VentMedic

Ft. Lauderdale Fire Rescue has an ALS Ocean Rescue team for Beach Patrol.

Correct me if I'm wrong, but I believe your transport team consists of RNs and RRTs for the critical children that require advanced procedures. These team members have many years of experience working in a PICU and NICU with advanced knowledge and skills. Are you also working in some compacity inside the ICUs at this facility to gain more experience? Both pedi and neo are very intense specialties which are barely mentioned in Paramedic school. If you are going to expand your scope, you will have to gain lots of knowledge and experience. The pedi transports might be a little easier for you to get more involved. Neonatal medicine is a whole different field. This is not an easy specialty field to get into. It is one that requires a lot of effort on your part and not a "my scope says so" type of job. It is a little more than just being "allowed" to do a skill per your state. Adult ATVs and a neonatal ventilator are two very different devices. You will have to LEARN (not memorize) all the drips AND be able to titrate them according to ventilation and hemodynamics as easily as you would run through your ACLS protocols. There is NO room for error in this field.

There some states, such as Florida, that still have their own state exam. Because of this and Florida's strong FF presence, the medic mills are safe. There will also be a petition or some legal position statement that will be presented as the deadline nears to have an extension granted that could be from 3 - 5 years with the option of another extension after that. Do the FDs not have any confidence in the learning ability of their FFs to be required to adhere to standards? In Florida, $30K is what it costs to maintain the potted plants at one station. Surely they could divert some of that money to meet the requirements.

http://www.ems1.com/ems-products/education...ication-changes Mich. EMS personnel brace for major certification changes By Emilia Askari Detroit Free Press DETROIT — The National Registry of Emergency Medical Technicians in 2013 no longer will certify paramedics who graduate from unaccredited training programs. It's a move the Columbus, Ohio-based registry — which certifies emergency medical service personnel nationwide — says will improve the quality of emergency responders across the country. Only two of the 42 EMS training programs in Michigan have the required accreditation — those operated by Lansing Community College and Huron Valley Ambulance in Ann Arbor. Last month, Bloomfield Township became one of the first municipalities in the state to pass a resolution expressing concern over the proposed changes. Also in July, the Southeast Michigan Association of Fire Chiefs drafted a proposed resolution in opposition to the new education standards. Fire chiefs fear that unaccredited programs — most based at fire stations — will close when the new rules take effect, leaving only longer and more expensive training programs. There are 29,000 emergency medical service personnel in the state. All must receive additional training every few years. "There already is a shortage of EMS responders in Michigan," said Jon Hockman of Livonia, vice president of the Michigan Association of Emergency Medical Technicians. "Yet we're getting this rammed down our throats. ... These new standards would create an even larger shortage. That means higher risk to the public." Michigan emergency medical service personnel must pass the same certification examinations as those attending programs accredited by the Texas-based Committee on Accreditation of Educational Programs for the EMS Professions. But proponents say paramedic accreditation is needed to create uniform minimum training requirements from state to state. They argue EMS training programs will adjust to the new standards and doubt the number of people training as emergency responders will drop significantly. Furthermore, proponents of the changes point out that all other allied health professionals, such as doctors and nurses, have to go through accredited training programs to get certified. "All we're trying to do is produce credible paramedics across the nation," said Bill Brown, executive director of the National Registry of Emergency Medical Technicians, which proposed the changes based on recommendations in several federal reports. "We're saying, 'You've got to do this for the betterment of the people in your state.' "Am I going to say that we're going to save millions of lives because we're going to go through this more rigorous training? No. But this is a part of getting there. It creates a culture of excellence." Most states already use the organization's test to certify paramedics and emergency medical technicians. Firehouse-based programs in Michigan are inspected and monitored by state EMS officials, but many would not meet national accreditation standards, fire officials say. For example, many of the unaccredited programs do not have extensive libraries or offer career counseling — which are required for accreditation. Adding those features and going through the accreditation process could cost up to $30,000, fire officials say. The process includes periodic program inspections by out-of-state emergency response professionals. "We would need a library, counseling, on-site inspections," said Ron Spears, director of a popular EMS training program based at the Waterford Fire Department. "Our school would cease to operate. We have a very successful pass rate on the certification exam. Many fire departments send their people to us. It would just be a shame." http://www.ems1.com/ems-products/education...ication-changes

This has been around for awhile with EMS/FFs being the initial guinea pigs for the first scanners.

