When are we going to wake up as a profession?

[EMS49393]

Education is very important but requiring a degree in a field that has historically attracted those who didn't want to go to college is not going to help our recruitment efforts.

Require all paramedics to hold a degree in paramedicine. All those that don't want to go to college to become a paramedic can go be firefighters.

I'd be willing to argue that recruitment and retention would improve if educational standards improve. Who knows how many educated people shy away from wanting to be a paramedic because the profession isn't respected, the pay is horrible, and the hours are even worse.

Seriously, I went to college, I became a paramedic. Now I'm turning my attention to nursing because I am flat out sick and tired of being associated with twits that think they don't need any college level classes because "they're boring." All the educated paramedics once employed by my service have moved on. Most are nurses, a few are doctors. My service has been unable to retain these paramedics, mostly because they opted to establish six month paramedic wonder class to deal with the shortage of paramedics. Now they are even more short-handed, and most of what is left is the lowest common denominator of provider.

Every single day I am faced with several paramedics that really could have used that English Composition class because their charting is atrocious. They could have really used college level anatomy and physiology because they have no idea how the body or any disease processes function. They could have really used some college psychology and sociology because they have no idea how to deal with patients that have mental illnesses, patients involved in crime, patients in differing economic areas. They could have used some college mathematics when they are unable to calculate a drug correctly and subsequently injure or kill a patient.

You don't want to go to college, fine. Be a tradesman. Be a plummer, an HVAC tech, whatever gets your motor churning. You don't want to go to college, fine, just get out of this profession. I'm tired of the non-college educated people dragging this profession down.

Oh, and you can have my soapbox, I'm finished with it.

[Sir Andrew]

steve_emt_68

We need to act like a profession. This means our actions our dress our speech our attitudes. It means not having Paramedics in the news because they stole narcotics or abused a patient. It means not being arrested for drunk driving while operating the ambulance. It means not wearing shorts, a wife beater and flip flops to calls. It means no more running down to the diner to talk about your last great call or worse yet the really nasty call. It means not standing at the convenience store telling off color jokes where others can hear you.

I agree with you there that would be a big help to any profession. Since I am not an EMT I don't know that side of things so I was not aware that it was a problem.

Just not sure about the shorts I personally would not want to but I can see why people in places that have very hot summers might

[toutdoors]

Education. No doubt it does no harm in expanding one's horizons and gaining a more in depth knowledge of a subject. Here is where I have a problem when people say education is the answer to everything.

I saw officers in the Marine Corps that made deciscions so stupid you had to ask yourself if they were serious, or just messing with you to see if you were dumb enough to do as they said. I have seen college graduates come into the fire service, pretty sure of themselves, thinking they have all the answers, and they have no knowledge or skills retention. I am an engine company officer, so I can say this with having seen this trend with my own eyes. It is sad. Some of the problem is the attitude of society in general as well. The younger generation seems to believe that they are owed something. Where did they ever come up with that idea?

If you want to put college classes into the mix for medic, that is ok, but then I think we should keep them classes pertinent to the subject material at hand. A&P I agree with, as well as some biology, how about medical terminology. I am enrolled in the paramedic program at our local college, and so far, the medication administration has been pretty straight forward as far as I can tell. Seriously, the vast majority of them are somewhat along the lines of : X amount of drug in X amount of solution, per Kg of body weight (sometimes), over a certain period of time. This isn't rocket science. It is basic math. It is Jr high general math, dealing with fractions, and ratios; simple addition, multiplication, and division for pete sakes! Oh sure, when we deal with a dopamine drip we are talking micrograms but then again, the majority of the time we deal with a situation like that, we titrate in the field, and the pump is used in the hospital.

English Comp as a college course? I don't know. I mean seriously, we are talking about writing a few simple paragraphs detailing what you saw, what you did, what the outcome was, and a few other pertinents. Sounds simple yes, but we all know a good report is a little more than that. Honestly though, this is simple composition. Another high school skill that was taught to me 20 years ago. Where has it gone? Are we that in depth with "No child left behind" that we pass any kid that walks through the doors of a school? How about we spend a little more time on this subject in the class? Make people write reports on the skill scenarios they had in class; everyone one of them, this way, they can make the mistakes in class, and not lose a court case someday.

I am not sure that college is needed to be an EMT. Now I am talking a basic here, not an advanced EMT. Let's think about this for a second. Basic EMT's are trained to identify and intiate treatment in life threatening illnesses or injuries. The word basic describes their very training and skill level. ( No offense to the B's out there) They are not trained in AMLS, ACLS, or PALS, they are taught how to treat for bleeding, identify a patient that is in danger of going into shock, and how to package with out causing further harm. These people are generally volunteers. (I know, we have talked about that too, but let's leave paid vs vollie in the other forum) They not only need to be educated to be able to perform to their skill level, but be educated enough to say we need ALS, or we need to get moving quickly if ALS is not an option. Can this be done with out college? I think so. Remember, these responders are the first line of defense in circumventing death.(I know, talked this one over too.)

