New Standards/Levels

[fireflymedic]

Okay I think I'm going to give a weigh in - I was waiting until the peeing match was over.

First off as many have said, your education is only what you make of it and continue to make of it. Frankly in EMS we are too lazy about moving forward and learning after we are done with class. When you sit down and think about it - how many people do you know that are making that last mad rush to get their CEU's in before their certs are due? We talk of continuing education which should always be happening, not wondering if at the end of the year if we have enough. Someone dedicated to their education should be in more than excess of the required hours (they're not that many anyway).

I'm a big advocate for degreed medics. However, there are some non degree programs which are almost as thorough as a college program only minus the "fluff" classes thrown in there. Granted they are few and far between, but they are out there. And yes, I don't see the purpose of a women's literature class for a degree in paramedicine. I am a bachelor degree medic and I think how much better the focused associates degree would have been to pursue - less time and the same quality of classes for the degree. All of the same exact classes would be required within the paramedic program. Just a lower amount of general education courses. So are those medics any less quality than me? Are they any better quality? I don't know - it's only what they made of the program. There is also a certification option within the college that eliminates all the general education classes minus the paramedic program pre reqs (anatomy/physiology 2 semesters, basic english, college algebra, cardiology, pharmacology, and medical ethics). So as far as prep and program content - all of it's the same, just the number of general education courses varies. There are some great instructors there and some fantastic medics and some really sorry medics. Entirely dependent on the work the student puts in. Ultimately we are not arguing for a piece of paper - we are arguing for improvement of education. Be that with or without a degree in place, if that improves, we have taken a drastic step forwards.

Finally as far as the AEMT/Intermediate level. I have mixed feelings on this. I do see it as a way to cheapen ALS, but I also see it as a way for extremely poor counties to cheaply upgrade their services when they cannot afford not only the cost of hiring medics (which everyone discusses) but the cost of supplying drugs, additional materials, etc. Many counties in this area run multiple BLS trucks and one medic per shift. They stay very busy and often are left struggling caring for a critical patient with no options other than basics. However, I do see a potential problem of further cheapening EMS, especially for the larger services that can afford dual medic trucks currently. I can see them no longer putting dual medics on a truck, but rather two AEMT/intermediates. Playing devil's advocate a bit though - how many calls require true ALS interventions? Many times we just place them on a monitor, put in an IV and that's all. For counties struggling with the option of downgrading service to BLS, or even potentially even closing their doors and becoming volunteer or passing the buck to surrounding counties (which yes, it's happened here) due to poor economic conditions, then this may be a viable option. There are several services in this area which have a low run volume, and are struggling to make it day to day. Pay has been cut as low as it can go, and the days of medics working for 8.00 an hour aren't gone in hopes of keeping the doors open. It's different when you're in a very rural area and when you are in the city with larger resources. Long term, I don't see it affecting the ability of medics to get a job as if we increase the education it will open even more doors for them to go into.

Ultimately, yes some services are going to see this as an opportunity to increase profit while minimizing cost hiring lower qualified ALS through the AEMT/Intermediates. I would be interested though to see if the billing structure changes as well for reimbursement. Something to consider.

Edited October 15, 2009 by fireflymedic

[VentMedic]

We can't even agree on definitions of semester hours.

No misunderstanding there. All one has to do is look at almost any college catalog as I did for the definition and explanation. Usually those that have not spent time in a college might not understand the difference between "tech school clock hours" and "college semester credit hours".

To require anyone in EMS to be a paramedic is simply not practical.

To require every FF to be a Paramedic is not practical. To require someone to be a Paramedic without all the inbetween steps is the only professional thing to do. There shouldn't be the "sorta like but not really" patches that have cluttered the profession. You either want the responsibility of being a Paramedic or you don't. Of course, the AEMT is an improvement for entry level but no more EMT-Is, Bs, Cs, Ds, or whatever.

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.

Actually, it matters alot. Thus, the word professionalism comes to be. Why do you think all of the other health care professions got their training out of the tech schools? There is no correlation with any degree or degree of standards. Why do you think even the traditional tech trades like welding and coal mining are now in the colleges?

