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Hello, You are dispatched to a suburban home for a 47 year-old female found unresponsive by her husband. The scene is safe and you are greeted by the patient's husband. He tells you that he has been out of town for the last 48 hours for work. When he came home today he found his wife laying on the bedroom floor. When you enter the bedroom you hear gurgling respriations and the patient appears pale and gray. Good luck

OK, I would say screw it, if my medic wasn't with me I would load her and intercept for my paramedic assist. I would put her on her side, hoping for vomit, preparing to remove the opa if she does with suction ready. Keep her covered with heat on in ambulance. Have hospital on alert with heli on standby (small hospital). 12 lead to send to ER and ready for my Paramedic.. Continue assisted ventilations with BVM with high concentration O2. Have IV set up ready and paramedic bag out. And lights and sirens. This is why I do not want to end my education at the EMT level.

We cannot advance until we focus on and correct our fundamental problems first. In my four years of teaching I've yet to see anatomy and physiology, English and college level mathematics required for paramedic education in my area. Through hard work and support, I am at the cusp of seeing this occur. Again, we are struggling to even establish ourselves as a profession and we are talking about going up against some of the most powerful lobby groups in nation? Nursing could destroy us. Sorry bro, as I stated earlier, following the failure of the Red River Project in the 90's, fundamental education issues in EMS has changed very little compared to other countries with robust education in place and relatively independent practitioners. CCEMTP is a 100 hour curriculum. I'm not sure you can make a competent critical care provider in 100 hours. Also remember the PA was derived from military medics (mainly corpsman who served in Vietnam) and is a direct descendent from prehospital medicine.

I cannot fault the passion and desire to advance the profession. However, the greatest battles that are being fought revolve around minimal educational standards, pay and the formal establishment of the paramedic as an allied health professional. I cannot support taking steps to put forth a practitioner with a few hundred hours of training while neglecting the fundamental problems with EMS. This way of thinking is hurting nursing and I've seen two nursing programmes loose their NLNAC accreditation in the past year where I live due to several unresolved issues that are largely being neglected in part because of the focus on less fundamental issues. As an educator and provider who holds multiple degrees and licenses, my biggest goal is with trying to work on fundamental EMS issues. A paramedic practitioner is not on my list of issues that need to be resolved.

I completely agree...and disagree. While I am all for EMS being run by, and for paramedics (which I think is ever so slowly becoming slightly more realistic), and it's because of that that I am vehemently opposed to anything other than a very limited role for nurses in the prehospital/CCT world, I think, if done correctly, that using PA's to fill a real need in EMS would be appropriate, and the right choice. Of course that's ignoring that things are rarely done "correctly" when it comes to EMS... While I think that paramedics and EMT's should retain (or attain) primacy when it comes to prehospital care, using PA's to provide in the field primary care wouldn't neccasarily endanger that. And using an allready established profession with known educational standards, licensing requirements, physician oversight and lobbying groups would be much easier than trying to create something new from scratch. Especially with the current state of the overall US healthcare system. As long as the PA's came from an EMS background (as in were practicing paramedics up till the point they entered PA school) and became PA's specifically to fill this role I think there would be less of a worry about anyone trying to force their way into a new field. Realistically, once a funding source was set up, it wouldn't be extremely hard to do, at least initially. The biggest hurdle would be getting a college to recognize the paramedic curriculum as a good sized chunk of the credit requirements for a bachelor's; as far as I know most PA school's require similar schooling to med schools (year of biology, chemistry, physics and I think anatomy). Let potential PP's (or PA's) take those required courses, use their paramedic school and background as a working paramedic for the rest of the requirements, and be given a bachelor's. After that it would just be a matter of being accepted into a PA school, and making it through the program. The really hard part would be eventually getting the option of focusing on both EMS and field primary care put into the curriculum. And since PA's can allready choice to focus more on various fields...and since EMS is now a recognized specialty by the AMA...and PA's are pretty closely linked to MD's...I think it would be doable. This ignores that you would need to get local funding to run such a program (since, as with EMS the return for billing wouldn't really offest the cost), that you would have to mandate that candidates were working paramedics up to entry into school, have a medical director agreeable to it, local facilities that would let the PA refer patient's directly to specific specialties, etc etc etc. But it's very doable. And much easier, and safer, than trying to create something new from scratch.

