Furthering the dialogue: EMTs and Paramedics

[reaper]

I think that we need to create a whole new educational system and EMS system.

I would like to see EMS do away with EMT training all together. At a minimum I would like to see a 4 year BS degree as the entry point of EMS.

When you start school, you are fresh, no prior training. You start with one year of class room work. After the first year, you can receive a student permit to work PT on an ambulance as an attendant ( similar to an EMT). The second year is a mix of class work and clinicals. Third year is advanced class work and advanced college classes. Fourth year would be a mix of major clinical time and advanced classes in management, leadership, and writing skills.

By the time you graduate, you have a BS degree in Paramedicne. You are prepared as a leader and able to handle management problems of a profession.

This setup would provide an educated professional, who has ample clinical time under their belt. This will give them the experience that they need to work the streets, without having to take time off from their education. The student permit would allow the student to earn a living and also gain more street experience. The difference would be the fact that they now have a year of college education under their belt, before they hit the streets.

If we were to setup a system like this now, the majority of the problems would be weeded off the streets, within 10 years.

Now for a system like this to work the EMS community would have to realize that they will have to pay a wage which is equal to the education. I see in a range of $25-40 an hour. That would be the biggest hurdle to over come.

Feel free to add or revise with your thoughts of a good degree setup. I am just tired and rambling!

[mshow00]

Eydawn- it pretty much boils down to what everyone has already said: EMS screwed itself when it fell under DOT and never left it; each state was allowed to set up its own system(the independent argument), the minimal education level required by DOT(that some try to lower). Which brings it all to a head, It is simply a lack of adequate training and knowledge across the board. I, being a current medic school student about half way through, truly understand that my basic education was extremely lacking, to the degree I am still discovering. I have come a long way from the "magic 15"(as in 15 LPM O2). I do see that my basic education was very lacking(I went to a community college for it where biology, english, medical terminology, and college algebra was required prior to the basic course) and I fail to see how any first responder course could be considered adequate for any who wish to work with the public. The first responder course should be a intro class not a licensing class. As I said in the other thread before it was locked(rightly so); it is my belief that current "first responders" be a semester long current "basic" class (with higher standards); the Basic class should be some sort of hybrid class that is heavily borrowed from a non-medic mill course. There should also be a national standard for all states (each state allowed minimal tweaking in SOGs to fit their needs) that raises the minimum requirements. Allowing for a true National Registry in which licensure is a gold standard that can be taken everywhere and equally recognized would be an asset to the profession. Bottom line the minimal requirements need to be raised, and we need to keep politics out, and people need to stop being so cheep. That is a start to a perfect world (IMHO).

[HARDCORE CAP]

i stay humble because i know my knowledge base compared to a medic is practically nil. i don't think i'm on an even level with a paramedic or even that i'm a useful part of the EMS system and i fully support those "straight to medic" ideas on this site. like dust said in the previous thread so un-politically correct , Bs are the "wetbacks" of the system. i usually tell people i'm a glorified ambulance driver. when i question a paramedic, i usually learn something in the process and it never ends up with any kind of hard feelings. i'll only firmly stand against them if i know beyond a shadow of a doubt that i'm right but that hasn't happened yet. why Bs don't get along with paramedics on this site, i have no clue. i love sitting around and listening to medics shoot the shit on different topics. i dunno, maybe it's because i'm new. so far i've embraced my place in the EMS field and look forward to medic school, after then i'll probably question medics more often and more firmly

[Eydawn]

There's more of what I was hoping to see. Way to go, folks.

Okey dokey... so we've established now that being under the DOT has contributed to our fragmentation and ridiculously low educational standards.

Solution: Extricate ourselves from the DOT

Solution: Require a 4 year minimum education to practice as a prehospital medical provider

Here's my questions that follow... how many of you actually would actively participate in a campaign to establish us in a department other than the DOT? What are some suggestions or ideas as to how to go about this?

How many of us are willing to petition the NREMT to change their educational standards, thereby forcing change at the state level? Even if it means forcing you to go back to school yourself, as an associate's degree Paramedic?

