HERBIE1

Not trying to be evasive, but it would depend on multiple factors- financial, political, logistical, etc. What is the area I serve look like? Rural or urban, or a combination of both? Large city, small city? Volume of calls? Transport times? Funding issues? Capabilities of local hospitals- teaching, research, university, private, etc? Specialty centers- stroke, STEMI, trauma, burn, bariatric centers, OB? How many outpatient facilities are there- ie free standing MRI facilities, dialysis centers, rehab facilities? How many comprehensive ER's will EMS be transporting to? What is the future of the area- is a dedicated revenue stream likely? Would your area be involved in FEMA type disaster preparation, mutual aid, etc? What type of providers do you have- 3rd service, fire based, hospital based? As medical director, you can develop protocols any way you see fit, but the skills you want your providers to have need to match the needs and capabilities of your area. Certainly you would be aiming high- and hoping to build a service for the future but you need to be realistic about what you can accomplish. We could assume that the associate degree program is the "better" program, but that is not always the case. Each program is mandated by the DOT to meet minimum standards. So what are the major differences between a 900 hour and an associate degree program? In this area, the major difference is the general education classes you must take to receive your 2 year degree- there are no additional classes related to EMS. If you are talking about a 2 "certificate", the gen ed requirements aren't as stringent, so you may get a few extra EMS related classes. Intuitively you would assume someone who takes more education is more committed to the profession, but that is a pretty big assumption and there are far too many variables to give you a simple answer. Let's put it this way-in a perfect world, if I am medical director and I have the money and resources, I would require a skills assessment of anyone before they worked in my system. Not only would they need to pass a system entry exam to test their knowledge of local protocols, I would want them to be able to demonstrate their skill set via preceptors(MD's, RN's, and EMT's,) in simulations, as well as clinical situations.

Pardon my ignorance here, but I have heard of a unibrow, but never uniboob. Similar?

It seems we have a common bond. About 15 years ago I was getting restless and needed a change. Before I got into this business, my only jobs were food service- worked from bus boy to line cook. Worked as a cook on summer breaks in college, and then got into this insane business. After working in EMS for awhile I wanted to find a diversion and go back to school. I took lots of classes that suited my interests- computers, accounting, writing, etc. I figured since I always enjoyed cooking I'd go to culinary school on the side. Spent a year in school, and in the meantime I met and married my wife. I knew the food service is a tough business, long hours, tons of dues to pay before you see the rewards, ie not the best field for a new husband and dad so I dropped out. Great experience, learned a lot, and the family appreciates the cooking skills. LOL Again- welcome, and good luck with your plans.

Interesting, and seems like a no-brainer, especially after a 15 meter fall, but around here, the converse is the problem. In this area, getting people to call 911- the emergency number here- is NOT an issue. Stubbed toes, paper cuts, tight shoes- nobody around here is shy about activating EMS for ANYTHING.

That was my point- I KNOW PA's and NP's need physician oversight, although they are still more autonomous and can provide more "independent" care than 99% of other allied helath professionals. I was responding to the issue of education and expanding the role of an EMS provider. We can have a PHD in EMS but unless someone ELSE(MD) is comfortable with AND is willing to allow us- to go beyond our current scope of practice, our future is limited. That's why I think that at least in the short term, we need to try to effect change within the boundaries we currently have. Being a cynic and a realist, I look at what organizations are in the forefront of legislation and initiatives. EMS issues are being dictated primarily by a group who's primary function is NOT EMS because they have the political clout, the numbers, the organization, and the money. The IAFF is the primary adversary here but for those who have been around for awhile, they are well aware of groups like the ENA and other nursing organizations that have a vested interest in this. Any time you propose something that is traditionally the domain of someone else- like home health- you are stepping on another group's toes and taking money and jobs from their members. They have and will continue to push back. We do not have the political capital to push back, and honestly, I wonder if we ever will. Think of all the resistance EMS saw just 20 years ago- often times we had open hostilities with ER RN's. Yes, this has changed, but as anyone who deals with old school RN's knows, there are still some hard feelings. They do NOT like the intrusion into their domain. Food for thought- Once EMS starts branching out into areas like public health initiatives- vaccinations, public inoculations, home health, hospice and palliative care, etc- can we still be called EMERGENCY medical services? Won't we morph into something very different? From a fiscal standpoint, would a local government love to see EMS providers participate in these things traditionally reserved for nurses? Of course, especially when at this point, an EMS provider is not paid the same as an RN.