It is much easier to place a value on a profession when there is a consistent analysis for the education and time spent in a program.

Insurance companies don't want to hear it took someone 2 years to do 700 clock hours of training. They want to know how that relates to the Federal guidelines for education which the code was updated a few years ago. Thus, the other professions have made sure their programs are in compliance which gets noticed in committee meetings for funding through the insurances such as Medicare. Once EMS gets over its hang up about education, the reimbursement may follow for "professional services" and not a tech level.

As far as quality education, many of the EMS programs have one instructor who only has the same cert as what the students are trying to obtain. Thus, EMT-Bs teaching EMT-Bs and Paramedics from medic mills muddling along trying to explain A&P. Thus we get "lido numbs the heart" and "CPAP pushes lung water". Those who often judge a Paramedic program may do so by how easy the insructor is or how laid back the clinicals are around the coffee pot or on the ALS engine sleepover. Often the instructor who tells all the exciting stories about "Trauma" like situations gets nominated teacher of the year because he/she didn't waste their time with the boring physiology crap.

Yes, there are so good tech programs out there but those schools do not give a health care profession the qualifications it needs to be recognized in the world of business and medicine. It is time EMS education stops taking the path of least resistance. The college programs may hold both the student and educator more accountable in the long run. If we don't start to change at least the qualifications for the instructors so they can be recognized as educators, EMS will continue to accept the lowest common denominator as the standard.

[cosgrojo]

Vent-

I do not disagree that having a measurable "number" of hours or credits helps in the advertisement of the profession... and in no way was I arguing against that. My number of accrued hours/credits do not define me as a professional... others may define me that way because of it, but that is a bias that I do not own. My point is that it doesn't affect the Quality of the education. My whole argument is that I wish we were able as a society to judge people of any profession by their individual merits, rather than an arbitrary number of hours completed. Since that is not the way the world works, I concede that increasing these blocks of hours/credits is probably the way to increase our respect in the hearts and minds of the public/medical world et al. Unfortunately, often times it is economy that holds people back from enrolling in the so-called "good" programs. There will be an opportunity cost to raising the standards in the manner that you wish... most likely in the short term, less people interested in the profession because of the amount of money and time spent to get a 14-16 dollar an hour job. I think firefly hit on something important as well. As long as reimbursement rates are the way they are, and percentages of paid runs stay where they are, the services will still not be able to increase the pay for all of this newly gained education. If they start paying us more for our now "profession," where is the money coming from and who's getting cut to afford it?

What I don't like is reading and listening to providers cast aspersions upon other providers simply because of the program that they took, and the number of hours that they accumulated sitting in a class room or standing in clinicals waiting for an opportunity to do a skill. If we can as a group hold each other accountable for our actual ability, rather than the "my school was better than yours" mentality, then we will be in a position to move forward. If we want to better EMS, shouldn't we learn to accept each other first? If we don't respect each other, how are we going to be respected by others? This phenomena does not hold to just which school you went to either. How many times have you heard a co-worker (hey, maybe even yourself... I know I've caught myself saying it) say something derogatory toward another EMS provider simply because of the service that they work for? Some services have crap reputations, and there are some people that think that if you work for that company, then you must be a sub-standard practitioner.

Firefly-

Very good post... you raise a lot of points that are very interesting, of which I do not have the answers either. I would like to comment on your CEU discussion. I am always struggling to find CEU's. It is certainly not because I don't spend a considerable amount of my own time researching and bettering myself. Rather that I don't go to "authorized" trainings haphazardly thrown together by someone that isn't passionate about the training. I also despise paying for con ed. There are free con-ed classes put on by my service semi-occasionally, but I live an hour away from where I work. I own the fact that I could acquire these trainings more frequently than I do, but are they any better than the information that I am attaining on my own? The countless discussions on this very web-site... the numerous links provided by the denizens of this community... the diverse off shoots that those links provide... the outrageous amount of time I spend on my services computer in between calls utilizing webmd...are they worth less than the hours offered by the bored out of their skull con-ed instructor? I do not think that the con-ed system that we have in place is worth much. I think that it actually hurts the majority of providers in rural settings... especially those who get their con-ed exclusively through fire departments. People who take an active role through personal education are not rewarded for their efforts. Con-ed is like the Borg... you must assimilate. Not to mention that one of the States I work in will not allow me to count con-ed if it is on a subject above my licensure level. There is only so many times that I want to learn about splinting and nasal cannula's.