And the original questions still apply... what is the real source of this problem and how can it be solved? More ideas on that original topic are still fair game.

Wendy

CO EMT-B

[Dustdevil]

Goddammit, it never ceases to amaze me how Asys just totally blows me away with his succinct, no-nonsense, no holds barred, clear, concise, and to the point summarisations of the most confounding concepts. As much as it impresses me, it also sort of pisses me off, because often, like now, I feel he has covered the topic so completely that I am left with nothing more to say. :? But, of course, it takes more than that to leave me speechless, so...

Why are they complacent with where they are?

It all goes back to the image that we project as a profession, which results in people entering this field for all the wrong reasons, and with completely unrealistic expectations. Yes, WE are to blame for this failure, not the n00bs themselves. We, by offering a quick path to glory with abysmally low standards of screening and education, have attracted a preponderance of applicants that simply aren't cut out for what the job really entails. It's not really even a poor reflection on those people. After all, they are cut out for what they thought the job was about. But it is only after encountering the realities of medical practice that it becomes painfully evident that they were never meant to be -- or even interested in being -- intelligently functioning medical professionals. First aiders and ambulance drivers is all they thought this field was about, and it's because we allow our profession to continue to be portrayed that way.

Think about it. What percentage of our applicants actually gave serious thought to any other medical profession? How many seriously considered spending two to four years to become an RN? How many seriously considered spending four years to become a Respiratory Therapist, Microbiologist, or Radiology Tech? How many seriously considered spending five to six years to become a Physical Therapist, Occupational Therapist, or Physician Assistant? Despite all the mouthing off we hear from people in EMS claiming they plan to "move up" to one of those professions, the truth is that very, very, very few ever even achieve an associates degree in EMS, much less Nursing or anything else. The sad fact is, they chose EMS for the very reason that has already been pointed out by Asys and others: because it's quick and easy, and they simply aren't up for all that book learnin'. That is the number one reason. It is the reason we so often hear the lame excuses like, "I learn better by experience than from lectures" and "I don't need all that book learnin' to shoot a tube better than you." They're making excuses for themselves, and themselves are the only ones being fooled by them. You could pay those people a full-time salary to attend an associates degree medic programme that is completely paid for, and they would still never become a medic. They simply do not have it in them.

So, how do we fix that? Is that a serious question? Everyone say it with me now... E D U C A T I O N !!! If people know from the get-go that this is not a job, but a PROFESSION, with professional educational requirements that only the educationally and intellectually motivated candidate can meet, the losers will avoid us just like they avoid med school, engineering school, and rocket science school (I was going to say law school too, but obviously, they somehow manage to still attract an overwhelming number of idiots to their profession, so they remain the enigmatic exception to the rule). There ya go. People should come into EMS with completely realistic understanding and expectations. Consequently, they will be prepared for the curriculum and the responsibilities. And that preparation results in a greater and more mature commitment to the profession that keeps them on the job for the long haul. No longer is EMS a simple hobby or pastime until they grow up and decide what they want to do with their lives. Neither is it a stepping stone to other professions that results in a constantly transient workforce.