Like II said, vent was building strawmen. You can't argue with a strawman. As for solutions, a minority group cannot by definition directly implement change. We can be the most professional and educated providers possible, but certain things will not change. Among them... First and foremost, the biggest obstacle to overcome is the organizational culture of the fire service, which is becoming more and more dominant in EMS. This is the underlying reason why it is so difficult for EMS to establish their own separate identity- independent of the fire service. EMS gets is not a self determining entity- we receive our marching orders from a medical director, and we can be quite educated and still require medical control. We will never be allowed to operate independently, unless our standards are elevated to the point of a physician. Even nurse practitioners, who are far more educated than EMS providers, do not operate without some physician oversight. IAFF is the premier and most powerful public safety organization, and receive the most publicity, the most funding, and have the most political clout to effect change and implement policies with their PAC's and lobbyists. EMS cannot compete with that and I see nothing that suggests that will change any time soon. Like it or not, fire departments are still absorbing EMS into their fold- with various degrees of success and quality of care. Fire departments have an established and necessary infrastructure- manpower, locations, apparatus, a dedicated revenue stream via taxes, but thanks to EMS also generate revenue via billing. That increases their political power and makes them even more valuable to a municipality. From a management standpoint, fire based EMS is more cost effective than EMS. You have one person able to do 2 jobs(note I am not discussing quality of that care here), which is attractive to a city's bottom line, and these days, that is job one. ALthough many areas have seen FD takeovers, there are still many independent EMS agencies, which makes it difficult to have a united front. Yes, the altruistic answer is that everything is about doing what's in the patient's best interest. Reality is quite different than that. Does that mean we change how we do our jobs- nope. It does mean we need to try new tactics. In too many instances these days, an EMS provider who becomes cross trained tends to emphasize their fire duties over EMS- despite the fact that EMS is the bulk of their work. Too many people also use EMS as a vehicle to get to the fire service- for better pay, better benefits, less call volume, or simply to fulfill their "true desire": to be a FF. As much as I hate to say it, I feel the only way to effect change is to work within the framework of the fire service system. The problem is, how many members of that system are willing to push the EMS agenda? I think the culture is slowly changing, and gradually fire leaders are realizing their profession is changing, and that they need to adapt to that new paradigm- one that is dominated by medical care. That will benefit the patient, but I am afraid that in many cases, single role EMS providers will become a casualty of the process, and will be reduced to more of a transport-only entity after initial treatment by a fire EMS provider. If the fire service truly embraces EMS-not just lip service at the national level- then quality of care will improve, but EMS will be fundamentally changed. I'm not happy about the direction of this, but I'm merely facing reality. This is about dollars and sense, and yes, patient care, but the almighty dollar is what drives this whole process- for a community, for the fire department, for EMS, and ultimately the town that employs them.

Why do you insist on creating and then attacking strawmen? First with the education statements you attribute to me, and now with nurses and their history. For the nth time, I have no issue with education. You insist it is the key to getting changes in EMS, and I take exception to that for the reasons I listed. I'm done- you don't want to discuss or debate, you want to lecture and build strawmen. Knock yourself out.

The primary reasons education for healthcare providers in other professions was raised were for patient care and safety. The higher wages just happened to follow. EMS seems not to be looking at what it can do for the patient but what the patient should do for EMS. This selfishness is the true downfall and failure of many EMS systems whether they are FD based or whatever. Pretty strong statement here, not to mention extremely condescending and arrogant. It also shows a lack of understanding of the issues involved here. We get it. You think all the problems of EMS will magically disappear if everyone received more education. Your opinion, and you're entitled to it, but based on conversations I'd had over the years with old time RN's, their opinions and experiences differ quite dramatically from your claims. They had the same concerns and problems that we talk about here- respect from doctors, acceptance of them as professionals, chronic shortages, understaffing, burnout, hours, high turnover rate, benefits, and pay. They still have many of these same issues. Nurses were finally able to move to earn BSN's and MSN- not for patient care and safety, but to move up the career ladder to supervisor, educator, and management positions for better working conditions, pay, and respect.

You are not addressing the issue here. A basic RN is essentially the same as an "entry level" paramedic. They can function just fine within their realm, but need extra training and certification if they choose a venue that requires that additional training. Why no outrage for the plain ole RN who chooses NOT to obtain advanced education beyond their RN license? Should a medic be certified to deal with decompression sickness when they work in the middle of North Dakota or some other landlocked area with little chance of seeing diving injuries?

This supports what I was saying. Your policies are dictated by your medical directors or whatever you call them in your area. You are able to provide care and use skills based on whatever they allow you to practice, REGARDLESS of how many initials are behind your name or how many certifications you hold. As for talking to a doctor- we call AFTER care has been provided and only get advice in unusual situations- rare. It's a courtesy call to the receiving hospital- which is often not the one at the other end of the radio- to allow them to prepare for a critical patient, to simply free up a bed (vast majority of the time), or to gauge what resources they may need for your patient when you arrive.