I do feel that the national registry needs to play a big role in this. Maybe the DOT needs to get involved and mandate that all states start to be on the same page, so that an EMT basic in FL is the same as SD, CA, MN, MO, NY, IA, or TX. Same would go for an advanced EMT, and Paramedics. This way we as an EMS community would be able to talk more clearly to one another for one thing. In this way it would be easier for us to talk to one another and identify problems, and hopefully solve a few of them.

In a perfect world, we would all have as much education as possible on the subject of EMS, have 4 year degrees, and be the utmost professional paramedics, there would be no EMT's or vollies. (No offense guys, just trying to make some of the others feel good) Then again, in a perfect world, we would be out of business; be careful what you wish for.

I humbly believe that we can not be faulted for doing the very best we can with what we have and strive for improvement. I don't think that the problem will be solved overnight, nor in a matter of a few years. I also think that when we do set new goals, we have to be realistic as to what we are trying to accomplish, and who will be impacted by these new goals. Yes, of course the patient will be impacted, but so will the provider. Let's be careful on how we dish out the requirements, and make sure we don't get our egos in the way when we began talking about how good we are because of how many letters are behind our names. No offense to anyone with a bunch of letters and abbreviations. I am just a fire based ems provider anyway.

[Ridryder 911]

Education. No doubt it does no harm in expanding one's horizons and gaining a more in depth knowledge of a subject. Here is where I have a problem when people say education is the answer to everything.

I saw officers in the Marine Corps that made deciscions so stupid you had to ask yourself if they were serious, or just messing with you to see if you were dumb enough to do as they said. I have seen college graduates come into the fire service, pretty sure of themselves, thinking they have all the answers, and they have no knowledge or skills retention. I am an engine company officer, so I can say this with having seen this trend with my own eyes. It is sad. Some of the problem is the attitude of society in general as well. The younger generation seems to believe that they are owed something. Where did they ever come up with that idea?

That has nothing to do with education, rather that most are "trained" the way most EMT's are taught. Hence part of the problem, training and education is NOT the same. Unfortunately most in EMS are not educated enough to recognize this. Even those that usually teach EMS courses are not educated; again what do we expect in return? Little 5 year old Johnny teacher requires to have a formal education, but the teacher that instructs those that shock and administers medications does not... Do we not see a problem with this?

If you want to put college classes into the mix for medic, that is ok, but then I think we should keep them classes pertinent to the subject material at hand. A&P I agree with, as well as some biology, how about medical terminology. I am enrolled in the paramedic program at our local college, and so far, the medication administration has been pretty straight forward as far as I can tell. Seriously, the vast majority of them are somewhat along the lines of : X amount of drug in X amount of solution, per Kg of body weight (sometimes), over a certain period of time. This isn't rocket science. It is basic math. It is Jr high general math, dealing with fractions, and ratios; simple addition, multiplication, and division for pete sakes! Oh sure, when we deal with a dopamine drip we are talking micrograms but then again, the majority of the time we deal with a situation like that, we titrate in the field, and the pump is used in the hospital.

If your pharmacology class is that simple your school sucks. As well, don't come to work at my EMS, we have IV pumps for the trucks. Yes, IV NTG and a lot of other medications have to be on a pump to regulate the amount. Yes, I do require the Paramedics to know how to perform drip ratios as well. If I find out any of our Paramedic is just "titrating per effect" on any medication and does not know the dosage, I will recommend formal action. Medications are given by weight/dosage for a reason. Reaching the appropriate therapeutic level is the goal for all medications.

English Comp as a college course? I don't know. I mean seriously, we are talking about writing a few simple paragraphs detailing what you saw, what you did, what the outcome was, and a few other pertinents. Sounds simple yes, but we all know a good report is a little more than that. Honestly though, this is simple composition. Another high school skill that was taught to me 20 years ago. Where has it gone? Are we that in depth with "No child left behind" that we pass any kid that walks through the doors of a school? How about we spend a little more time on this subject in the class? Make people write reports on the skill scenarios they had in class; everyone one of them, this way, they can make the mistakes in class, and not lose a court case someday.

