New Standards/Levels

[RavEMTGun]

WTH is a semester hour? Every college I know of in the US uses semester credits... so a typical class is 3 credits meaning you meet for 3 hours a week...

Semantics. "semester hour" = "semester credit"

Most colleges operate on a 16 week semester and therefor, 1 credit = 16 contact hours. That is excepting labs where you usually get half credit for time spent... or less...

But I agree with Dusty... hours don't mean jack shyt if the instruction is piss poor. I know some colleges who I wouldn't trust the quality of their degrees at all but they're still universities and colleges.

No debate there. And certainly, poor instructor quality is a major issue in EMS.

But is time a worthless measure? ABSOLUTELY NOT

Take two equal professors and give one 48 hours to teach his students Algebra and one 16 hours to teach his students Algebra, guess whose students are going to be better (assuming the students are equal).

Now take two equal EMS educators and give one 200 hours and another 400 hours. I bet they can take that extra 200 and put a lot good information to help their students understand WHY they are doing what they are doing in the protocols which will make them better care givers. As well, they'll have more time for their students to do proctored practice. So all students being equal, which class is going to create the more competent provider? I'd place money on the longer one.

As it is EMS classes are too short to cover, for example, in depth pathophysiology. Wouldn't TIME to teach that be a GOOD THING? Or more advanced A&P? Or pharmokinetics?

And why are you opposed to 300 hours of education being the minimum standard? Is it not better than 120?

Great question. Actually, I said:

I'd rather see an EMT-B class that was 300 hours long instead of making the basic level of EMS a 300 hour EMT-I99.

I preferred 300 hours, but I'd rather have the 300 hours spent creating a provider with a smaller scope, but who understands their medicine better vs a provider with a larger scope who understands it less.

Of course the ultimate goal is to get the provider with the larger scope who understands it better. But that takes even more TIME, effort, intelligence, and ultimately money.

Edited October 15, 2009 by RavEMTGun

[EMT City Administrator]

Lets put the personal attacks aside and debate without them.

[VentMedic]

Semantics. "semester hour" = "semester credit"

Most colleges operate on a 16 week semester and therefor, 1 credit = 16 contact hours. That is excepting labs where you usually get half credit for time spent... or less...

Incorrect in your analysis. You are viewing the college semester credit hour as the equivalent of "tech school" where the expectation is counted as literal clock hours.

The number of credit hours assigned to a course quantitatively reflects the outcomes expected, the mode of instruction, the amount of time spent in class, and the amount of outside preparatory work expected for the class. These consistencies have made it possible for accrediting groups to compare programs at multiple institutions. Additionally, federal and state reporting requirements can be analyzed, achieved, and communicated.

For lecture, each classroom hour is expected to have 2 hours of prep work.

For lab, each credit hour can be up to 200 minutes per week or almost 4 hours.

For clinic, each credit hour can be up to 300 minutes or about 5 hours per week. Thus, a 3 hour class is about 16 hours of clinic per week.

When you look at tech school clock hours, they are usually literal. Also, when someone says their program was 2 years long but only 700 hours, there but is a 1 night per week 2 hour class, there is no comparison to a college credit system with the work of an Associates degree.

Thus, when legislators attempt to evaluate worth, the clock hour system is not feasible.

The other advantage of a college system is the different in educator education. The instructor must meet minimum educational requiremments. Thses same standards are lacking in the tech schools.

Edited October 15, 2009 by VentMedic

[VentMedic]

In a perfect world, everyone should be a licensed, "college" educated WITH a degree, advanced life support provider. But put into perspective where how often you actually NEED an ALS. Not many providers will want to use their education hauling cheese or normal run of the mill BLS. Then again, you won't really know if you need ALS or not, unless ALS assesses the patient.

If the U.S. BLS was the equivalent of BLS in other countries, this would not be such as issue. Those in the U.S. who try to argue for BLS have attempted to use the OPALS studies which used the BLS qualifications for that area of Canada. Their education and training is longer than the ALS Paramedic in the U.S.

Increasing our BLS eduation and eliminating "inbetween" levels must happen to see any advancement in the U.S. system. The patchwork, make do stuff has go to be eliminated.

Education requirements didn't go far enough. The biggest mistake made was not divesting non-emergency medical transport from emergency medical services. These two fields are separate with different patient populations and different needs. Neither is more important or better than the other just as RNs, RTs, and other allied health can't be compared in terms of importance or better. Once you remove non-emergent medical transports from EMS you remove one of the big reasons for keeping the EMT-B level around.