Herbie and P_instructor- Thank you for your kind words.

[Lone Star]

What I find frightening is this:

Alot of those that are rallying against a 300 hour course as 'entry level' are the same ones that support that 120 hour course as 'entry level', and they're fine with that!

I've said it before and I'll continue saying it: EMS needs to back away from the 'minimalistic attitude' when it comes to education! We're talking about peoples lives here...

As far as the debate between EMT-I (I-85 and I-99), it's a 'no brainer'. Obviously the I-85 level of education isn't as expansive as the I-99. Could this be why they revised it in 1999?

No, not every patient is going to need ALS treatments; hell, they're not all going to need LALS either!

EMT-B has a spot in EMS, especially when dealing with the 'boo boo crowd', the 'hey y'all watch this/here, hold my beer crowd' who does stupid shit and recieves minor injuries! (Yes, I even saw my own 'value' as such when I was an EMT-B!)

Do I advocate higher educational standards for EMS? You bet I do!

Even the systems that have been suggested that we model after have multiple levels of providers!

Yes, I may be in EMT-I class right now, but I'm NOT stopping there! I'm pushing for an Associates Degree in Paramedicine. The ONLY reason I'm in EMT-I class is because that's how the program was set up....EMT-B/EMT-I (I85) are one course.....

[VentMedic]

Vent-

I do not disagree that having a measurable "number" of hours or credits helps in the advertisement of the profession... and in no way was I arguing against that. My number of accrued hours/credits do not define me as a professional... others may define me that way because of it, but that is a bias that I do not own. My point is that it doesn't affect the Quality of the education. My whole argument is that I wish we were able as a society to judge people of any profession by their individual merits, rather than an arbitrary number of hours completed. Since that is not the way the world works, I concede that increasing these blocks of hours/credits is probably the way to increase our respect in the hearts and minds of the public/medical world et al. Unfortunately, often times it is economy that holds people back from enrolling in the so-called "good" programs. There will be an opportunity cost to raising the standards in the manner that you wish... most likely in the short term, less people interested in the profession because of the amount of money and time spent to get a 14-16 dollar an hour job. I think firefly hit on something important as well. As long as reimbursement rates are the way they are, and percentages of paid runs stay where they are, the services will still not be able to increase the pay for all of this newly gained education. If they start paying us more for our now "profession," where is the money coming from and who's getting cut to afford it?

You are making $14 dollars an hour because the Paramedic has not achieved professional recognition in legislative issues that concern the insurances. With over 50 different certs in EMS and all of them at a technician status there is no way for the legislators to even figure out what exactly a Paramedic is or does. This is not about advertisement. This is about achieving professional status that is recognized by the insurances. Do you realize that for the "tech" health care programs, there are only the Medical Assistants, Nursing Assistants and Paramedics left. The EKG techs have moved on to the 2 year CVT and the Massage Therapists are now petitioning for the 2 year degree in many states.

For goodness sakes it is only a 2 year degree that some are discussing for the Paramedic. But, it seems that it will be a long time with the reluctance that exists. Do you realize even nursing and RT are embarrassed by having a mere 2 year degree for entry into their profession? Thus, both professions are pushing for as many of their students to get the Bachelors. RT long ago saw the 2 year was going to be the minimum and started pushing people in that direction long before the change took place.

RT, SLP, OT, RN, PA, PT, NP and MDs are not crazy for getting degrees and lavishing in their professional status for reimbursment. How many of them still make $14/hour since their profession achieved that? And, while times are rough, do you know the number of people that are still willing to make the sacrifice to get a decent education?