You do realize most Paramedic texts are only written at 10'th grade reading level? Look at the posts on EMS forums and tell me English should not be required! Most ePCR's are checked box configuration and very little is written in paragraph form, but this should NOT exclude a health care professional not having the BASIC EDUCATION. Technically you cannot even call yourself a professional without a degree. Yes more should be taught about patient care, hence the reason there should be more than one text book or "series". Each segment should have detailed education. Alike all other medical professions have.. Each text book should be written in detailed and specific to that area, and usually consist > than a 1000 pages in length. How can we proclaim to have knowledge in anything that is covered in a paragraph or chapter? Does your school not require outside study time, such as thesis projects and additional scenarios and lab time? Again, if they don't it sucks.

I am not sure that college is needed to be an EMT. Now I am talking a basic here, not an advanced EMT. Let's think about this for a second. Basic EMT's are trained to identify and intiate treatment in life threatening illnesses or injuries. The word basic describes their very training and skill level. ( No offense to the B's out there) They are not trained in AMLS, ACLS, or PALS, they are taught how to treat for bleeding, identify a patient that is in danger of going into shock, and how to package with out causing further harm. These people are generally volunteers. (I know, we have talked about that too, but let's leave paid vs vollie in the other forum) They not only need to be educated to be able to perform to their skill level, but be educated enough to say we need ALS, or we need to get moving quickly if ALS is not an option. Can this be done with out college? I think so. Remember, these responders are the first line of defense in circumventing death.(I know, talked this one over too.)

That is what first aid classes are for. Basically that is all EMT courses are... just a little more than advanced first aid. (again prove me wrong)

I do feel that the national registry needs to play a big role in this. Maybe the DOT needs to get involved and mandate that all states start to be on the same page, so that an EMT basic in FL is the same as SD, CA, MN, MO, NY, IA, or TX. Same would go for an advanced EMT, and Paramedics. This way we as an EMS community would be able to talk more clearly to one another for one thing. In this way it would be easier for us to talk to one another and identify problems, and hopefully solve a few of them.

They have and there is. NREMT is now requiring all Paramedic level educational institutions to be CoEMSP accredited by 2012. To be such, usually one is associated with a higher education system. In regards to being the same taught.. it is. It's called the National Curriculum which all states are supposed to be following. Something that has been out since the beginning of EMS. The National Highway Traffic Safety Administration (NHTSA) formerly known as DOT, oversees it. All EMT level text books are based and written upon it.

In a perfect world, we would all have as much education as possible on the subject of EMS, have 4 year degrees, and be the utmost professional paramedics, there would be no EMT's or vollies. (No offense guys, just trying to make some of the others feel good) Then again, in a perfect world, we would be out of business; be careful what you wish for.

B.S.! Too bad. Those types have prevented EMS from becoming a profession since its concept. Again, I can prove it. Every time a curriculum changes, there is wailing among those groups and the curriculum is watered down. Shame the patient has to pay for it.

Really the severity of the patient does not change because there is lack of knowledge by the provider. Can't do the care, get out. Someone will. As long as there is excuses then communities will use one.

I humbly believe that we can not be faulted for doing the very best we can with what we have and strive for improvement. I don't think that the problem will be solved overnight, nor in a matter of a few years. I also think that when we do set new goals, we have to be realistic as to what we are trying to accomplish, and who will be impacted by these new goals. Yes, of course the patient will be impacted, but so will the provider. Let's be careful on how we dish out the requirements, and make sure we don't get our egos in the way when we began talking about how good we are because of how many letters are behind our names. No offense to anyone with a bunch of letters and abbreviations. I am just a fire based ems provider anyway.

Ooh now I see the problem. Seriously, how many people dying does it take to change a system? It has been over 40 years worth, is that not enough?

You are right there is an ego problem.

It is not those of us with letters behind our names. It is those that acclaim that they are "doing something" which is correct. Their preventing EMS to progress. As well, those of us with those letters are tired of seeing needless deaths. Too many first aiders, too many levels of EMT (or substitute Paramedics) out there. Time we quit making excuses, and get on with being a real health care profession and having those that just have a 150 hour class does not cut it. Want to be in health care? Then meet the standards.

R/r 911

[mstovall]

I think everyone is missing the point. The problem with low pay in EMS is not education, union representation, certification, or other addressable problems. It boils down to one thing, cash flow. The cash flow that is generated by EMS resides many times on entities that under pay for the service. Medicare, medicaid, and self pays (which are the three biggest parts of our run volumes) pay the full bill at a much lower rate than insurance companies. The ambulance then has little recourse as it is infinitely hard to get the individual to pay the remainder as most don't have the money in the first place. Hospital based services around my area pay better, they make their money on the admission rate after the service takes them to the hospital. fire base services have their runs supplemented by tax dollars. It is hard for a service to pay higher wages with a low rate of return.

