Is There a Need for the Advanced Practice Paramedic?

[john_boston]

Dust - Agree with your thoughtful anaylsis. When you're not tearing into others on here, you're a pleasure to read.

[Riblett]

Ha Ha. No offense intended for the poster, but that "idiot" as he was so eloquently referred to, would be Dr Brent Myers.

Dr Myers is, in my opinion, one of the greatest emergency physicians to ever carry the title. He also probably the most EMS-friendly, clinically and professionally supportive medical directors in this country. He is personally involved in the education of all technicians within the Wake EMS system, and I don't mean as a pencil pusher. He personally makes sure each and every ALS practitioner working in his system is competent to his standards, which are far above the state or even national level. As a Medical Director who absolutely abhors cook book paramedicine, he teaches his own monthly continuing education for those of us within the Wake EMS System. The man is so dedicated that he is out on his "MD-1" QRV unit checking in on calls and assisting his paramedics and EMTs. And he consistently shows us that he does not believe any task is below him in the field.

I will admit that his APP program still has some kinks to be worked out, what new program doesn't? But from seeing the list of his 15 or so medics that he selected for this project, it already has a really good start. Just like the fact that all EMS practitioners should be Nationally Registered Paramedics, with 4 year degrees, and adhere to the utmost highest level of clinical competence, all paramedics should indeed be trained to this Wake EMS APP standard. But the reality is, we are not. Not here, probably not really anywhere. But give the man some credit for having a vision, reaching for a higher standard, and attempting to advance the profession.

[Dustdevil]

If he's not an idiot, he at least has a poor grasp of the English language.

There is nothing "advanced" about what he proposes. Nothing at all. It is standard curriculum in many paramedic schools.

Anyone who wants to dumb down the majority of medics in order to call a remaining few "advanced" is an EMS idiot in my book, I don't care what his education is. Knowing medicine and knowing EMS are not synonymous. Feel free to tell him I said so and give him my address.

[Riblett]

Hi Matt,

I think the focus for the APPs, as far as intubation is concerned, would be the ability to RSI. This is currently not part of the Wake Co EMS protocols. It has been my experience thus far (for better or worse), that the tube is always done by the newbie with the presumption that they need the skill. If they are unwilling or unable the more experienced tech will do it.

[scott33]

I like the idea of being able to treat and release rather than transport.

Why not treat and aminister enough meds to get them to the next business day to follow up with their regular doctor?

I think this will lead to higher education required. Higher pay for added responsibilty. A cut back on transports, making ambulances more quicly back in service for real emergencys.

Agreed.

Regardless of how its set up we must have the right to deny transport to those that are non emergent. If you do not have enough education and common sense to determine if it is a true emergency you need to get out of my profession.

Sure - as long as your employer, who will probably stand to lose $$$'s with every non-transport, and the physician who's license you are making these decisions under, are on the same page as you are.

I fully support the treat and release / treat and refer model of EMS delivery, but do you see the catch?

[UMSTUDENT]

If he's not an idiot, he at least has a poor grasp of the English language.

There is nothing "advanced" about what he proposes. Nothing at all. It is standard curriculum in many paramedic schools.

Anyone who wants to dumb down the majority of medics in order to call a remaining few "advanced" is an EMS idiot in my book, I don't care what his education is. Knowing medicine and knowing EMS are not synonymous. Feel free to tell him I said so and give him my address.

Dust, seriously. I've never known you to be politically correct or anything on this forum, but damn.

I respect Dr. Myers for many reasons. I respect that he is a medical director who was trained in an EMS fellowship first and foremost.

Second, I respect what he is trying to do. You're absolutely right. You and I both know that skills like drug assisted intubation and transport decision making are things taught in a good paramedic program.

My thinking is that Dr. Myers needs to sell this idea to the public. Whether you agree with it or not, the home is where the paramedic's future is. The current system doesn't work. We spend more money annually on health care than any other western nation with continually disappointing results. My idea, at least from I was taught about public health, is that there is probably a deep socioeconomic and cultural divide between our version of Western Medicine and what will really work given our diverse, American population. The future will be about mitigating injury and illness and about approaching illness during it's most infant phases...where it first happens.

Call it stupid. You may be right. Call it misguided. You might be right. BUT, there has to be some sort of professional preservation, or our profession, the "largest hoax ever foisted on the American People", will be erased into history as nothing more than an experiment. The Ontario Prehospital Study was the beginning. More and more research will begin debunking our practice. Our fall will be a combination of poor intuition (skills that don't work, but made sense) and poor professional standards (idiots making us all look stupid). Our profession is full of unprofessional fools and fire monkeys who are degrading the meaning of being a paramedic every day and nursing, with its far more elaborate professional representation, is simultaneously assisting us in this goal.

Someone is going to get smart and start doing research into the efficacy of every, tiny thing we do. And one day, while we were all sitting on a couch in a station, someone's going to publish our end. Someone is going to prove that 85% of what we do offers no decrease in mortality or morbidity when done in the prehospital environment. Not because it is categorically true, but because when these skills are given to the majority of providers...people die faster/have worse outcomes. It will be a world of BLS...

APPs with advanced education for an advanced health care solution. I hope they do have Master's Degrees. Hell, I hope they're fully licensed PAs. Whatever that means...it means more education. It means producing a future of kids who grow-up, go to college, and become professional, educated paramedics. Somewhere I believe there will be better health care.

If we keep drinking our Koolaid, we'll be pushed under the rug. Nurses started out as nothing more than assistants to physicians and now represent one of the most respected professions in the world. Hm, somewhere they even convinced the world to let them have individual practice. I'm not suggesting such grand things, but I am suggesting advancement.

[Spock]

I have to side with Dust on this topic. The basic paramedic program must be more consistent across the board and the diploma mills need to go away but I would say the same for nursing diploma programs since I believe the BSN should be the entry level degree for all RN's. I wouldn't say a BS should be required for paramedics because the pay would not rise along with the degree but I see nothing wrong with an associates degree for paramedics.

I wouldn't be quick to compare the US with what is done overeas. The medical and legal systems are different and comparisons are difficult. I'm not saying one system is better than the other just that they are different. Patient expectations are also different. I'm certain the US system could be improved and I suspect our colleagues overseas would say their systems could also stand improvement.

Live long and prosper.

Spock

[MSDeltaFlt]

Advanced Practice Paramedics, I believe, should be able to bring critical care to EMS. RSI, surgical crics, chest tubes, vents, yadda, yadda, yadda should all be made available.

[Arizonaffcep]

Advanced Practice Paramedics, I believe, should be able to bring critical care to EMS. RSI, surgical crics, chest tubes, vents, yadda, yadda, yadda should all be made available.

But...as a "regular medic" the only one of those I can't do is a chest tube. DHS says we can't touch those.

[Dustdevil]

But...as a "regular medic" the only one of those I can't do is a chest tube. DHS says we can't touch those.

Seriously. All that may sound "advanced" to a 13-week Southern California medic, or a shake-and-bake NEMSA medic from Louisiana. But to me it sounds like the entry level for professional practice.