There are other factors also that contribute to the statistics. Patients are living longer and hospitals are able to save patients or prolong their lives longer dispite to over all prognosis. The subacutes are full of vegetative patients on ventilators. Last weak I had 3 med-surg codes in 2 shifts with pts older than 95. 2 of them made it to the ICU. Was it the hospital's fault they coded or was their age a contributing factor? When should we say enough is enough and let some commonsense come into the medical profession? The expense of keeping a patient along is astronomical and I am always amazed at what we can do as we seem to get more, new and improved technology every week. Just the cost for training staff on all the technology is incredible. Then, to continue proficiency in updating educating and skills along with all of the regular education/training updates requires a lot of didication from staff as well as expense. Here an article on today's business wire: http://www.insidebayarea.com/business/ci_10256926 Heart device pumping new life in patients, firm's bottomline By David Morrill Contra Costa Times Article Last Updated: 08/20/2008 06:38:04 PM PDT PLEASANTON — The heart of Chula Vista resident Debra Kinney was down to its last beats. Medication that served as her savior battlling back her congestive heart failure for 25 years suddenly didn't work anymore. In 2006, her doctors said she had probably a month to live. "My life turned from being very active to basically coming to a grinding halt," she said. Her doctor said there was nothing more that could be done and sent her to San Diego for more help. That's where she was told of one last option. An experimental device called the HeartMate II manufactured by Pleasanton-based Thoratec. Four days later she had it implanted, and it saved her life. "They put it in, and within a month I was up and running around doing stuff I had done in the past," she said. "It was a miracle." The HeartMate II is a left ventricular assist device implanted into the body that delivers a continuous flow of blood through the body using a propeller-like mechanism. Because it's a steady flow, a pulse on a patient is hard to find. Not only is the device giving patients a new lease on life, but it's been a financial boost for Thoratec's bottom line as well. Earlier this month, Thoratec reported its second quarter earnings had risen almost sevenfold largely because of the success in sales of this pump, which received government approval in April to be used to treat patients as a bridge to a heart transplant. Its revenue rose 44 percent, to $82.6 million from $57.3 million. The cost of the device is about $80,000. The devices are also benefiting from more acceptance by Medicare and other insurance companies. Shares of Thoratec closed at $24.44 Wednesday,. Its 52-week range is from $12.92 to $25.87. Jayson Bedford, an analyst with Raymond Rames & Associates, called the HeartMate II "one of the more exciting new product launches in our medical device universe." The larger market in the future for the HeartMate II is in "destination therapy," or patients with end-stage heart failure who are too ill for a transplant, said Ryan Bachman, analyst with RBC Capital Markets. An official approval from the Food and Drug Administration for the HeartMate II and destination therapy could come by mid-2010. The HeartMate II is Thoratec's follow up to its previous assist device the HeartMate XVE which is currently approved for destination therapy. more at: http://www.insidebayarea.com/business/ci_10256926