Vouchers-interesting idea. My question is, how do they track down the caller if it's a 3rd person? Ie- driving by an accident scene, calling for a friend or family member but not actually being there, etc. Most of our callers are NOT there when we arrive unless it's a house call. Few people want to admit they called. If they track this via cell phone, an easy solution to avoid the charge would be to block your name and number from being displayed- something that any cell phone user can do.

Interesting discussion. First, according to our protocols, we cannot "deny" transport to anyone- regardless of their complaint. We can suggest they would be better served by seeing their own doctor, for example, but if they insist on going, they get a ride. We bill everyone, but obviously nobody is denied service if they cannot or refuse to pay. As for charging for refusals, the most common incident for us where we provide treatment would be a diabetic who receives dextrose. I'd just as soon transport and avoid the hassles of justifying the refusal as well as obtaining replacement supplies, but many times people simply do not want to go. Where would we draw the line here? What if it was a mistaken caller- the person was homeless, sleeping and needed a nudge to wake up and be on their way? WHo would receive the bill- the person who called(who has long since left the scene and all we may have is a cell phone number) or the person who never asked for the service to begin with? I realize that everyone is concerned with recovering costs, but this seems like a tough thing to enforce.

Yep. the dad was a stuttering fool when asked to explain his son's remark. Eventually he claimed it was in regards to showing the news crew where he was hiding. I call BS again. This story has taken on epic proportions. I heard a clip from You Tube where the dad was highly animated, describing how he thought Hillary Clinton was some type of lizard. I'm not making this up. Then I hear that for months the family was shopping around to the studios with an idea for a reality series centered on their wacky exploits- storm chasing, searching for evidence that man descended from an alien race, etc... Apparently they videotaped the launch of their balloon for that reason, although I'm not sure that tape was from this incident.

I'm not sure what you mean by "911 medic" here. Nurses have tons of specializations and extended credentials- critical care, mobile intensive care nurse, Trauma Nurse specialist, surgical nurse, critical care nurse, etc- all beyond the scope of their initial nursing training. Nobody would think it was odd that an RN or even a BSN could not function in any nursing capacity or think the RN curriculum was somehow deficient because they could not. Same for a doc- they receive even more training, yet nobody would think a cardiologist should be able to function as a neurosurgeon. Why not the same for paramedics? Despite what a certain poster thinks, I am PRO education, but I do not think that increased education is the answer to most of the problems of EMS as a whole. I am very grateful for the years I spent working in a busy urban Level 1 trauma center. It allowed me to see the "other side" as you say, and it certainly has helped my understanding of how EMS fits into the whole process of providing heath care. Is it good to know why a certain medication is contraindicated in the RSI of a burn patient- sure, but what if you are not allowed to use that skill? I am better able to explain to patients what is likely to occur once they arrive at the hospital- possible tests and procedures that may be needed, based on their complaints. Is this mandatory for me to do my job? Nope, but I do think it makes me a better provider. On the other hand, if I am a flight medic, then I darn well better understand the physiologic differences of providing care in pressurized and unpressurized environments and would need additional training for that. When I was a flight medic(eons ago), I received no additional training other than what I learned on my own. I admit that I did not feel adequately prepared for what I was doing. Granted, they were not critical care transports, but I did have a few hairy situations. As for the comment about something not being applicable to 911 medics, I have heard the same thing. It depends on the context of the remark- was this a mandatory class, or something they took for their own benefit? When I hear a similar comment- usually while taking a mandatory class, I shrug and say that it is something that is good to know. Problem is, just like those who only want to be a "plain ole firefighter", or "only" a med/surg nurse, some EMS people are perfectly content not challenging themselves or doing anything more than the bare minimum for their job. Sad, but true.