So how does EMS move forward. We have to find ways to get paid more. My service doesn't charge for responding to MVA's. I was looking at my insurance policy the other day though and they will pay $250 to fire, $250 to ambulance, and $100 to wrecker service. I called worried about the low level of pay to the ambulance service and the reason for a low set rate was, "this is only if you refuse treatment. Many places are starting to charge for showing up on scene for taking an ambulance out of service." Our service handled 6 wrecks in the last 36 hours. The volunteers lost money that could start paying paid-on-call people. We as an ambulance service didn't get the info to even pay for the response if they wanted to charge.

We need to expect payment for our services. We are not just a fly-by-night group. If we do not expect to gain the info needed to charge individuals, then we can't complain about low pay. We need to help increase cash flow.

Higher education is just one venue of increasing cash flow. However, education doesn't dictate more money. Look at the psychological field. Most places require a masters to work in addition to state certs. Look at social workers. Masters degrees and state certs don't help them either. Both have low income sources with limited funding thus they have low rates of pay also.

Look at stock brokers. No education requirements, just licensing and a few endorsements and you can make a lot. They also aren't afraid to charge for what they give you, service.

Education is a good starting place, but better cash-flow-in is where we need to work on. The companies will be more likely to pay us more if we can prove they will make more in return.

JMHO,

Michael

[KSEMT122]

This is one way to get the egos overflowing. Bringing up education on this forum does it time and time again. The summary I have upon reading the three pages is basically this. Anyone without a College degree is worthless and those that try to say otherwise are then being thrown under the bus and written off as incompetent. That's really a progression since the last time I've been involved in this argument on here. At least in times past those of us who think REQUIRING College degrees for any and every level of EMS were listened to and actually engaged in the conversation. I see a lot of people with that view now being steam rolled. I don't think that is right and am disappointed to see it.

It's always easy to look back AFTER you've gone to College and then tell people "it should be required". That just implies to me a desire to make up for something that may be lacking in ones personal life. It would appear those of you with College degrees want to be the ONLY ones who are in this profession. You don't want anyone else to have a shot at it. Or you only want people who have suffered through College as long as you have to be able to be in EMS. Maybe it upsets those of you who have gone through College to know there are those of us who can accomplish the same things that you do without a College degree, maybe even better. I don't know why egos have to get involved in this discussion. It just makes me roll my eyes and wonder where we really are going as a profession. We may be headed up with education, but I see a terrible downward spiral of attitudes and sense of entitlement. Now I will step out of the way as to not get steam rolled.

[KSEMT122]

At least in times past those of us who think REQUIRING College degrees for any and every level of EMS were listened to and actually engaged in the conversation.

I meant to say ".....for any and every level of EMS is ridiculous were listened to and actually engaged in the conversation".

I would like to state for the record more education can't hurt. It is great if somebody doesn't pursue a degree, but the world doesn't stop and start with a degree. Some may argue the world is progressing that way, but in reality, it doesn't.

[Ridryder 911]

.

It is great if somebody doesn't pursue a degree, but the world doesn't stop and start with a degree. Some may argue the world is progressing that way, but in reality, it doesn't.

It does in medicine. Period. Sorry, medical field is considered a professional level, hence it requires college. You may do the same thing, but I have something to prove I went on and beyond and as well have proof of my educational level.

Technical training is designed for "blue collar", non-scientific workers. What is EMS or healthcare is not. This does not make anyone more superior, just usually more educated.

The only we are going to get payers such as Medicare, Insurance corporation to reimburse EMS is by increasing educational standards. What corporation is going to justify an EMS/ambulance for $500-$1200 with some personnel training is lower in hours than beautician? Kinda high for a taxi cab ride... and that is exactly what payers alike Medicare and Blue Cross & Blue Shield, AETNA, etc. is thinking.

Look at (Gasp! shall we say it? ) other medical professions. Look at how they increased their payment structures, and reimbursement rates. Remember the old saying... "what does not come in, can't go out".. For example look at Respiratory Therapy. A few years ago it was mainly OJT, then trade school (technology) and now a degree is required. Again, look at their salary range.. the same with physical therapy, roentogram (x-ray), etc..

Want more money, more respect, be considered a peer in the medical community? Then do what a professional has to do... get an education! (Not training).

Otherwise, suffer the consequences since you are part of the problem not part of the solution.

R/r 911

[Mateo_1387]

This is one way to get the egos overflowing. Bringing up education on this forum does it time and time again.

Me spidy senses tell me that ye are we bit jealous

Anyone without a College degree is worthless and those that try to say otherwise are then being thrown under the bus and written off as incompetent.