This problem is a little more complex with many variables. Insurance and availability of medical care also plays a large part. People are ending up in the hospital sicker because they don't go to doctors for routine checkups. There is a waiting list for uninsured women for a routine mammogram for some places in this country of almost 18 months if there is even a program for them. Most do not know their colesterol level. Factor in all the patients that have abused their bodies with drugs and alcohol. Even the 30 minute guarantee ran into some problems and many hospitals no longer emphasize that. It was a quick fix resulting from some media stories but was not always thought through thoroughly before implementing it. We can fix a lot of problems but each fix may require more invasive procedures or medications that lead to other problems. Look at the treatment course of a cancer patient of almost any type. PNA is another example of what can be done but the invasive procedures and antibiotics use set the patient up for more potential problems. The reason why nurses do call the doctors in the ICUs for more orders even if there are protocols in place is there may be signs of another body system or organ failing and that bears some responsibility of determining if another course of treatment may have to be taken or if it is necessary to continue even with the possibility of permanent damage to another organ or at least temporarily enough to where more treatment will be needed to counteract those problems stemming from that damage. There are also budget issues as staff and services are cut. If CNAs, EKG techs and Phlebotomists are cut, the RN may be doing primary with complete care on no less than 10 patients for 12 hours on a med-surg floors. Many more than that if you count admissions and discharges. In some places ICU RNs take 3 - 4 patients while others may have 2 but of a very high acuity. In either place, that is less eyes watching the patients to intervene when something does happen or to prevent it from happening. This problem is not new and hospitals have been aware of it for many years. There are just some many human variables that can not always be controlled. One could look at the deaths that resulted in the field from poor RSI techniques and the poor oversight of Paramedics to intubate. However, if one also looks across the country at the varying levels of EMS coverage, there is less emphasis placed in that area. San Francisco and other cities' media are taking the response time thing to the max for being just a minute off their target times. What they have not emphasized is what type of services and quality from medical oversight that is done once the ALS ambulance gets to the patient. Trying to fix one problem quickly may also have required them to take shortcuts to free up ambulances quicker. That could impact patient care either directly or indirectly.

If you want more interesting reading about a hospital's awareness now for every procedure done. : The Check List http://www.newyorker.com/reporting/2007/12...fa_fact_gawande

This is already having a huge effect on different procedures and transport which directly or indirectly affect EMS. Medicare will no longer pay for hospital acquired infections. In the past hospitals had let the field IV slide through and laxed their policy on restarting in the ED. That is again being examined. If there is a central line done by anyone, flight or ground, there will be documentation and follow up. There are also studies being done at some hospitals acrosss the country on VAP and what percentage of the ETTs were started in the field. We also use a different ETT in the hospital and if a patient is going to be on a vent more than 24 hours, we may switch tubes in the ED. For the past few years hospitals have also started to participate in the 100,000 Lives Campaign and establish emergency or Rapid Response teams (RN/RRT) to respond to a patient inside the hospital before they do code. This gets the pt a higher level of care while the transfer is being made. Hospitals are also establishing their own CCT teams with their own equipment to have a better handle on training and infection control. Infection control is still something EMS skims and does not fullly address when it comes to protecting the patient as well as the provider. Some CCT/EMS crews still do not even filter their transport ventilators properly or even do adequate cleaning between transfers. The CCT team formed by hospitals will also help in that some EMS teams still take MIs to little general hospitals and not the Cardiac hospital a few blocks down the street.

The diploma will be very limiting in the long run for promotions or advancements into areas such as Critical Care and Specialty transport. Almost all of our RNs in these positions have at least a BSN. There are very few with only an Associates that have been allowed to stay in the CC specialty areas because they are near retirement. If your state decides to change to Associates as the requirement, while you may be grand-fathered in, you will be the lowest link in the hierarchy of that profession. Many diploma programs are now linked to community colleges. If that is the case in this situation, take advantage of it and get the Associates while getting the quality clinical experience a hospital diploma program can offer.

Nursing is not the "easy" option. As a nurse in a busy ER, 28 patients in 12 hours will be a slow day. Often that nurse will have 4 - 6 patients at any given time and they will be the same patients that are seen on the streets and at their very worst as the shift progresses. You really don't want to know what a med-surg nurse's shift can be like with 8 - 12 of these patients that are detoxing and sick. There are some key points to avoiding burnout. 1. Find a career and not a job. 2. You should choose your job based on your passion for that type of work and not just money or perceived easiness of the job. Even the simplest of jobs can seem difficult if you hate what you do. There also shouldn't be too many surprises when applying for some jobs when it comes to hours and pay. The question is, do you have want the job bad enough to accept it as is? 3. Keep the job fresh and your brain stimulated by learning something new even if it isn't required for your job. 4. Accept the fact that you did all you could for the patient even if they died. That happens and many times there is little that can be done to change the inevitable. 5. Accept even the most annoying patient for what they are, provide care and move on. 4. Leave the job at work. However, that is nothing wrong with sharing your enthusiasm for your profession within reason. Just don't let it consume your life. 7. Enjoy your family and friends. 8. Vacations are great but are short term. Adapting attitude changes during the other 50 weeks of work will leave the mind and body in a position to enjoy that vacation.