You could also look at any other profession. Bookkeeping cert from a tech school or Accountant with a degree? How about teachers? Most require at least a 4 year degree to teach 1st grade and usually a Masters. But yet for the Paramedic we are content with 700 clock hours of training from a tech school. Cosmotologists, Massage Therapists, pet groomers and manicurists require 2x more clock hours than that for their tech schools. The fact that some even want to argue that is "best" for the patient gives the wrong message about EMS to those that hold the purse strings of reimbursement.

[RavEMTGun]

You are making $14 dollars an hour because the Paramedic has not achieved professional recognition in legislative issues that concern the insurances. With over 50 different certs in EMS and all of them at a technician status there is no way for the legislators to even figure out what exactly a Paramedic is or does. This is not about advertisement. This is about achieving professional status that is recognized by the insurances. Do you realize that for the "tech" health care programs, there are only the Medical Assistants, Nursing Assistants and Paramedics left. The EKG techs have moved on to the 2 year CVT and the Massage Therapists are now petitioning for the 2 year degree in many states.

For goodness sakes it is only a 2 year degree that some are discussing for the Paramedic. But, it seems that it will be a long time with the reluctance that exists. Do you realize even nursing and RT are embarrassed by having a mere 2 year degree for entry into their profession? Thus, both professions are pushing for as many of their students to get the Bachelors. RT long ago saw the 2 year was going to be the minimum and started pushing people in that direction long before the change took place.

RT, SLP, OT, RN, PA, PT, NP and MDs are not crazy for getting degrees and lavishing in their professional status for reimbursment. How many of them still make $14/hour since their profession achieved that? And, while times are rough, do you know the number of people that are still willing to make the sacrifice to get a decent education?

You could also look at any other profession. Bookkeeping cert from a tech school or Accountant with a degree? How about teachers? Most require at least a 4 year degree to teach 1st grade and usually a Masters. But yet for the Paramedic we are content with 700 clock hours of training from a tech school. Cosmotologists, Massage Therapists, pet groomers and manicurists require 2x more clock hours than that for their tech schools. The fact that some even want to argue that is "best" for the patient gives the wrong message about EMS to those that hold the purse strings of reimbursement.

+100000000000

[cosgrojo]

You are making $14 dollars an hour because the Paramedic has not achieved professional recognition in legislative issues that concern the insurances. With over 50 different certs in EMS and all of them at a technician status there is no way for the legislators to even figure out what exactly a Paramedic is or does. This is not about advertisement. This is about achieving professional status that is recognized by the insurances. Do you realize that for the "tech" health care programs, there are only the Medical Assistants, Nursing Assistants and Paramedics left. The EKG techs have moved on to the 2 year CVT and the Massage Therapists are now petitioning for the 2 year degree in many states.

For goodness sakes it is only a 2 year degree that some are discussing for the Paramedic. But, it seems that it will be a long time with the reluctance that exists. Do you realize even nursing and RT are embarrassed by having a mere 2 year degree for entry into their profession? Thus, both professions are pushing for as many of their students to get the Bachelors. RT long ago saw the 2 year was going to be the minimum and started pushing people in that direction long before the change took place.

RT, SLP, OT, RN, PA, PT, NP and MDs are not crazy for getting degrees and lavishing in their professional status for reimbursment. How many of them still make $14/hour since their profession achieved that? And, while times are rough, do you know the number of people that are still willing to make the sacrifice to get a decent education?

You could also look at any other profession. Bookkeeping cert from a tech school or Accountant with a degree? How about teachers? Most require at least a 4 year degree to teach 1st grade and usually a Masters. But yet for the Paramedic we are content with 700 clock hours of training from a tech school. Cosmotologists, Massage Therapists, pet groomers and manicurists require 2x more clock hours than that for their tech schools. The fact that some even want to argue that is "best" for the patient gives the wrong message about EMS to those that hold the purse strings of reimbursement.