Of course, the immediate cry from the ignorant is about the economics of this proposition. Who will go to school for four years only to enter a $30k profession? Who will pay premium wages for those graduates when they can hire 120 hour amateurs instead? Where will the money come from to pay those higher wages? Seriously, folks, think about it. The exact same argument came up before nursing elevated their game, yet they now enjoy the benefits of that elevation. Sure, nursing has a one hundred and fifty year jump on us, but what about Respiratory Therapists? That is a very young profession, yet they have come a long way in a very short time to achieve the professional status and rewards of nursing. When I entered RT in 1979, there were very few degree programmes, with most formal training being simple technical certificate programmes of a year's length. And ninety five percent of those in the field -- myself included -- were just OJT trained, with no formal RT education. So, how is it that, in two short decades, they went from exactly where we are today to eliminating the certificate courses, and requiring an absolute minimum of an Associates Degree for entry, and the majority pushing for a Bachelor's Degree entry level? Where did the money to support professional wages come from? Amazing how the money can be found when we actually earn and demand it through merit! Same thing with the Physical Therapists. Twenty years ago, a Bachelors Degree was the entry level, and less than half of the therapists went any higher. They were still "mother may I" technicians for the doctors in the 1980s, as even the medical community fought against their autonomy. Today, they are independently licensed practitioners who prescribe and treat without even the requirement of a doctor's order. They are the experts in what they do, not the doctors, and they are recognised as such. And yes, they are paid as such. So, with the doctors traditionally on our sides, why do so many persist in the belief that we can never achieve that level of professionalism? Simple. It all goes back to the type of people who populate EMS today. People of low commitment, low potential, and low expectations. Before EMS can change, we first have to change the people in EMS. That's not going to make a lot of people happy, because they don't want to give to the profession. They only want to take from the profession. Why on earth do any of us worry about the loss of those who do not support our professional growth? Seriously, who sheds a tear for anyone who loses their hobby or their minimum wage ambulance driver job for the benefit of the greater good? Not me. As all the other professions have already demonstrated. This can be done. But there is collateral damage in every battle. You have to break a few eggs to make fruit salad. I can live with that.

Solution: Extricate ourselves from the DOT

That is only the tip of the iceberg. We have to extricate ourselves not only from the DOT, but also from the state agencies that currently regulate us (Dept. of Health, First Aid Council, etc...), from FEMA, from the National Fire Administration, and from public safety as a whole. We even have to eventually extricate ourselves from the physicians. Do you see any physicians on the nursing boards? Do you see any hospital administrators on the nursing boards? Do you see any non-nursing government bureaucrats on the nursing boards? No. Without SELF-regulation, you are not a true profession. Period.

Here's my questions that follow... how many of you actually would actively participate in a campaign to establish us in a department other than the DOT?

Not enough, that's for sure. It all goes back to the current population of EMS. With over half of our people being hobbyists (vollies), tourists ("this is just a stepping stone to medical school!"), and part-timers (firemonkeys), we simply do not have the numbers to attain political clout. Therefore, a grassroots revolution cannot happen. It's going to have to come from above. The educators are going to have to decide that they are no longer going to run patch factories for quick money, and voluntarily elevate their standards beyond the reach of the aforementioned scabs. Medical directors are going to have to put their foot down, begin to take seriously their commitment to provide the best possible care, and refuse to put their licenses in jeopardy for the sake of political expediency and the almighty dollar. We have to put the educational requirement for professional entry out of the reach of the fire departments, vollies, and tourists. The rest will follow with little effort at all.

What are some suggestions or ideas as to how to go about this?

As already demonstrated, this is not a new dilemma. This is not something that's never been done before. Half a dozen health professions have successfully undertaken this challenge before us, so there is no need to reinvent the wheel. No need for mind-blowing brain-storming sessions to tackle seemingly insurmountable obstacles. All we have to do is to follow the lead of those who have gone before us. Unfortunately, the $hitty, anti-nursing attitudes displayed by the many ignorant morons among us have so seriously alienated the nursing profession over the last thirty years, that I am afraid we cannot count on them for much support. That is truly unfortunate. But the Respiratory Therapists and Physical Therapists are still fresh from their fights, and can be invaluable resources to us. And, of course, we MUST enlist the support of the medical community. ACEP and NAEMSP must be solidly behind us or we haven't the slightest hope of success. But we have to recognise that, in order for them to help us, they will first have to do many things that, on the surface, will appear to many to be hurting us. That means they are going to have to start withdrawing their support from poorly educated and poorly performing medics and systems in order to demand improvement. That means they are going to have to start cutting back on the "skills" we are allowed to perform under their licences until we can demonstrate that we have earned their trust, which quite frankly, we have FAILED to do in thirty-five years. Yes, there will be much whining, bitching, and bellyaching from the majority of those in EMS, as well as the fire chiefs, the vollies, the crappy instructors, the city managers, and the private employers. But the good news is, when we begin to hear that moaning, we will know we are on the right track.