Nursing takes at least two years and if you really have no interest in the medical profession it will be a waste. You'll will probably be washed from the program during your first clinical. While yes, RNs make great money in the Bay area, they also may have to put up with for 12 hours every shift 4 - 6 of those "undesirable" patients that EMTs and Paramedics complain about but can unload in 15 minutes in the Bay area. If you got on at SFFD as a FF and not EMS you might be okay. However they are scrutinizing all their OT after some of their FFs made $100,000K in just OT to which this make national news since SF is in financial trouble. The nation already saw what happened in Vallejo, CA. Of course, the one FF that worked 19 24-hour shifts led the public to believe there isn't much to a FF job if they don't tire out or questioning if the public's safety is an issue because of tired workers. Oakland had the 10,000 applicants for their 20 FD positions because they dropped their EMT requirement. I understand Oakland's Mayor Dellums will be dropping the "felon" box from city applications also. Stick with the departments that are separate and just go for the FD. However, you must also consider the nature of the FF job and it is truly not for everyone. For your safety and that of anyone who works with you who will depend on your abilities, your heart and head must be into the job. The job has too many hazards and concerns for the lives of others as well as yourself to do half arsed.

It is a great idea but you also have to approach the public with a little tact and respect. Instead of focusing on what you are called and sounding like you have an ego inflation problem, stick to impressing them with your knowledge about safety and when to call. There will be other professionals in the audience that you have probably mislabeled their proper titles also. Don't come off like you are being critical of the public by scaring them into not calling or sound like you are scolding them. Once you offend, hearing problems develop. Also, you do not want to discourage people from calling or make them hesitate especially for the signs of a heart attack. Elderly law biding citizens might take you for your word and not want to bother those nice young paramedics. When you state education requirements, make sure the public won't see a TV ad for a medic mill to "be all that in just 3 easy months". I believe Iowa still requires less than 1000 "hours of training" as entry level Paramedic and not a two year degree. Keep the issues simple. Show more concern for the public than your own egos. The respect will follow if public sees genuine caring and professionalism. Hire a PR specialist if you want to choose your words more carefully and have professional advice to maintain a public image.

Intubation and defibrillation from an ACLS class? The one point that has always been stressed in ACLS is that it does not "certify" someone to do these skills nor does it provide enough information in the time allowed to adequately teach intubation or defibrillation. Again, skills without the appropriate education is not the way to advance this profession. Usually, with our titles and job descriptions there are expected certs for extra knowledge that must be maintained. A nurse or RRT who puts one of the specialty credentials behind their name has the expected experience and must now maintain a certain set of experience and continuing education (100 hours for some) as well as recredentialing to stay current. There is a difference between an ACLS class and one of the CCRN certifications.

Those days are over and credentialing is now a must. Again, one must notice the NATIONAL accreditation and credentialing process. If they have done the time in school and have the experience, they can test. An EMT cert by itself does not qualify you for this position. This is yet another very new and growing profession that now has national standards for credentialing as well as a national organization to take on the benefits of reimbursement through professional recognition. http://www.brpt.org/ BRPT Testing Dates: June 16-28, 2008 Application deadline May 16* September 15-27, 2008 Application deadline August 15* December 1-13, 2008 Application deadline November 3* *BRPT must receive your application by the specified deadline no later than 5pm EST Eligibility Requirements To take the RPSGT exam, applicants must satisfy one of the following eligibility criteria: *Complete a minimum of 18 months of paid clinical experience where duties performed are primarily polysomnography. OR *Complete a minimum of 6 months of paid clinical experience where duties performed are primarily polysomnography AND the applicant holds a credential in one of the following allied health fields accepted by the BRPT: Nursing - (RN, LPN), Respiratory care - (RRT, CRT), Electroneurodiagnostics - (R.EEG.T.), MD, D.O., or National EMT-P. Applicants MUST submit a copy of a certificate or official correspondence from the credentialing agency with the application if mailed, or in the case of online appliations, a copy must be mailed to complete eligibility. NOTE: On the job experience must be within a 3-year period prior to the exam. AS of July 2008: Any candidate qualifying for the examination process through one of the above experiential pathways must meet eligibility requirements by submitting proof of completion of the American Academy of Sleep Medicine's modules, or an equivalent educational program, with their application to sit for the registry exam. This change does not apply to candidates who have completed a comprehensive tra ining program accredited by the Commission on Accreditation of Allied Health Educational Programs (CAAHEP) under the CoA-PSG, or an add-on sleep technology program under the CoA-END or the CoA-RC. For more information, please go to www.brpt.org