The EMT-B is wrong for MEDICAL transports. The medically complex patients need someone who is educated/trained for medical situations with knowledge of disease processes and not a first aider. The EMT-B's clinic time would also be better spent with a hospital nursing assistant logging in a couple hundred sets of vitals on many different types of patients as well as learning to move medically complex patients with brittle bones and many tubes or lines. The skill of communication between provider and patient might also be acquired. Sitting around a coffee pot waiting for a cool trauma call that may never happen or hanging out in the corner of the ED serves very little purpose for educating/training one to adequately and appropriately care for a sick elderly patient. The fact that many will transport several dialysis patients in their trucks but can not tell you why the patient is on dialysis except for "renal failure" or know why some of these patients do need an ambulance speaks volumes of the inadequacies in the EMT training for the job of medical transports.

[P_Instructor]

Thank you for the 'discussion' whether it be a little personal or not. I have come to realize that each state will have to adopt the standards that will meet there regional requirements. This may very difficult for some states to adhere to. In my opinion (as of now), the process is to clean up the current mess that is out there. If everyone can get to a standardized format, the EMS nation as a whole may progress forward, however this will take time and a lot of effort. It is about time to bring everyone back in line and not let states go rampant with what they want personnally. Again, my opinion only and looking forward how this hopefully will improve even better the EMS field response.

[HERBIE1]

Like nearly everything else discussed here, looking for a universal answer is impossible in this business. We can't even agree on definitions of semester hours. To require anyone in EMS to be a paramedic is simply not practical. Think about the different systems all around the world. Some services operate with a doc on board, some or 2 medics, some are BLS, some are a combination of all of the above. Some areas simply do not have the resources to have an all ALS system. Isn't it better to at least have providers with SOME medical training vs having nothing at all?

As we all know, despite national standards here, all EMS programs are NOT created equal. Some are medic or EMTB mills who's goal is to crank out as many folks as they can. Requiring a degree program is not the answer either. The quality of the instruction is not based on how many classroom hours you put in(although obviously more would probably be better), but the reputation, ability, and character of the instructors and program coordinators.

Even medical schools vary- think about how a doctor who graduates from a Caribbean medical school is viewed by his peers. They could be a brilliant clinician, but will always have a stigma attached to their education.

We could demand that a person must spend an unworldly amount of time in classroom and in training for EMS, and even require a college degree, but unless there is a payoff at the end- ie the person can make a decent wage once they are done, we won't be able to provide enough bodies to fill those spots.

[cosgrojo]

Hours or credits.... really? Neither matters. Arbitrary units of measure do not define the quality of the education. There are tech schools that are just as good if not better than college and university schools. As someone who went to a traditional college (with a good reputation) and graduated with a BS in BAD, I can tell you I was quite under-impressed with my educational experience. I have taken classes at "Tech" schools since and currently teach for a "trade" school, and feel that the education provided is on par or better than that of traditional colleges. The people who are teaching at these trade schools teach with more passion then their tenured counterparts... and it makes a difference.

It is the curriculum that matters... it is the quality of the educator that matters... and it is the quality of the student matters. Now I understand that these factors are not really able to be broken into easily deduced numerical values, and thus makes it difficult to quantify, but they should not be ignored because it is easier to. My feeling is that any educational endeavor that its' quality is judged by the "credits" or "hours" it takes to complete it, is probably not worth taking it. I don't care if your basic class took 120 hours or 400 hours... if you know what you are supposed to know and you have been taught even the slightest bit of professionalism, then you are OK to ride with me.

While I am all for increased education and increased standards, I do not buy in to some of the elitism that we some times espouse in conversation here at the city( of which I have participated). I read a lot about bashing "medic-mills" and "tech schools," and while I understand why we don't like them, sometimes I get the feeling that we are downgrading the providers just for having taken that program. I do not believe that the program or the school makes the provider. Any educational experience is what you make of it. Sure it can be easier if the program is top notch, and your instructor is top notch, but they don't have to be for a student to take the bull by the horns and overcome the inadequacies of their program. If I were to start tomorrow to read every paramedicine book that there is, completely engross myself in learning everything about being a paramedic, would my knowledge mean less because I didn't have an "instructor" tell me to read it? Of course not... knowledge gained is knowledge gained. Obviously, I would be violating many laws, and possibly some civil rights, if I were to take the practical portion of it into my own hands... but I think reasonable people will see my point... which is... judge a provider on his own merits first, then move on to figuring out who is to blame for their quality.

This was not directed at anyone by the way... just a rant I've been feeling coming on for a while, and it kinda fit into this discussion. This is more of a self-check than it is a referendum on anyone else.