Where do you get that idea? I think almost everyone here appreciates people that do not require degrees for their jobs. I personally appreciate garbage men, lawn cutters, clerks, janitors, fire fighters, cooks, Nursing Assistants, road pavers, and pizza delivery men. The list is longer, but I think you probably get my point.

When it comes to my health care, I want the best. I want someone who is dedicated enough to earn a degree in their profession, who will have the competence to care for me. I want all my healthc are workers to be very competent. That includes my nurse, my respiratory therapist, my radiology technician, my nurse practitioner, my doctor, my surgical technician, and my pharmacist. They learned all the ins and outs of their profession. I expect the same out of the paramedic I call to pick up my grandparents. I want someone who went to school, and knows all the ins and outs of EMS, and the care provided by them, know the care the hospital will provide, and how their treatment will impact my grandparents. That education cannot be provided in a non degreed paramedic school. It takes at least a two year degree to get a solid foundation. Hours of paramedic training cannot equate to years of study of paramedic education. I would rather see it be a bachelor degree as an entry requirement. This is coming from someone who currently only holds his associates degree !

That's really a progression since the last time I've been involved in this argument on here. At least in times past those of us who think REQUIRING College degrees for any and every level of EMS were listened to and actually engaged in the conversation. I see a lot of people with that view now being steam rolled. I don't think that is right and am disappointed to see it.

This topic has been vastly discussed. People who advocate degreed paramedics do so because they are generally educated as such. It is the people who do not poses the degree that do not see the point. The quote "you don't know what you don't know until you learn it" applies in this case.

It's always easy to look back AFTER you've gone to College and then tell people "it should be required". That just implies to me a desire to make up for something that may be lacking in ones personal life. It would appear those of you with College degrees want to be the ONLY ones who are in this profession. You don't want anyone else to have a shot at it.

I think this is true, except the part about lacking in ones personal life. I know plenty of college graduates who are now professionals, who spent their college days with quite a life. The reason people with college degrees want to be the only ones in EMS is because they want to see the profession move forward. And personally, I do not want just "anyone" to have a shot at EMS. The profession is not for everyone.

Maybe it upsets those of you who have gone through College to know there are those of us who can accomplish the same things that you do without a College degree, maybe even better. I don't know why egos have to get involved in this discussion.

It is sad that someone can do a paramedic job with inadequate training next to a well prepared degreed paramedic. I do not agree that non degreed paramedics can do it better than degreed paramedics. It takes a non degreed paramedic many years and calls to catch up to the starting point of a primarily degreed paramedic.

As far as egos are concerned, I think that you might have a confidence problem. Degreed paramedics are normally confident in their skills, and people who are not as well prepared may view it as being egotistic. I do not know you case, but that is what it appears like. Just an opinion. As far as degreed paramedics, I do not know many that are egotistical, and most degreed paramedics would feel the same. I am not saying they are not out there, I just do not think it is a big problem like you are making it out to be.

I would like to state for the record more education can't hurt.

Then what is the problem with the entry requirement being a degree. I agree with you that education does not hurt, it is the lack of that is hurting everyone the whole way around.

[ccmedoc]

Require all paramedics to hold a degree in paramedicine. All those that don't want to go to college to become a paramedic can go be firefighters.

I'd be willing to argue that recruitment and retention would improve if educational standards improve. Who knows how many educated people shy away from wanting to be a paramedic because the profession isn't respected, the pay is horrible, and the hours are even worse.

Seriously, I went to college, I became a paramedic. Now I'm turning my attention to nursing because I am flat out sick and tired of being associated with twits that think they don't need any college level classes because "they're boring." All the educated paramedics once employed by my service have moved on. Most are nurses, a few are doctors. My service has been unable to retain these paramedics, mostly because they opted to establish six month paramedic wonder class to deal with the shortage of paramedics. Now they are even more short-handed, and most of what is left is the lowest common denominator of provider.

Every single day I am faced with several paramedics that really could have used that English Composition class because their charting is atrocious. They could have really used college level anatomy and physiology because they have no idea how the body or any disease processes function. They could have really used some college psychology and sociology because they have no idea how to deal with patients that have mental illnesses, patients involved in crime, patients in differing economic areas. They could have used some college mathematics when they are unable to calculate a drug correctly and subsequently injure or kill a patient.

You don't want to go to college, fine. Be a tradesman. Be a plummer, an HVAC tech, whatever gets your motor churning. You don't want to go to college, fine, just get out of this profession. I'm tired of the non-college educated people dragging this profession down.

Oh, and you can have my soapbox, I'm finished with it.

=D> =D> =D> =D> Well said...