If your company is running that many transports with the HT50 then you should be aware of the problems with them. There were notices sent out concerning the problems over the past 2 -3 years. One of our sub-acutes now has $250,000 of scrap metal waiting for a settlement with Newport. This is nothing new, the company was warned they needed to fix a couple of problems but failed to do so on the first notifications. The Newport is not designed to do BiPAP or CPAP effectively. A PSV mode does not always equate to "BiPAP". That would depend on the leak compensation, demand valve, peak flow capability, sensitivity and head gear/mask you are using. PSV can be used on a 2 limb ICU ventilator but the flow capability is up to 240 l/m. On a transport ventilator, your flow is going to depend on the Venturi/Bernoulli effect for entrainment. The Eagle is decent but don't get suckered by the sales pitch for the Plateau Pressure. It is NOT a measurement of static compliance on that machine so the "ARDSnet" speech some sales people give you is crap. Viasys's (Pulmonetics) LTV series is my choice (and Christopher Reeve's) especially if you are attempting a BiPAP (trade name for Respironics only) or CPAP mode. It is leak compensated and can achieve the flows necessary. The 1200 also has internal PEEP which makes a big difference for ICU pts. However, these machines also had a couple of recalls that put our 900 and 1000 out of service for a new circuit board and there is a shortage of rentals to wait out the fix. http://www.pulmoneticsystems.com/?1134213839 The Parapac is a work horse but has few options. http://www.smiths-medical.com/catalog/mech...-mri-p200d.html When looking at ventilators, remember they are expensive technology which is sold just like cars and you'll get the same line from the representatives that you do on a car lot. If you don't believe me, look at some of the "stuff" EMS has be sold by a salesperson calling it "CPAP". You also have to understand how a ventilator works just like a car enthusiast also. Consult your local RT department.

But, until EMS gets something standardized, adding more skills without adding increased understanding of how and why things work like they do in relation to the body, there will be continued criticism. The advertisements for this profession still read, "You too can do all this in just a few short months". Like adding intubation to the EMT-B level, Paramedics are also adding more "skills" without the additional education. Look at the agencies, example is L.A., that are relying on the EKG interpretation of the machine and not bothering to teach 12-lead interpretation. More recipes without a foundation is not the answer. I personally cringe at the thought of some 3 month Paramedics doing RSI with little understanding of the paralytics, sedation or ETCO2 and let's not forget basic intubation skills. Couple that with the fact that many FFs are "trained" to be Paramedics whether they have ever wanted to be a Paramedic or not. How much effort do you think will be put into their continuing education for medicine? In some cities, it is the FDs that provide the CC ambulance service for interfacility transport. The FD/EMT-Ps can also put CCEMT-P on their tags after a quick inservice. Not all states have the CICP.

If you look at what each state calls a Paramedic in their statute, that is your official title. If you want to use a "cert" title, great, just remember what state you are in. In states that use their own exam, you may be asked to show proof of your licensure in that state if you only hold yourself out to be NREMT-P by signature or name tag. Dr. Bledloe is responding to comments on his article and the CCEMT-P cert at the website where the article was posted. http://www.ems1.com/columnists/bryan-bleds...e-Vanity-of-EMS There is a big difference in that the UMBC does not hold itself out to be a "certifying" agency and only certifies (certifcate of completion) that you have completed an introductory course. It offers no more than that. Rid mentioned the FP-C earlier which is a nationally recognized certification offered by the Board for Critical Care Transport Paramedic Certification (BCCTPC) and has certain mandates along with CEU requirements. http://www.certifiedflightparamedic.org/ This certification is a test of one's knowledge and is much more difficult than the UMBC CCEMTP test. I do not see the same wording in UMBC's course. Now for the CCRN certifications, the AARN even details how and when the certification is to be placed after one's name. http://www.aacn.org/WD/Certifications/Cont...u=Certification And, this is also included: Being accredited by accepted national agencies who provide standards is very different than PDQ ambulance service or medic mill handing out titles after a few hours of an inservice.