Once again, I agree with almost everything you say here. But it is not a complete diagnoses of the issue. It is too simple to conclude that if we all get degrees, we will be paid more, and respected in both the legislative and medical worlds. I will argue that it certainly is about advertisement. Everything is about marketing. Do you think the purse holders actually care about the scope of practice or the length and breadth of EMS education? I don't think they do. I think that they care about what they were told and what they believe...which can be summed up with marketing. Lobbyist groups that get the majority of governmental funding... marketers. Firefighters that get increased wages, job security, and benefit despite a decline in services needed and rendered... have an aggressive marketing component (IAFF). It is not about what is best for the people and the patients to them, it is what you can sell them on. Certainly you can more easily sell them that we are professionals if we all have gone to an accredited university. How long will we have to do that before we get re-compensated with higher wages and benefits? Who will be there to market on our behalf once we've changed the standards? Currently we have no one. Unless National Registry becomes exponentially more powerful in the near future, and actually is recognized nationally, we will not have that support that we need. It is much more than simple education... if you want to get down to it, it is much more about organization.

I am not arguing against education, I'm pointing out some of the potential pitfalls, and trying not to disrespect those that have already gone through the processes that you so despise (educationally).

[Dustdevil]

It is too simple to conclude that if we all get degrees, we will be paid more, and respected in both the legislative and medical worlds.

Supply and demand FTW

[fireflymedic]

I am always struggling to find CEU's. It is certainly not because I don't spend a considerable amount of my own time researching and bettering myself. Rather that I don't go to "authorized" trainings haphazardly thrown together by someone that isn't passionate about the training. I also despise paying for con ed. There are free con-ed classes put on by my service semi-occasionally, but I live an hour away from where I work. I own the fact that I could acquire these trainings more frequently than I do, but are they any better than the information that I am attaining on my own? The countless discussions on this very web-site... the numerous links provided by the denizens of this community... the diverse off shoots that those links provide... the outrageous amount of time I spend on my services computer in between calls utilizing webmd...are they worth less than the hours offered by the bored out of their skull con-ed instructor? I do not think that the con-ed system that we have in place is worth much. I think that it actually hurts the majority of providers in rural settings... especially those who get their con-ed exclusively through fire departments. People who take an active role through personal education are not rewarded for their efforts. Con-ed is like the Borg... you must assimilate. Not to mention that one of the States I work in will not allow me to count con-ed if it is on a subject above my licensure level. There is only so many times that I want to learn about splinting and nasal cannula's.

I'm not sure of your level but I do know the farther up the ems ladder you go, the more difficult it is to find CEU's. I find myself almost always going out of state for CEU's because most of the things around here are the same topic just repeated multiple times. For example, I skipped the state conference this year for that very reason - I had heard all of the topics at another conference. I am in agreement rural services do have the most difficult time trying to find them simply because there just isn't much to choose from locally. As I said, to get much anything of any quality, I've had to go out of state. Sorry to sound rough, but I'm afraid if you are going to be particular about what you get education in and not the typical refresher that everybody usually does then it's going to require a bit of time and investment on your part away from work. Check with flight services see what they offer in the way of education (I know many offer a vast amount of classes), call your state board, check the net (medic ed is a great site with alot of different topics approved for all different levels), sometimes the hospitals offer things and will grant EMS credit. I also know alot of the foundations (ie diabetes, als, whatever) already do the paperwork to get CEU's for nurses and don't mind putting forth a little effort and getting it for EMS as well. Check with them - you can learn an amazing amount about stuff that won't put you to sleep. I don't argue that there are some good resources here and I've been sent in good directions as well researching things. I know the suggestion was brought up to admin about at some point putting CEU's on here, but I don't know if that's possible.

Best of luck to you and always stay safe.

[cosgrojo]

I'm not sure of your level but I do know the farther up the ems ladder you go, the more difficult it is to find CEU's.

Just a Basic my dear... And I do utilise the on-line con-ed sites, I just despise spending money.