[letmesleep]

Interesting, almost 15hrs without any rebuttal or support to this post. 15hrs with nothing left to say, that says a lot. Thanks for saying what everybody didn't want to believe Dust. Your post is very insightful and profound, to say the very least.

[Eydawn]

That's the sort of well thought out response I was looking for in this discussion. Well said, Dust. I'm going to be interested to see if anyone has rebuttals to it...

(P.S. 15 hours without response from me is due to school and all that... ya know... that edjumication thing.)

Wendy

CO EMT-B

[Arizonaffcep]

Not enough, that's for sure. It all goes back to the current population of EMS. With over half of our people being hobbyists (vollies), tourists ("this is just a stepping stone to medical school!"), and part-timers (firemonkeys), we simply do not have the numbers to attain political clout. Therefore, a grassroots revolution cannot happen. It's going to have to come from above. The educators are going to have to decide that they are no longer going to run patch factories for quick money, and voluntarily elevate their standards beyond the reach of the aforementioned scabs. Medical directors are going to have to put their foot down, begin to take seriously their commitment to provide the best possible care, and refuse to put their licenses in jeopardy for the sake of political expediency and the almighty dollar. We have to put the educational requirement for professional entry out of the reach of the fire departments, vollies, and tourists. The rest will follow with little effort at all.

My question for you Dust is: How do we do this? I'll use an example that I'm fairly familiar with (although I know you don't like it, but please hear me out). If you look at the amount of Firefighters across the U.S., MOST of them are vollies. By most, I mean most...last stat I heard was something along the lines of 2/3 to 3/4 were not career FF's. Yet they have a HUGE amount of political clout, and seem to have a system worked out, educationally, that works for both the career depts as well as vollies. In AZ, according to the state, you only need to be "trained" in FF tactics, skills, etc to be a FF. This works well for the vollie folks, but the career depts. have all the formalized training (so to speak), and are held to IFSTA, NFA, and other national standards. This system, even is such a backwards state as AZ has a tendency to be, has led to the rise of what most consider one of the top fire departments in the country...Phoenix Fire. Now...granted that has a lot to do with their previous leader, Alan Brunacini--truly a remarkable man.

I use this example not to say we "need to integrate" or any other crap like that...just that clearly a system where there is a preponderance of vollies vs career folks can work, and does quite well. Should we be like that...no. But under CURRENT conditions, with a large number of vollies and the like, would it not be in our best interest to get a system up and running that would WORK to our advantage, and then change it as time goes on to be more "picture perfect?" Basically, compromise now to gain what we want in the long run.

One reason I firmly belive that EMS is so fragmented is because, for some reason we, as opposed to PD and even FD seem to have a more "eat our own" mentality, where harmony and loyalty seem to have taken a back seat to discord and individualism. If we can get a "single" voice for our ideas, then I believe that we would be more successful in our endeavors.

[sirduke]

[fiznat]

I like it Dust, but for the sake of argument let me play a little:

You suggest that we manufacture a demand for highly educated prehospital providers more or less by force. What gets lost in the translation is whether this truly is the best thing for our patients. Research suggests that the value of ALS in critically injured patients (particularly in trauma) may not be as high as expected. This value is further diminished with proximity to a hospital, which means that our most paramedic-dense areas (cities) are the same areas that need it least. Unfortunately, urban areas seem to be the only places capable of shouldering the financial and educational load that comes with ALS saturation. Your conclusion that "more is more" seems to be well founded observationally, but I'm not sure if the science would agree. Regardless of how much we'd like to rally and force a change for the betterment of ourselves, it might be prudent to give pause and reflect on the following truths:

1. Medicine is becoming increasingly expensive each and every day, which limits patients access to care.

2. Raising the educational bar of each intermediate step to "doctor" both increases cost and muddles continuity of care.

3. The value of a highly trained, ultra-advanced prehospital provider has yet to be verified. Nevermind our current level of ALS.

You are suggesting that we establish a system that costs more for a questionable benefit. I understand other professions have "made it happen" through organization and whatever else, but is this really the responsible thing to do?

Who's interests are we really looking after?