I am completely for paramedic practitioners. I do not think that they should be entering the hospital or clinic realm, as NP's and PA's and physicians already hold dominion over those areas; rather, I believe that we should focus on transitioning ourselves from emergency medical services to mobile health services. The notion itself is expansive, but it has a lot to do with our own perceptions of our profession, even down to little things such as referring to ourselves as out-of-hospital providers rather than pre-hospital providers (the latter implies that the next step is necessarily the hospital, something which we know to be untrue, even if it is the most commonly practiced model currently). Things such as community paramedics will pave the way toward this transition, I believe, and indeed may assume the roles of the first "paramedic practitioners", but as a current community paramedic student I will be the first to admit that the educational level needs to continue to grow and increase. Still, it's the first step. Some people have suggested that NP's or PA's fill the role of these out-of-hospital practitioners, which is something I simply cannot support. Since its inception, EMS has always been under the thumb of another, frequently unrelated group of professionals. Now, we certainly need to maintain some oversight, and that is perfectly fine, but on the same token we have to take charge of our own profession and become more self-regulating. EMS-based EMS. It's a great misfortune that through our own ignorance and lack of motivation that we have allowed our profession to be at the mercy of so many others; something which I do not see occurring among other providers or professions. We need to get away from that, and have the self-determination to truly become self-regulating; this means increasing our educational standards and improving our clinical practices from within, not waiting for other professions to elevate it for us. Someone also remarked that EMS shouldn't enter into the realm of primary care. Unfortunately, this is impossible. The majority of our calls are already non-emergent, but rather than provide us with the education and the tools to treat these conditions, we have simply relied on the expensive method of transporting all patients to the ER, where their needs can be somewhat met until the next exacerbation. In order to provide a greater benefit to our patients, we have to become stronger preventative and primary care providers; after all, it's from lack of these two care types that the community paramedic was born. This isn't to say that we should enter the hospital or clinic realm, but instead we should become a part of that continuum of care working in collaboration with the patient's physicians, NP's, PA's, hospitals and clinics and serve as the out-of-hospital barrier to preventable hospitalization. While I don't know if prescription powers are necessary or wise, I think that limited dispensing might be prudent in some circumstances. There are other skills and tools we need to add to our repertoire in order to become more potent primary care and urgent (non-emergent) providers in order to give the right treatment to the patient on scene instead of transporting them unnecessarily, but the primary focus should be on increasing our educational level. Associates degree minimum NATIONALLY, more Bachelors options, and even Masters and above. In doing all of this, we're going to have to avoid getting greedy. Ultimately, EMT's and paramedics exist because other health care professionals won't work for our wages. And while we certainly deserve better pay than what we receive now, I'm hesitant to feed into the mentality that increased wages aren't something that we must earn through elevating our standards. When that happens, though, and when the CMS changes the schedule of billing for ambulance services, I suspect we will face a greater challenge to hold onto our profession than we have before. Nurses will say "we have mandatory degrees, we're the right ones to do EMS!", NP's and PA's will say "why use community paramedics when we will do the job!" The answer which keeps EMT's and paramedics as the primary out-of-hospital health care providers will HAVE to be "we have equivalent education, and we'll do it for less" if we're to hold onto our jobs. Just as nurses vehemently oppose paramedics working as paramedics in the hospital, and NP's and PA's will oppose community paramedics, and as physicians have opposed mid-levels, we in EMS have to hold firm onto our profession if we want it to remain ours. Like I've said, since our inception we have pretty much constantly been under the beck and call of another group, whether it be fire or nurses or physicians, and if we're to survive and truly be our own PROFESSION, we've got to distance ourselves from the rest, be self-regulating, and demand the same level of professional autonomy as these other groups do. But at the end of the day, the cards are in our hands. Nurses have no vested interest in us increasing our educational standards, and may in fact have a vested interest in us remaining uneducated; NP's and PA's likewise have no vested interest in our community paramedics and paramedic practitioners becoming a greater threat to them. The ONLY ones who have a need for EMS to evolve are EMT's and paramedics, and until we realize that and start fighting for our own profession, we will never be just that: a profession. Going back to the clinical aspects of paramedic practitioners, yes I feel there is a need for better out-of-hospital health care. There are too many preventable transports, exacerbations of disease, and too many people without access to adequate primary care. We can provide that care, and we will provide it, if we get our hearts in the game.

Yup.... I know lots of Denver Paramedics. Very difficult to get on there if you're not from their system. They work 10's. Very nice system to work for. - It's technically the Paramedic Division of Denver Health - It's a urban system with a lot of trauma calls - They pay the best for the area - Again, good luck getting hired there, they like their own medics that they trained and unless you have a lot of education under your belt it will be a challenge PM me if you want more or need specifics

Just get a Hold of yourself. No better advice ever given. Get the pun???