emt_hound Posted August 8, 2005 Posted August 8, 2005 Hmm...good question. I don't honestly know...but probably the nature of emergency medicine makes people fear roving, independent EMT's operating outside the scope of a medical director.
EMS-Cat Posted August 8, 2005 Posted August 8, 2005 Okay, I probably didn't word that right. I'm not talking about practicing outside of the scope of medical direction, I'm talking about simply being able to renew my state license without being 'owned' by someone. I can't practice respiratory therapy under my RT license without medical direction, nor can I do nursing care under my nursing license without an MD writing orders somewhere. But I can give the state my money and get my license renewed so long as I keep my cont ed credits up, don't break the law, etc. I don't even have to keep private malpractice insurance. But here in the state of Washington, you can't get/keep/maintain an EMT-B, EMT-I or EMT-P license if you don't have a 'sponsor'. In my case, yes I do have one. It's the American Red Cross. But they don't have a local medical director I work under, they're simply the folks who have said 'Yeah, she can belong to us' - right now I professionally fall under the MD for the county EMS system. [Not sure what happens if I end up going somewhere/doing something - I'm sure the ARC has something in place, I just don't know about it yet]. And all they do is 'sign' off my 'request for state license' as my 'sponsor' [isn't that such a great, nebulous term? Sponsor?]. They are not my employer like a hospital, an ambulance service or the fire department would be [even a volunteer fire service]. I simply exist under their 'umbrella' because the State has to have that space on their 'request for license' filled in. But they don't *do* anything: keep cont ed records, require me to attend in-services, etc. I do all of that myself. To repay them for their sponsorship [and don't get me wrong, I am *most* glad I have it otherwise I couldn't get back into EMS right now], I owe them "X" number of hours in a year. And those don't even have to be doing EMS - they could be stacking boxes in a warehouse, typing and filing in the office, etc. So, why can't I do the same for my EMT, et all? Why do I have to 'belong' to someone to simply pay the state money? I have no problems with the need for cont ed and I know it's my responsibility to find it and get it. So as long as I meet the binding cont ed requirements, what's the harm in my simply 'getting my license'? Interesting food for thought.
Summit Posted August 8, 2005 Posted August 8, 2005 I present the 72 semester hour AS Advanced EMT: (I was nice and made it four full semesters) Semester I English Comp I 3hr College Algebra 4hr Biology I /w lab 5hr Chemistry I /w lab 5hr Medical Terminology 3hr 20hrs Semester II A&P I /w lab 5hr General Pyschology 3hr Public Speaking 3hr Physics I Algebra based /w lab 4hr Nutrition 3hr 18hrs Semester III A&P II /w lab 4hr Pharmacology 3hr EMT Didadtic 5hr EMT Practical 6hr 18hr Semester IV Pathophysiology 4hr IV Therapy 2hr (compressed at the beginning) Basic EKG 2hr (compressed at the beginning) EMT Hospital Clinicals 5hr (after IV/EKG) EMT PreHospital Clinicals 5hr (after Hospital) 18hr Clinicals would be 200hrs. That first semester will suck without AP credit... but it is guaranteed to weed out the riff-raff. Course crediting: Algebra - Test out AP A&P I&II min score 9 cumulative (5 on one, 4 or 5 on othe other) AP Bio minimum 4 AP Chem minimum 4 AP English minimum 4 AP Physics (B exam 4) (C exam 3) *puts on flame proof suit* (but before you flame me too hard I do have 13/18 of those classes, I'm a Basic)
EMS-Cat Posted August 8, 2005 Posted August 8, 2005 I present the 70hr AS Advanced EMT: Semester I ENG 101 English Comp I 3hr MAT 101 College Algebra 4hr BIO 101 Biology I /w lab 5hr CHE 101 Basic Chem /w lab 5hr PHY 101 Physics Algebra I /w lab 4hr 21hrs Semester II BIO 201 A&P I /w lab 5hr EMS 201 EMT Didadtic 5hr EMS 202 EMT Practical 5hr EMS 135 IV Therapy 2hr HPR 104 Nutrition 3hr 20hrs Semester III BIO 202 A&P II /w lab 4hr EMS 160 Simple Pharmacology 2hr BIO 240 Patho Physiology 4 HPR 190 Basic EKG 2hr EMS 210 Clinicals 8hr 20hr Summer semster (betwee I & II or II & III) PSY 101 Gen Pysch 3hr COM 101 Public Speaking 3hr HPR 105 Medical Terminology 3hr 9hrs Clinicals would be 150-200hrs. That first semester will suck without AP credit... but it is guaranteed to weed out the riff-raff. Course crediting: Algebra - Test out AP A&P I&II min score 9 cumulative (5 on one, 4 or 5 on othe other) AP Bio minimum 4 AP Chem minimum 4 AP English minimum 4 AP Physics (B exam 4) (C exam 3) *puts on flame proof suit* (but before you flame me too hard I do have 13/18 of those classes, I'm a Basic) Not going to flame anyone. I'm just running the lists and coming up with: Already have [in a couple