So, if you write CCEMTP behind your name you are considered to be a higher level of care? The point I am trying to make and I believe Bledsoe was also, although CCEMTP is a trademark, it is being used by anyone and everyone working on these trucks and billing as Critical Care Paramedics with little or no proof of critical care training. It is just a bunch of letters. Many of these trucks still require an RN and/or RRT from the hospital (not an ambulance employee) to accompany them because they are not qualified to take care of the patients on many of the ICU drip or technology. Some of the hospitals have set up their own CCT teams to get out of that very grey area of legalities. For the RN, nothing can be added to the original license designated letters. You can stick any and all certs behind it but not attached to those letters. There have been many controversies in Florida over the use of NREMT-P since that is not the official exam for the state at the Paramedic level. However, some counties were requiring their Paramedics to take the test. The EMT-P is still the official license letters for Florida. The NREMT-P is an extra cert. Your state statutes should be your guide. If you use the letters CCEMTP behind your name just for billing but have no proof to back it up, where does that leave you? Is this not a deception to the insurance companies? Respiratory Therapy has some technical difference in their letters also. CRT and RRT are credentials from the national certification board. Some states, like California, use the term RCP as a catch all in their licensure. Thus, in the signature, it is RCP first for the license and RRT for the cert to follow.

RNs again for fighting for raising the standards in health care even if it meant saccrificing their own (LVNs). They're not against the EMT or Paramedic personally, they just prefer not to have "techs" doing advanced pt care procedures. If you (as a whole group) all had a two year degree, they probably would not have said a word. But, with the attitude and a medic mill cert, I can see their point of view. I work with RNs on Flight, on Specialty transport teams and in the units. When you respect each others profession and learn how they compliment each other, it makes for better care for the patient. Everyday I am in awe of some of the professionals that make up the heathcare teams. I always tell EMTs not to waste those precious BLS transports by copping an attitude. They should go into the hospital with their eyes wide open for all of the neatest medical innovations and care they might see. Networking with others is a great way to get respect by showing an interest in what they do and letting them know who and what you are. I worship some of our Physical Therapists, Occupational Therapists and Speech Therapists. The rehab center puts the best gyms to shame. Their work at getting some of our near dead patients back to fully functioning people again is amazing. The research our Exercise Science and Cardiopulmonary Center is doing is astounding. Saving the patient's life is just one chapter. The end outcome is what matters and there are so many other professionals (nurses and RTs included) that work to make your effort in the field a true SAVE.