Clearly you have a personal bias here and seem to love taking things out of context. You also cannot directly compare prehospital care with allied health care in a hospital setting for the reasons I outlined previously- apples and Buicks. Once again, save the sanctimonious, holier than thou attitude. Make a comment, engage in a debate, but don't pretend your opinions carry any more weight in this area than those of a brand new EMT. The initial topic was about new standards and levels of certification, which means anyone is qualified to state their opinions- regardless of where they work. On several occasions you are stating that I am bashing education or reluctant to endorse it. I am not, and I dare you to cite where I said otherwise. I said that simply mandating a certain level of education will not solve the problems faced by EMS, and in some instances it may actually make things worse. I have news for you- someone who holds an MBA and starts out working at Starbucks makes the same as someone with a GED. Their career paths may soon diverge, but their pay is the same for doing the same job. Unless that education is mandated and increased compensation is specifically awarded for that education, it's only for someone's personal edification. If you are impressed with someone's alphabet soup, you should become an academic. Those folks are highly educated, but many have a hard time discussing anything outside their area of expertise. The attitudes about FF and education ARE changing, but in most cases, the basic requirements for the job have not. You do NOT need a 4 year degree to fight a fire, but to become an effective officer or chief, you do need to learn about far more than just combustion and the behavior of fire- there are far more concerns these days to be aware of. If a FF so desires, they can remain a FF their entire career, with no worries of licensure or Con Ed hours. Hospitals still employ LPN's, CNA's, and patient care techs. Why shouldn't they also be required to have increased education? Everyone plays a role in health care, and the role of EMS is certainly evolving, but to say something like a 4 year degree is a magic bullet to improving EMS is contrary to common sense. This is about organizational culture, traditions, and the power structure of public safety. Education allows us to better understand why things are, but doesn't automatically mean they will change.

Vent, I think you are naive about the IAFF, and also are applying standards from a hospital setting here. Inappropriate. You also misconstrue and misinterpret what I said. First, simply getting a degree will NOT change the problems in EMS. You need to understand the underlying reasons why EMS is struggling for respectability and recognition. The vast majority of IAFF members have nothing more than a high school education or a GED. They may have multiple classes in HazMat, technical rescue, but their baseline education is the same. Some places require various levels of college education to advance within their ranks, but in most areas, an entry level FF does not NEED a college education. Why? Because what they do does not REQUIRE advanced training or education. The vast majority of what they learn is technical instruction in a fire academy, and the rest is on the job training. So, why are they able to dictate and determine the future of EMS in many areas? It's about established culture. They, along with LEO's are the dominant force in public safety. Why? History, numbers, and tradition- NOT the level of their education. More education will certainly benefit the provider, but not necessarily EMS in general. A college degree or advanced education is not like a magic wand that will cure what ails EMS. It's far more complicated than that and education is only one piece of the puzzle. We are at a crossroads in EMS, and I think we need to be very careful how we proceed here. If you are suggesting(as is the current trend) that we transform EMS into something new- ie advanced care providers with multiple certifications and competencies- that's fine, but it's also a fundamental shift in prehospital care. Like I said, I think you are neglecting the impact this would have in smaller areas who would be unable to pay the salaries someone who has these competencies and education would demand.

Well, no aches and pains today(other than the usual back pain, LOL) so it's all good.

Not to beat a dead horse here but... Your young child is missing. You fear he may be in danger. So the first call you make is to the local TV station for help from their news chopper, not 911?? Busted. http://www.npr.org/templates/story/story.php?storyId=113856719 The saga began Thursday when the homemade helium balloon slipped away from its tether in the yard. The father had scolded Falcon for playing inside the balloon while he was working on it in the yard, and an older brother saw Falcon go inside a compartment in the balloon but had not seen him come out. Enlarge David Zalubowski/APSix-year-old Falcon Heene (front right) joins his parents Richard and Mayumi during a news conference outside the family's home in Fort Collins, Colo. on Thursday. David Zalubowski/APSix-year-old Falcon Heene (front right) joins his parents Richard and Mayumi during a news conference outside the family's home in Fort Collins, Colo. on Thursday. The family panicked and called KUSA-TV, asking for help from the station's news helicopter.

I agree about the SAR thing, but this kid was in his own house, not out wandering in unfamiliar territory. A kid lost in the woods usually WANTS to be found, unless we are talking about a runaway or discipline situation. I don't fault SAR, the sheriff, or anyone involved in this search- they did their jobs admirably as always. If the kid didn't want to be found, it's easy enough for him to hide from his "rescuers". Like someone said above, the parents are not likely to admit to a hoax, so we may never know for sure, but something stinks here, and my BS detector is usually pretty accurate.

There are multiple issues here- education, politics, promoting the profession, money, and providing care. I would also say that all allied health professions are not created equal, so comparing an RT vs a medic is probably disingenuous. EMS is unique in the sense that we operate independently from a traditional hospital setting. We make decisions- guided by established protocols, but essentially on our own. Xrays, ultrasound, MRI's physical therapists, nuclear med techs- all provide a service based on a specific order from a physician. Someone does not seek out radiation therapy on their own, but someone can request and receive EMS based only on their desire. Ultimately a person requests EMS as a means to get treatment from a doctor, but we act as the first line of treatment for that doctor. It's not simply about the level of training, although obviously the argument could be made that more education is vital since we do operate outside the norm of most medical care. First, I have been an urban medic for most of my career, although I did receive my initial EMT training in a rural setting, and even was trained in Wilderness techniques. That said, I am no longer in that rural setting, but based on what I saw, there is a real need for medical providers in these rural settings. Not only are they lacking in prehospital providers, but they also have very limited options for any medical care. If a volunteer crew is all they can get, then yes, it IS better than nothing. After all, isn't that what this is all about- caring for people who need it most? Once you mandate a certain level of care, along with a mandated level of education, tell me how a small, rural, financially strapped city or county can afford to have their area compliant with these standards? It costs big money to fund an advanced care system, and in many areas, people are hurting. There is a very limited pool of money and resources in these areas and an initiative to ask for more money to expand EMS means another area suffers. At least they have a basic level of service AND that extra money can be used to help a farmer, subsidize a local industry that is struggling, establish a food pantry, or provide social services to needy folks. In a larger area, there are many more options for increasing a revenue stream. I'm the first to advocate education- Even after grad school I have continued my education, and am even considering pursuing a Phd. That doesn't mean this education makes me a better provider. Minimum standards are the answer, not a bunch of letters piled up at the end of our names on a business card. The problem with our profession is that we do NOT determine or control our own destiny. The standards we use, the protocols we comply with- are ultimately determined by a doctor, who's license we work under. Mandated national standards are the key. I've been involved in high level planning and policy drafting- but not in the strictly EMS setting. The single most important thing to be successful at promoting an agenda is politics(also known as clout or power). Unless you have the backing/blessing of an established presence in your arena, even a good idea may die an untimely death. Yes, in our case the IAFF is probably the biggest deterrent to EMS getting the recognition/respect/pay we deserve, and education certainly is a plus, but don't fool yourself. Do you really think that all we need to do is throw up some folks with college educations against the IAFF, they will cower in fear, and agree to our agenda? This is about a long established organizational culture, and we are the young upstarts who are threatening their stranglehold on our progress. Most fire services are funded by tax revenues, and EMS is generally a fee for service so each. I don't know all the answers here, but I do know the trend is for fire service to absorb EMS- NOT the other way around. I do think we need to be realistic as to what we intend to accomplish, especially since our future is not entirely up to us.

LOL Thanks for the first round. I've been know to drink amazing amounts of booze back in my prime. I'm thinking it probably wouldn't take that much practice to get back into "drinking shape". Just like riding a bike...

Well, I'm thinking my initial cynical hunch was accurate. The kid's statement, the parents reaction to it- busted, IMHO. I heard an interview with a sheriff who said that house AND garage was thoroughly searched. He said they were not aware of storage space in the attack and that there was debris/stuff in the garage, and a pole, but no ladder or stairs that led them to believe there was any attic storage area in that garage. The sheriff suggested that maybe the kid climbed up on the debris and/or the pole and hoisted himself up(or was helped) to the rafters. The sheriff also said that while they were at the house, it seemed that the parents had absolutely no control or discipline over these kids- they seemed to be running around like maniacs and were oblivious to what was going on. Here's the thing folks- If anyone has or had a kid that age, they know a child's perception of time is warped. Tell a kid to stay in his room, take a time out, no TV- whatever, and a 10 minute punishment seems like 12 hours to them. This kid was hiding for several hours. I am not buying it. I feel bad for the kid- he was probably doing what his parents told him to do- it's not his fault. Then I hear the kid has the flu- which, in conjunction with the media attention, would explain why he threw up while doing the national TV thing. So, let's pretend this was an accident/mistake/misunderstanding (BS) but, WTF are the parents doing dragging that sick kid in front of the media- CNN, GMA, and countless other interviews? They could make a statement, tell their side of the story, issue a press release, etc as they should in a case like this, but to drag that kid out and do multiple interviews- they are media whores. You need a license to fish, to have a dog, but any idiot can be a parent. And so folks, we have the next nominees for parents of the year...

Dad says it wasn't a stunt. I wonder if he made that statement before or after he found out how much the search would cost? They diverted aircraft, scrambled jets and helos, and shut down Denver Airport for a time. Still not buying it. http://news.yahoo.co..._boy_in_balloon

Playing the role of cynic here( one of my favorite roles)... What if this was some stupid, ill conceived hoax or stunt? The family(parents) seem to crave attention. Dad is a storm chaser wannabe, and they appeared on the TV show "Wife Swap". Maybe just a stupid mistake by a kid, but glad the little guy is OK.