of cases at least twice - RT, nursing, ACLS plus an ATA on comp programming/system analysis and had to take several of these 'again']: ENG 101 English Comp I 3hr - MAT 101 College Algebra 4hr BIO 101 Biology I /w lab 5hr CHE 101 Basic Chem /w lab 5hr PHY 101 Physics Algebra I /w lab 4hr BIO 201 A&P I /w lab 5hr EMS 135 IV Therapy 2hr HPR 104 Nutrition 3hr BIO 202 A&P II /w lab 4hr EMS 160 Simple Pharmacology 2hr BIO 240 Patho Physiology 4 HPR 190 Basic EKG 2hr PSY 101 Gen Pysch 3hr COM 101 Public Speaking 3hr HPR 105 Medical Terminology 3hr So, that effectively leaves EMS 201, 202 & 210 out of this program that I can't say I've 'done' [except maybe for the clinical]. I just worked out the number of hours I spent getting my EMT-B: 112. That's not counting 10 hours of clinical ER rotation or the 8+ hours of finals [written and team practical] or the state written exam. Add those and it comes up to over 130 hours. For an EMT-B. No EKG's other than what we cover in AED [and our instructor did go over basic rhythms - he didn't have to but he expects us to be the Paramed's extra hands and knowledge never hurts], basic EMT meds and how they interact with everything else [in my county we use O2, gluc, charcoal, epi, ASA and assist with MDI's and NTG], we do finger sticks as part of our county protocol, etc. This was 130+ hours of nothing but EMT. No speech, nothing else. So, based on what you've presented, I should be able to add three classes to what I already have on record and qualify for my 'advanced EMT' [not sure what you mean by advanced - EMT-I maybe? Our EMT-I's tube and start lines.] Now, I have no problem if this scenario would work out - just tell me where you live and I'll be on the next bus there [ ] . And I realize I'm probably the exception to the rule, but let's face it. I'm in the 50's, want to get back into EMS to teach and don't want to spend an arm and a leg [and my pocket book] going back to school for 2+ years to redo and re-validate stuff I can already prove I know and can do. So yeah, I want there to be an acceptable 'option' for us 'Old Farts' who have been around since an MA-1 was a brand new ventilator, nobody knew what the hell PEEP or CPAP was and the idea of "Medic One' and the 'Medic Two - citizen CPR program' was just getting off the ground. There's not a lot of us out here, but we've got a personal database of 'real life' that could be helpful and useful out there in the 'Real World' [tm]. I'm sure it sounds terribly selfish to all you young bucks out there, but life is like that sometimes.
Summit Posted August 8, 2005 Posted August 8, 2005 'advanced EMT' [not sure what you mean by advanced - EMT-I maybe? Our EMT-I's tube and start lines. "AEMT" or whatever you want to call it (just plain old EMT) replaces EMT-B and EMT-I. Would have a national scope and training for: Skills (above and beyond what basics do with possibility of standing order or most/all): IV/SC BGL Sellik Nebs CPAP Combitube 3-Lead Monitoring (no interp) Formulary: O2 NO Albuterol Atrovent Atropine/2Pam Autoinjector Epinephrine SC Diphenhydramine Naxalone Glucose Charcol ASA (anaglesic and for CP) NTG Glucagon D50 D5W LR NS More advanced assesment. Etc.
EMS-Cat Posted August 8, 2005 Posted August 8, 2005 I like! I could go for this. Is it just in the planning-chat stage or is it getting off the ground? Who'd be the certifying body? Local? State? Fed? NAEMT? You've deff. got my interest.
Summit Posted August 8, 2005 Posted August 8, 2005 I like! I could go for this. Is it just in the planning-chat stage or is it getting off the ground? Who'd be the certifying body? Local? State? Fed? NAEMT? You've deff. got my interest. HOLY CRAP THIS IS JUST A FANTASY! A good idea. I think it should be a goal of a EMS lobbying agency.
vs-eh? Posted August 8, 2005 Posted August 8, 2005 Summit, Comments: IM - should be added IV - I assume you allow bolus in that, with respective chest assessment q volume CPAP - do alot of services really carry CPAP? 3-lead - meh, with that drug list you should really have the education of 3-lead interpretation. 3-lead means very little anyway. 12-lead - you can do them, just not interpret Atropine - is that for symptomatic bradycardia? or just cholinergic toxidrome? I would be open to treat for symptomatic brady Epi - we give it for croup here as well. If you like that as an option Dimenhydranate - I be open to this NTG - I assume first time ntg is ok with the line? for chf/pe as well? Narcan - I still don't understand why narcan is such a big drug elsewhere. We rarely use it, and those times we do it is for known/suspected acute opioid use (i.e. peds) or as a reversal for failed facilitated intubation. But anyways.... Looks good.
EMS-Cat Posted August 8, 2005 Posted August 8, 2005 Great fantasy! Keep me in your dreams, will ya? :wink:
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