If you could change one thing in EMS .......................

[crotchitymedic1986]

I always think more education is a good thing, but let me play devil's advocate for a moment. In my area, the hours (class room) needed to gain paramedic certification was significantly increased a few years ago. The result was, emts who might have went for medic decided to go for nursing instead (more money, better benefits). The medic shortage got worse in the rural areas, so EMT B was allowed to occur (previously we only allowed EMT I). So the end result of longer educational requirements was "less" educated personnel in the field. If this were implemented nation-wide, why do you believe the result would be different ?

[spenac]

I always think more education is a good thing, but let me play devil's advocate for a moment. In my area, the hours (class room) needed to gain paramedic certification was significantly increased a few years ago. The result was, emts who might have went for medic decided to go for nursing instead (more money, better benefits). The medic shortage got worse in the rural areas, so EMT B was allowed to occur (previously we only allowed EMT I). So the end result of longer educational requirements was "less" educated personnel in the field. If this were implemented nation-wide, why do you believe the result would be different ?

Your system failed. It should never have lessened it's standards of care by allowing basics.

If all levels were done away with and as the others described all had real education, first patient care would improve, second pay would improve and those that really want to be prehospital medical professionals would get the education.

[fiznat]

but let me play devil's advocate for a moment....

The idea is that change doesn't occur as a single item in a static system. More education brings a higher level of care, which ostensibly brings more value to the profession in general. More collaborative respect with the hospital providers, higher pay, higher requirements, etc. Given how EMS works and is paid for in most places, though, I'm not sure that this progression would really happen. Why would private companies pay BA-holding medics reasonable wages when their reimbursement hasn't changed? How could they?

Oh, and there's still that whole issue questioning whether ALS even makes a difference for many of our patients... Would BA-educated medics really reduce mortality/morbidity in our communities? Nobody has really been able to say that yet.

If I could change one thing I would increase standardization and oversight amongst what we've already got. I don't see how we can advocate for anything more until we start taking ourselves (and our practice) seriously. That means introducing accountability and transparency to a system that severely lacks both.

[crotchitymedic1986]

OK, after reading another post, i have to change my answer. having an ISTAT machine (for those that do not know, it is a handheld lab machine that is accurate but expensive) on my truck so that i can get troponin levels, H&H, or a white count. That would definitely change the quality of care provided in the field.

[Dustdevil]

If this were implemented nation-wide, why do you believe the result would be different ?

What nation? Your flag doesn't jibe with your lingo.

Istat my arse. The vast majority of those in the field in the U.S. don't even know how to properly utilise the EKG or pulse oximeter yet. Gotta fix education first. Gear is WAY down the list of professional priorities.

[crotchitymedic1986]

I would argue that if you need a pulse ox to treat respiratory distress, you should go back to school. But I was trained before there was such a thing, so i am biased. And you have a good eye -- i am a yankee american in canada.

[Dustdevil]

Canadia is a big place. Can you be more specific? EMS quality varies greatly from province to province.

[crotchitymedic1986]

I do not practice in canada -- my part-time job i took in sales 10 years ago ended up paying more than my fulltime medic job --- i got transferred to the canada office -- havent been on a bus in 6-7 months.

[Dustdevil]

I do not practice in canada -- my part-time job i took in sales 10 years ago ended up paying more than my fulltime medic job --- i got transferred to the canada office -- havent been on a bus in 6-7 months.

Okay, that clears that up. Thanks.

I would agree that, if you need a pulse ox to treat respiratory distress, you need to go back to a better school. But that was not my point. My point is that the vast majority of medics in the U.S. know just enough about pulse oximetry to be dangerous. Same thing with EKGs. Sticking any other kind of labs in an ambulance (we're not particularly fond of the B-word on this forum) would only lead to the same dilemma. Paramedics refuse to even learn the basics. And schools refuse to teach it, because it would lengthen their class, which in turn causes prospective students to choose the shorter school over them. Or else because the FD won't let them lengthen the class with "all that book learnin'". Consequently, the bottom line is, most medics in this country are ill prepared for anything short of the very basics. Until we start requiring a degree level education out of our entry level medics, just forget extending our current capabilities in any way whatsoever. We've gone thirty-six years now, adding more and more to the curriculum, yet barely extending the time it is all taught in. That's not education. That's just an insanely inadequate advanced first aid cram course. And people with that little education are at the maximum of their potential until they get a lot more.

[crotchitymedic1986]

Amen to that, but i would shift the blame a little. In any business, 5-10% of employees are exceptional, 20% are just waiting to get fired, and the rest are somewhere in the middle. If you extend school to a 4 year program, you might be able to teach "everything" a medic might encounter in his/her career, but I am not sure you can guarantee it. I think a good bit of the blame falls on ems companies themselves and lawyers. The doctor kevorkians and drug abusers in our field just get passed from employer to employer instead of getting removed from the system all together. A better in-house orientation/training program would help those who are teachable, but many systems only have the most bare-boned and pencil whipped programs to educate their employees (I said many, not all).