Thank you, and have a nice day!

[46Young]

My FRD has always considered I's and P's the same for all intents and purposes. The problem is with the difference in knowledge base between the two. There are many areas in the US where an EMT I-85 or I-99 many be the only game in town. Some say that if EMT-P becomes the entry level position, mandated by federal law, then these local Govt's will somehow find the money to compensate degreed medics. I'm not so sure. It's like trying to squeeze blood out of a rock.

[P_Instructor]

I do not believe that the program or the school makes the provider...Any educational experience is what you make of it.... I think reasonable people will see my point... which is... judge a provider on his own merits first, then move on to figuring out who is to blame for their quality.

Thank you. As an instructor of a tech college, it is my job to provide guidance to the student so they can fully comprehend what being a paramedic is, all facets......It IS what the student makes of it. If they know their 'worth', and are willing to learn, they will do fine. If an instructor cannot do their job, the student will suffer and the public will suffer, maybe......the key as you stated is judge them on their merits, but be careful moving on to figuring out who is to blame, as this will most likely be the student themselves. Thanks for the 'vent'.

[HERBIE1]

Hours or credits.... really? Neither matters. Arbitrary units of measure do not define the quality of the education. There are tech schools that are just as good if not better than college and university schools. As someone who went to a traditional college (with a good reputation) and graduated with a BS in BAD, I can tell you I was quite under-impressed with my educational experience. I have taken classes at "Tech" schools since and currently teach for a "trade" school, and feel that the education provided is on par or better than that of traditional colleges. The people who are teaching at these trade schools teach with more passion then their tenured counterparts... and it makes a difference.

It is the curriculum that matters... it is the quality of the educator that matters... and it is the quality of the student matters. Now I understand that these factors are not really able to be broken into easily deduced numerical values, and thus makes it difficult to quantify, but they should not be ignored because it is easier to. My feeling is that any educational endeavor that its' quality is judged by the "credits" or "hours" it takes to complete it, is probably not worth taking it. I don't care if your basic class took 120 hours or 400 hours... if you know what you are supposed to know and you have been taught even the slightest bit of professionalism, then you are OK to ride with me.

While I am all for increased education and increased standards, I do not buy in to some of the elitism that we some times espouse in conversation here at the city( of which I have participated). I read a lot about bashing "medic-mills" and "tech schools," and while I understand why we don't like them, sometimes I get the feeling that we are downgrading the providers just for having taken that program. I do not believe that the program or the school makes the provider. Any educational experience is what you make of it. Sure it can be easier if the program is top notch, and your instructor is top notch, but they don't have to be for a student to take the bull by the horns and overcome the inadequacies of their program. If I were to start tomorrow to read every paramedicine book that there is, completely engross myself in learning everything about being a paramedic, would my knowledge mean less because I didn't have an "instructor" tell me to read it? Of course not... knowledge gained is knowledge gained. Obviously, I would be violating many laws, and possibly some civil rights, if I were to take the practical portion of it into my own hands... but I think reasonable people will see my point... which is... judge a provider on his own merits first, then move on to figuring out who is to blame for their quality.

This was not directed at anyone by the way... just a rant I've been feeling coming on for a while, and it kinda fit into this discussion. This is more of a self-check than it is a referendum on anyone else.

Thank you, and have a nice day!

Good post. I will say that WHERE a person is educated can give them an advantage. The reputation of a school- JR college, university, technical school, or trade school is important. It generally means there are some minimum standards- generally better than other places- that a student must meet in order to successfully complete their program.

That said, the old adage of you can get a great education at a lousy school, and vice versa- is true. You get what you put into anything. I've had people swear that they love a certain hospital that has a lousy reputation, and I've seen things at supposedly top notch, world class facilities that would make your hair turn white.

I agree about judging folks on their own merits. The school they attended is irrelevant to me- unless they demonstrate some deficiencies you need to correct, and then you need to go back and determine if the problem is with the student or the instruction they received at the school. In my experience with EMS providers, the school is not usually the problem.

Thank you. As an instructor of a tech college, it is my job to provide guidance to the student so they can fully comprehend what being a paramedic is, all facets......It IS what the student makes of it. If they know their 'worth', and are willing to learn, they will do fine. If an instructor cannot do their job, the student will suffer and the public will suffer, maybe......the key as you stated is judge them on their merits, but be careful moving on to figuring out who is to blame, as this will most likely be the student themselves. Thanks for the 'vent'.

Agreed. We posted at the same time and said essentially the same things.

Great minds, and all that...