Is There a Need for the Advanced Practice Paramedic?

[UMSTUDENT]

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.

Chest tubes are definitely not a DOT curriculum skill...

[Dustdevil]

It also does not sound like something I need to sit on a scene and wait for an "Advanced Practice Paramedic" to come attempt before getting on the road either.

[Arizonaffcep]

Its true. A tension pneumo can be treated very well with a needle decompression. For a hemo, we can't transfuse and can't fix the bleed. So, it's rather irrelevant anyway. If they had one, we wouldn't be able to adequately treat it anyway. Although it would be nice if we could do chest tubes and use them for autotransfusion.

[UMSTUDENT]

It also does not sound like something I need to sit on a scene and wait for an "Advanced Practice Paramedic" to come attempt before getting on the road either.

Agreed. I can see very few needs for such invasive skills in EMS. Looking at the APP as a glamor position is wrong. It should be more of a bridge between emergency interventionalist/primary care in the home.

[Dustdevil]

This APP thing is nothing more than the stupid "fly car" concept revisited. Paramedics will be relegated to being nothing more than first responders and transport monkeys for the glamour boys in the fly car. And again, patients will be stuck waiting for the care they need right now because the APPs don't want to be bothered by the mundane. There is nothing new, innovative, or progressive about the entire concept. It's the same old shyte they've been doing in the Northeast for decades with a different spin.

And again, we are not primary care. We are emergency care. Do you really want our name to change from EMS to PMS? Me neither. If it's not an emergency, it is none of our business. Not now. Not ever. We are decades away from even being minimally competent at providing emergency care. To even think that we could begin to undertake primary care on a large scale is dilusionally grandiose on an incredibly naive scale.

[Timmy]

In Australia we have Intensive Care Paramedics, Remote Area Paramedics and Extended Care Paramedics on top of the normal Road Paramedics.

The scope of practice and programs differ from state to state. Generally an ICP is able to initiate a lot of treatment that may happen in the Emergency Department, there only called to the sickest of the sick and rotate in a fly car, to a full ICP transport vehicle or medic/ICP. Remote Care Paramedics may run the medical clinic and ambulance in a remote area and Extended Care Paramedics can look after a lot of minor complaints that you commonly receive calls for that result in non transport.

ECP:

[web:0cfc048da0]http://www.ambulance.nsw.gov.au/media_publications/2008_pages/080829ecp.html[/web:0cfc048da0]

I cant really find any good information in regards to scope of practice or job descriptions for the ICPs and RAPs.

[UMSTUDENT]

And again, we are not primary care. We are emergency care. Do you really want our name to change from EMS to PMS? Me neither. If it's not an emergency, it is none of our business. Not now. Not ever. We are decades away from even being minimally competent at providing emergency care. To even think that we could begin to undertake primary care on a large scale is dilusionally grandiose on an incredibly naive scale.

I'm not talking about You or We, or Our. We'll be extinct in 40 years...at least in the form we see today. Stop worrying about "we" and worry about "them." The future...those guys and gals who will be educated and trained well enough to do the job.

My whole point is that prehospital emergency care as we see it today is a joke. It is 50% science and 50% nonsense that gets destroyed by hundreds of years of fire-oriented tradition. For every amazing innovation that our forefathers brought to our industry we diluted our mission with countless more "interventions" that probably don't make much of a difference in survivability when implemented in their current fashion.

Everything we do is good...just often not in the hands of the people we choose, or at the time we choose, or the place we choose. Look where our profession is going. Advanced interventions like intubation and needle decompression, when placed in the hands of this generation's paramedics, are harming more people than helping. First line ACLS drugs may be of little benefit if not delivered earlier than what we can currently achieve. Good, consistent CPR along with induced hypothermia is leading the way in cardiac arrest survival. ALS interventions that focus more on weighing the risk vs. simply doing. Acting prudently instead of acting quickly.

Research is suggesting that we better implement ourselves in the overall disease process.

1.Preventing disease through proper preventive care...wherever it can be administered.

2.Educating the public to initiate EMS services when they are most useful.

3.Responding in a timely manner.

4.Initiating interventions that can be safely performed in our setting with maximal benefit. That means weighing the cost of doing it in the field vs. doing it in a controlled setting. If time is really essential, then research and develop a means to safely eliminate and mitigate the risk in the field.

5. Developing new diagnostic technologies that can be deployed to the field.

6. DEMANDING higher professional standards. Higher education. Entry-level competencies.

[Dustdevil]

Nonsense. We cannot expand into the future until we perfect what we are already doing. You don't go to the university until you learn the basics in high school. Right now, EMS is still in pre-school, and you think we're ready for the future and more responsibility? They're sure blowing a lot of smoke up your arse there in the ivory tower. I know the ghost of Cowley reminds you everyday that you guys are the chosen ones, who are sent by God to lead us into the future. But the fact is, so far all you've done is f*ck up the present. Get real. Live in the present. Hell, if we could even catch up with the 20th century needs of EMS, that would be progress. And we have to prove that EMERGENCY medical service is a viable concept before we start adding primary care to our responsibilities.

This "better implement ourselves in the overall disease process" is utilitarian bullshit that rates right up there with the firemonkeys claiming that they should run EMS on the bullshit scale. We can't really spout that crap and then tell the firemonkeys that they shouldn't be running EMS with a clear conscience. If there is one thing I will not tolerate it is hypocrisy, and that's exactly what your idea is.

Pediatricians don't need to perform brain surgery to "better implement" themselves. Plumbers don't need to build bridges to "better implement" themselves. Auto mechanics don't need to fly airliners to "better implement" themselves. Even an engineer or general contractor has to hire specialists to perform all of the functions necessary to complete their projects. Professions that are successful are successful because they have focus. They do one thing and they do it well. They don't try to be all things to all people. That is a recipe for FAIL. And for pushing it, I hereby deem you "Jack Off All Trades."

EMS is not a difficult concept. There really isn't that much to it. How the greatest nation on Earth has managed to f*ck it up so badly is a testament to the chaos of democracy. Your idea that we should further complicate it before we even master the basics is the stupidest nonsense I have ever heard here on this forum.

[UMSTUDENT]

Nonsense. We cannot expand into the future until we perfect what we are already doing. You don't go to the university until you learn the basics in high school. Right now, EMS is still in pre-school, and you think we're ready for the future and more responsibility? They're sure blowing a lot of smoke up your arse there in the ivory tower. I know the ghost of Cowley reminds you everyday that you guys are the chosen ones, who are sent by God to lead us into the future. But the fact is, so far all you've done is f*ck up the present. Get real. Live in the present. Hell, if we could even catch up with the 20th century needs of EMS, that would be progress. And we have to prove that EMERGENCY medical service is a viable concept before we start adding primary care to our responsibilities.

This "better implement ourselves in the overall disease process" is utilitarian bullshit that rates right up there with the firemonkeys claiming that they should run EMS on the bullshit scale. We can't really spout that crap and then tell the firemonkeys that they shouldn't be running EMS with a clear conscience. If there is one thing I will not tolerate it is hypocrisy, and that's exactly what your idea is.

Pediatricians don't need to perform brain surgery to "better implement" themselves. Plumbers don't need to build bridges to "better implement" themselves. Auto mechanics don't need to fly airliners to "better implement" themselves. Even an engineer or general contractor has to hire specialists to perform all of the functions necessary to complete their projects. Professions that are successful are successful because they have focus. They do one thing and they do it well. They don't try to be all things to all people. That is a recipe for FAIL. And for pushing it, I hereby deem you "Jack Off All Trades."

EMS is not a difficult concept. There really isn't that much to it. How the greatest nation on Earth has managed to f*ck it up so badly is a testament to the chaos of democracy. Your idea that we should further complicate it before we even master the basics is the stupidest nonsense I have ever heard here on this forum.

Damn you're bitter. That's why I love you Dust.

I've never disagreed with you. I think, minus the rhetoric, that you're 90% correct. I really do deeply agree with you.

I think you should really scrap EMS all together Dust. It's done. It's failed you. That's where we differ. You can't undo what's been done to it. You just have to manuever around it. Make giant leaps in order to preserve a dream.

As for Cowley's Ghost Comment:

You know a lot about us...a lot actually. BUT, I should be the first to tell you that a lot of people messed up that dream. It's not like that anymore and I wasn't taught that way. The stuff you hear is mine alone, not someone else preaching.

I love these arguments because somewhere I believe that it'll be these arguments, one day, that will be had in conferences. Stats, tables, PowerPoints. Yep. Some day people like you and me won't be confined to message boards.

Same vision. Different experiences. Different outlooks.

[Dustdevil]

I think you should really scrap EMS all together Dust. It's done. It's failed you. That's where we differ. You can't undo what's been done to it.

That's very definitely where we differ. I think you can scrap it. I don't think we have to follow the same path we've always followed simply because we've always done it that way. Barbers used to practise dentistry in their chairs only a century ago. Was it wrong for the dentists to scrap that and establish a more focused professional specialty? Come on. What would be the upside of clinging to the failed policies of the past? Yes, you have to remember history in order to avoid repeating it, but that is the only useful purpose the last three decades of EMS have served: to show us how not to do it.