Being kept down? No, that we did all by ourselves. If anything the RNs have supported EMS by helping to establish many Paramedic programs and foster continuing education. For their thanks, EMS providers have continuously bashed and insulted RNs for years. The RNs didn't tell us not to go to college or get our education in the backroom of a FD or ambulance station. However, just like they fight to maintain the highest level of care possible inside the hospital, they expect others to step up to the plate. This included gnawing away at some of their own including LVNs. Every healthcare profession within the walls of the hospital has had to challenge nursing in some way. Guess what? That was done through education. Now almost every licensed professional inside the hospital has at least a two year degree. Even the phlebotomists are getting nationally certified for recognition in some states. We didn't join them in their profession but joined forces with them as educated and respected professionals. For those of us OJT tank jockeys in RT, that was quite a feat. Why should be poor paramedic be treated any differently? Every other profession knows there is a different between votech education and college degreed. To be an accountant one must have at least a Bachelors degree. And with that, this person may only get the entry level status of book keeper or file clerk at minimum wage until more eduation is obtained. The skill set the Paramedic possesses is not unique (except for the places you work) as many other professionals can do the same things plus more both inside and outside of the hospital environment. The difference is the other professionals have an educational background from which to build upon. The education first, then the skills. My next comment is not meant to be insulting but some of the "skills" , including ETI, a Paramedic has is now EMT-B level. I cringe but again EMS has done its patch work of handing our certs instead of fixing the problems with any definitive solutions. RNs and MDs love to teach but as I said in one of my posts, I, too, will not formally teach Paramedic students in a classroom unless college level A&P (both semesters) is a prerequisite. It is great to show interesting stuff here and there but there needs to be a structured foundation so what is being shown will have some true meaning. Too often people try to pigeon hole some disease process into some they thought they saw before and it could've been that. Treating from the 12-lead along with other symptoms, which is what you are really treating, has been around for awhile. However, not that many services utilize the 12 lead and some are trusting the machine interpretion. ETCO2, another great device, is not well understood even on CCTs. There's so much work to be done within the EMS educational system. It is time to get qualified instructors and not just someone who can tell good field stories. Then, if the instructors had higher education, they could mentor others for higher education. No instructor who "got to where he/she is today and with no education" is providing the mentorship or foundation to make the EMS leaders of tomorrow. RN and RT educators have at least a Masters degree with some teaching methods within that degree. The statistics in this country for EMS providers that have little or no college education are overwhelming. The backroom medic mills at the FDs and ambulance companies have churned out some impressed numbers over the past couple of decades. Couple that with the private for profit medic mills and you have some very poor numbers to build a solid foundation from. Start with raising the standards on the educators. Get all the programs accredited (in the works) to weed out the weak.

Your employer and the differing scope of practice can restrict you. I do not use RRT when working EMS because my scope for RRT is much broader than a Paramedic's, yet, I am bound by the scope and protocols from state and my medical director while working as a Paramedic. Inside the hospital, the Paramedic credential is not recognized since the statutes were written a "Prehospital". Also, if someone saw me doing something as an RRT, they might only recognize EMT-P and question my ability to do that "skill" or medication as an EMT-P. Since RRT is the higher education level, if I am trying to impress with all my credentials, RRT would go before EMT-P as would RN for those that have that credential. Actually, in NY and FL, Licensed Massage Therapist (LMT) would probably be listed before EMT-P by the higher education. Flight nurses that do HEMS in Florida must have a prehospital credential. However, they can get the EMT-B in about 2 weeks and challenge the EMT-P test. So for them, it is just another cert. Until the Paramedics, as RT had to, advances their education to close that loop hole, this will continue in many parts of the country. Once that happens, the RNs will probably consider the PHRN certification. However, at the rate of EMS advancing in education, the RNs can take their time for enacting another certification. The prehospital credential is not required for Flight or ground interfacility transport. Several RRTs, like myself, were EMT-Ps first and then went back for a degree (or 2nd degree) in RT or Cardiopulmonary. Some work in both professions to have the best of both worlds.

No, Paramedics, as a whole, do not have the education level to be on RN boards. You should become more familiar with how your state EMS office operates. Until more people become involved and know the basics of how their own state system functions, very few advancements will ever happen to this profession. RNs are again re-emerging into prehospital and out of hospital transport. They have been part of Flight HEMS, CCT and Specialty transports for several decades. RNs have had to ride along with the Paramedics for interfacility transports for many years because the Paramedic on the truck could not even monitor certain drips or equipment. RNs are involved EMS volunteer agencies with various state statutes that allow them. RNs in some states even have their own certification for PreHospital. EMS needs to focus on creating its own identity and stop with "just like them" stuff. Nursing has its act together and if EMS doesn't get its act together soon, nurses may have to come to our rescue. I see you have the flag of Ireland. I can not speak for that country if that is where you are from. I am only talking about the EMS system in the U.S.

They were. Know your history. They also have been involved in the education and training of the Paramedic. Many Paramedic programs and EMS state offices still have RNs in management or educational postions.

For more info about the CCRN: http://www.aacn.org/WD/Certifications/Cont...n.pcms?mid=2869 And as Rid stated: