types of paramedic classes

[sevenball]

Calvair,

You don't want to go there, trust me. I rode that horse until it was beaten dead, revived and then beaten dead again. I was with you, I felt that basic EMT "experience" was the way to go. I was proven wrong a billion times over. The conclusion that was agreed upon was that education is the key. Nurses and doctors are required in their education to have thousands of pt. contact hours before licensure. That is the difference, which brings us back to our original discussion about the need for education, and more of it.

I still stand by my original post that says that a degree doesn't make the medic. I'll agree that a degree may make a better person, a more intelligent person, but in terms of practicioner, I don't see it. Your inability to spell and count to ten may make you look foolish to those around you, but if you can tell me all about the creb cycle, I'll take you seriously.

That being said, jsadin said it correct. Can a non-degreed medic be a superb provider? Absolutely. And a degreed medic can be a horrible clinician. This post seems to have two different arguments being applied here. I'm viewing pro-degree posts as the need for education to establish ourselves as professionals. I see anti-degree posts being from individuals seeking acceptance from the EMS community.

If it's acceptance from the rest of the medical community that we seek, then yes! a degree should be required. If it's acceptance from the EMS community that you seek, I will pose this question to all degreed, non-degree, and medic-mill individuals:

CAN'T WE ALL JUST GET ALONG?!?!

[Ridryder 911]

NO! I can't just get along nor do I want to anymore! That is one of our major problems! We have got along way to long! Over 40+ years now, and still trying to attempt to make excuses for our piss poor profession. We all whine and bitch about things then we coddle and make excuses for each other. Seriously, there is NO reason that the entry level is not required to be at the least an Associate Degree!

Boo-hoo...sniff, sniff.. So sorry that we may enforce one to actually demonstrate that they have competency in English, Mathematics and basic Science.. and yes then attend a course taught by those with more than just ..."good ole boy" experience!

Give me any other reason than laziness..not to complete an degree program! Money, sorry pawn those lights & scanners or do alike the other 80% of the population and get a student loan. Why do you think you are so special? Maybe owing a little money will make you want others to take and consider your profession more serious!

Getting tired of reading 10'th grade level textbooks and magazines such as JEMS & EMS ? Containing articles that are so watered down one can expect to see a "seek & find" in the next issue?

C'mon folks this is not in-depth conversation, rather again attempts for those to "water down" the profession instead of promoting it upwards. How asinine to even make an innuendo that an education would be harmful or not even be needed? Really? Obviously the current system we use SUCKS! Maybe a time for a change?

It is ludicrous to even consider anything other than a higher education, in fact any thing else should be considered harmful to the profession and towards patient care. We are not talking 10 years out of someones life, just two years to start as a professional.. Much easier in comparison than other health care professions.

Sorry, if the truth hurts!

R/r 911

[sevenball]

Ridryder,

Again, you're making an argument for education solely to appease others in the medical field. Make no mistake though, I agree with you. I think a degree makes a well rounded individual. One that can converse with many different social circles. Certainly, holding a degree of any type holds clout among others in the field.

My argument is that holding a degree does not make you practice medicine any better. Now before you blow a stack, hear me out. Our field is protocol driven, is it not? Those protocols are in place as a "recipe", as someone already put it, to dictate which treatment we are to administer. In many systems, those protocols do not allow for any tolerance to operate outside of those protocols. Until we can get the protocols to allow freedom, we cannot use the extraneous knowledge gained from our degrees. We may know what the problem is, but do not possess the equipment or medications to treat it. Our knowledge may lead to frustrations, which those of us with higher education hold.

Some would say that the reason for not giving us freedom from protocol is the lack of required education, and you may be right. But it will only lead to us chasing our tails. I think we can all agree that holding a higher education makes you a better person, smarter, more quick witted, and I suppose in some cases a better paramedic, but we are still bound by protocols that others give us. The real question is, how do we fix it? How do we make the system work for us? To do what we want it to do?

[Ridryder 911]

I thank you for your response, but here is where we may disagree. My protocols are only 30 pages long.. that's it for a Paramedic level. Yet, we are expected to perform as one would normally as in any advanced system.. why? Because, my medical director expects us to use those protocols as .."guidelines".. as protocols should be used. Ironically even physicians and EMS administrators are ignorant on the fact more protocols may only open them up to more litigation and "should had, could had" type scenarios.

If we had truly educated Paramedics, then again protocols would be used only as such as I described.. guidelines. One cannot expect to have more in-depth privileges, and less control with less recognized knowledge.

I am not attempting to .."appease" the other health care professionals, rather to appease our PATIENTS. Our patients deserve to have well educated personnel that can make clinical impressions (diagnosis) based upon a thorough, highly intense program, taught by only well educated professors with clinical professors to assure that they have met and been exposed to clinical environments. As other posts have demonstrated, one does not need anymore studies in medicine to prove that a formal education is needed.

At this time most Paramedic texts is written at a 10'th grade reading level, and the Basic at a elementary grade level.. Why? Because it has been determined that most Paramedics cannot read above such levels.. and we do not think this is not going to affect patient care?

One can only imagine if the our texts were written at a level that would ensure that Paramedics have been exposed to medicine rather than diluted science.

So does the paper of the Degree make one practice medicine better.. technically no. Definitely neither does NOT having it either. As well, we can assume that the individual have the drive to pursue to be better and have had the opportunities to be exposed to education rather than training. That they have met at least the minimum satisfaction in the building blocks of an education process such as reading, writing and mathematics. Something that a non- higher education institutions cannot fulfill.

Can one really legitimately say that having a profession that allows a non formal education be better for patient care? Obviously not, again look at our profession. Look at the other medical professions they did not remain stagnant. Also, can one actually believe without requiring a formal education that our profession can ensure quality care and be able to require the demanded increasing knowledge? Apparently not. After 40+ years, we still do not do such. Can we expect our profession to move forward, (again meaning our professions main goal is patient care) and to grow as a profession without a formal education? Again, forty years has proven to us it cannot.. and now one needs to compare us to other professions that have.

Yes, as much as those in EMS that are linked to non-medical institutions hate to admit it, EMS is medical. Therefore EMS will always be associated with the medical profession community and its peers. Since our profession is medical we should be expected to have the same entry education level, the same ideologies to promote patient care by competent and well educated professionals, and also be judged by our peers and also be able to judge them as well... something that cannot be done at this time.

We also cannot expect payers (Insurance/Medicare) in our system to recognize us as professionals. Sorry, the general definition in the work field for professional is to have a degree. Therefore we can never expect the pay to be above the technical or trade level. That is what we are classified at this time. Without the payers increasing reimbursement rates, pay structure will never increase, turnover can be expected and yes less attractable persons should be expected to enter the market. Do you think this is better for patient care? So one can associate education with direct patient care.

How do we fix it? Simple. Just alike all other health care professions before us did. Place current training programs into a collegiate level institution meeting their requirements. Employers demanding that their associations and legislators recognize us as professionals and start receiving and distributing the funding. Nurses did not always make the money they did, nor did RT, PT's, etc.. It has to start from the beginning.. the entry point and that is education.

R/r 911

[Doug]

Ok for the sake of arguement, let's say I agree that we need a degree. What level? An associates degree? Considering that our scope of practice often exceeds that of an RN in the pre-hospital setting it hardly seems enough, plus in many countries an associates degree is called an "Advanced Diploma" (hence my grade 13-14 comments earlier) hardly professional sounding.

[VentMedic]

Ok for the sake of arguement, let's say I agree that we need a degree. What level? An associates degree? Considering that our scope of practice often exceeds that of an RN in the pre-hospital setting it hardly seems enough, plus in many countries an associates degree is called an "Advanced Diploma" (hence my grade 13-14 comments earlier) hardly professional sounding.

Advanced Diploma? I'm only talking about the United States and the education system recognized in this country. The other countries have already passed us up with established educational requirements and there is some difficulty recognizing the "diplomas" between the countries. Of course, there is also some difficulty recognizing the 48 different certifications just within the U.S. since the majority are trade school certs.

The paramedic's scope of practice is for prehospital . In many states a nurse (and RRT) can be trained to do every "skill" a paramedic can do and perform those skills both inside and outside of the hospital. My scope of practice as an RRT exceeds what I can do as a Paramedic on interfacility transports. My "skill" set also exceeds what I did on HEMS. The same for the Critical Care (for all ages) RNs that I work with. It is the education that sets these professionals apart from Paramedics and allows them to advance their skills, knowledge and training to whatever direction they choose.

This is not rocket science. Look at any college catalog for the prerequisites and requirements for almost any medical profession. The basics for the initial foundation are not that much different. It is the core specialization that differs. The Associates would be a great start. EMS does not have enough qualified instructors with the required higher education at this time to go with a Bachelors for a national standard.

CoAEMSP and CAAHEP have already accredited several Associates programs for Paramedics across the country. This is not a new degree.

Other health care professionals realize that the Associates degree is just the beginning of their education.

[Ridryder 911]

Ok for the sake of arguement, let's say I agree that we need a degree. What level? An associates degree? Considering that our scope of practice often exceeds that of an RN in the pre-hospital setting it hardly seems enough, plus in many countries an associates degree is called an "Advanced Diploma" (hence my grade 13-14 comments earlier) hardly professional sounding.

I agree with Vent and furthermore:

How do you figure that? ..exceeds? Really, in what way? Seriously the skills are very, very simplistic and basic, the patient assessment level is nill to none, and the usual Paramedic pharmacology is a joke.. Hmmm advanced enough that all of that information can be contained in one single book? Yet, again that book is written at high school sophomore level.. Can we really say that is advanced?

Sure, the RN is NOT supposed to function in a prehospital arena. The same is true that they are not usually prepared to function in critical or emergency areas immediately after graduation either.. there is no requirements for teaching or being educated in that specialized area. So one cannot compare the new RN against a Paramedic that is supposed to be soley specialized in only one area... The same arguement if I was to place a new Paramedic on med-surg floor.

What I would like to be able to see is that the general education of the Paramedic to include general medicine. That our texts be specialized and have great detail, that our knowledge would be comparable to other health care practitioners. Our interventions would not be mandated from cookbook medicine rather be based upon the physical findings of the patient, along with diagnostic aids and of course from the knowledge the practitioner (Paramedic) that has developed this knowledge through education and clinical experience.

It is embarrassing that a so called professional is taught in chapter forms instead of texts. Seriously, my Pediatric text was over 2000 pages and Nursing Pyschology alone was over 3,000 pages long. The Paramedic that has to deal with the worse case scenario... uh, two paragraphs or maybe 15 pages at the most? Do we not see a problem here? How can one take care of problem if they do not know the norm.. we teach this philosophy to basics all the time.. yet, we ignore it through out our Advanced Programs.

Really, are we not tired of using other professions texts to teach out of? Just because ours is so watered down that any moron could meet such simplistic objectives? Yes, it is embarrassing, shameful to have to rely upon another professions text just to teach the basics out of.

If we want this so called profession to grow or worse to even stay around, then we will have to change the attitudes that the status quo is okay. Again, over & over it has been proven it is not. Again, you cannot fix what you do not acknowledge what is broken.

As well, I do not understand your 13'th & 14'th grade labeling. Grade levels such is usually left in high school arena. Alike clock hours is left to trade or blue collar training areas.

R/r 911

[Doug]

Not enough qualified instructors to teach at the Bachelors level Vent? So? Didn't stop nursing from requireing higher certification to teach...hence the often 2-3 year waiting list to get into an RN program.

[VentMedic]

Not enough qualified instructors to teach at the Bachelors level Vent? So? Didn't stop nursing from requireing higher certification to teach...hence the often 2-3 year waiting list to get into an RN program.

There is a waiting list for nursing because of the wages in some parts (not all) of the country, travel opportunities and the many different directions RNs can go once they have achieved their basic education. The number of RNs with MSNs are ever increasing as some move into education, some into critical care advanced practice and some on to the NP. There is also an entry level MSN for people who already have a Bachelors in another program of study. Many hospitals are now demanding RNs with a Bachelors degree even though the minimum for licensure is Associates. The same for RRT. I hope you had a chance to read the evidence based articles on education that were posted for you. At least nursing (and RT) is stepping up to the demand for higher education and doing their part to keep their programs full.

In the U.S. college system, one should have at least one degree higher than the degree program they are teaching. In some states, even the community colleges (2 year) a Masters may be required to teach. Some exceptions may be made for some adjunct instuctors but usually the bare minimum is Bachelors. For this reason many Paramedic programs in the colleges still have RNs with higher degrees as the directors and coordinators. You might also be surprised at the number of RNs in the administrative offices for EMS in many states because the position they hold requires a higher level of education.

[Ridryder 911]

Vent makes some very interesting points. I do not know any state that allows RN's to be taught by any thing less than a MSN. Yes, clinical adjuncts may do so and then most have to prove documentation that they are currently pursuing the MSN. Alike, most BSN programs usually require the Director or Chairperson to hold at the least a PhD or DNSc. level. As well, nursing shortages are well planned. Yes, instead of compromising the ..."quality versus quantity"... not alike EMS that will accept and take anything. Also the law of supply & demand is well used. Why flood the market and demand? Yes, control the amount that is needed to maintain salaries, job openings, etc. Again, where I have seen EMS make the serious mistake of flooding the market and need.

Yes, you are correct there is a demand for educators. This is one of my reasons for abandoning the NP route and pursuing the education route.

Just imagine that educators of EMS was that. Educators, not trainers. That true lesson plans with in-depth knowledge of different teaching techniques could be used. Correct pronunciation, grammar and usage of teaching materials would be expected. Course work could be more scientific using techniques as thesis and even ..(gulp!) true scientific research!... Unfortunately until we obtain that level, we will not be able to do so.

Doug.. you might want to stop while your ahead .. You are pointing out the need for more education in other areas of EMS than just the clinical area. Would you really want most of the Paramedics you have met, be in charge of a State Level EMS Authority? Joe Bob wearing his NREMT baseball cap, and please just read the postings on EMS forums. Now, this is the person you want representing your profession to the Legislature, Senate, Governor's and to Physician level professionals? I am and always will be a proponent that we should govern ourselves, but unfortunately until we have those that can present and be educated and professional, there is no reason to even to do so. It would be disastrous. Another valid point for higher education.

Now let's review back to the clinical arena. Wonder what Supervisors would be like if they were required to have a basic minimum education level at least an Associate or alike most healthcare supervisors a Baccalaureate. Can one imagine, if that position was based upon those that had some real management & human behavior courses, rather than the "good ole boys" syndrome? Wow! What type of profession this would be, what care could be expected? .. Something to think about...