS would be best served (in the short term at least) if it came under the umbrella of an EM organization such as ABEM. You would then have doctors, and not politicians, who could set the standards based on the best evidence (though this is sorely lacking in EMS). I think EMS would also gain more respect at the street level from hospital staff if they knew that EMS was being guided by the EM people. I think this would also help to raise the level of education as anyone in medicine respects and understands the need for education vesus training. I think you would see a move towards a college level program (for medics at least). Who knows, maybe down the line we could see the birth of the ABEPM (American Board of Emergency Prehospital Medicine)?

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Hell, they wouldn't even have to take a leadership role to get the ball rolling and start improving EMS. I've always dreamed of seeing somebody like ACEP step up and put forth some serious propositions, and back them up with ultimatums. Take a position, for crying out loud. Step up and say, "we will no longer allow uneducated and inadequately trained lay persons to practise under our licensure. Period." I would never let one of them work off of my licence, that is for sure. EMS has had thirty years to get its act together and has failed miserably.

Drastic times call for drastic measures.

If you aren't part of the solution, you're part of the problem.

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Just checked the website for ABEM or ACEP. They do have a contact us button. If everybody started sending e-mails to them wanting them to step up it might get their attention. Invite them to come here and hear what we think needs to change.

Lust a thought

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Just checked the website for ABEM or ACEP. They do have a contact us button. If everybody started sending e-mails to them wanting them to step up it might get their attention. Invite them to come here and hear what we think needs to change.

Lust a thought

Didn't your mommy tell you that lustful thoughts are bad. [-X :lol:

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I cast my vote to start reform from the top down. Want to change the system? Start working with medical directors and universities to offer/require education. Better yet, run that class or become that medical/EMS director. You can't require more education until the educational resources are available and you can't expect people to go for the higher/more expensive education as long as they'd be lucky to find a job for $10/hr.

Personally, I think a good system would be an associate's degree for the BLS level and a bachelor'S degree for the ALS level. Granted, this might require the addition of 2 cert levels to set the groups apart in terms of scope and pay. The BLS level focuses more on broad theory and breath (courses: chem, physics, writing, intro to physical exam, intro bio, intro to psych, genetics, biochem, etc) with the ALS level being courses taught through university medical schools like the special masters programs (SMP programs are like "Med school light" where it is a 1 year masters program with most of the courses being 1st year medical school classes. The classes are handled anywhere from fully integrated classes, separate classes, same professor, or distance learning with taped lectures).

I think that one of the biggest crimes right now is the lack of practical experience prior to letting basics loose on the public. A physical exam is more than memorizing and regurgitating a sheet and being able to ask OPQRST/SAMPLE. You have to understand what your asking for, why your asking it, and what, if any, follow up questions you need to ask. Basics are neither expected or required to be able to do that. Too many of us are content to play with plastic O2 masks and cardboard arm splints to expect more.

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