New Standards/Levels

[fireflymedic]

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

I'm sorry, I was thinking for some reason you were more advanced...don't know why, just did. And yeah, I'll be the first to say it sucks to have to pay for CEU's. Fortunately I get mine paid for.

[cosgrojo]

I'm sorry, I was thinking for some reason you were more advanced...don't know why, just did. And yeah, I'll be the first to say it sucks to have to pay for CEU's. Fortunately I get mine paid for.

No need to be sorry, I'll take your confusion as a compliment.

[Jwade]

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.

In regards to the highlighted portion of the text......In the most basic terms....NO, Advanced education is the key, and I will probably offend a lot of people on this board in a second when i say, YOU REALLY DONT KNOW, WHAT YOU DONT KNOW!!!!! There is NOTHING worse with someone who has a little bit of knowledge on a subject to start imparting opinions to the masses as if fact......

Unfortunately, I can easily give an example is the world of HEMS.....You take type A medical people, put them on a helicopter or airplane for 1 year, and all of a sudden they are experts on METAR's, Cloud Ceilings, Prognostic charts, Approach plates, and last but not least, think they can fly the aircraft if ever needed in an emergency.....I see it all the time.....This is why you have the inherent in fighting between pilots and medical crew.....It makes for a bunch of second guessing....However, you never see a pilot lean over and say, " Did you really need to Intubate that patient?"

I can speak on both sides because i have the education as BOTH a pilot and flight paramedic! So, the bottom line IMO, Make the EMT-I the new EMT-B, and force all Paramedic programs to a minimum of a 2 year degree, and then give us the option of pursuing the Critical Care Paramedic or Certified Flight Paramedic.....Both latter certs are way beyond the general paramedic and require much more extensive knowledge....I cannot imagine not having taken Pathophysiology, Organic / Inorganic Chem, Pharm I & II, etc.....and be where I am at today....Again, a little bit of knowledge is the scariest thing alive!

I apologize in advance if I offend anyone..Not my intention....

Respectfully,

JW

Edited October 15, 2009 by Jwade

[VentMedic]

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.

Why do you put so little faith into education? Do you think all the professions I mentioned were wrong and they just got their nice salaries out of the blue for no good reason? Their education made them marketable. Once more EMS professionals start taking their own careers seriously, the IAFF will not be able to keep their strong stance. The more you use the IAFF as an excuse for not continuing your own education or discouraging others, the longer they will have a say in YOUR career. If you have not gotten higher education, it is difficult to sell this concept you. If you have never attended a committee meeting at the state or national level, it would be difficult for you to understand how professions are evaluated. For RT at a national level, we can say all RTs entering the profession must have an Associates with a large percentage now having a Bachelors. This is the push we have made for a Bill that puts the RTs with a Bachelors or Masters as an Independent Practitioner realm for reimbursement for certain services. That bill in now its final stages of reimbursement. For EMS at the national level, "we have 50 plus different certs and for the Paramedic level the training starts at 500 hours and one state does require a degree". Now which one sounds better? Yes it is about marketing but only if you allow lobbyists like the IAFF to rule YOUR own destiny. The more in EMS that realize the IAFF does not control what education they get, the sooner the educated can gain some ground. Once RTs took control of their own destiny, all that was left was signing the paperwork at the state and national levels for the Associates degree. The RTs themselves did all the preparation prior by getting their education as they saw a benefit to it for the profession and to their patients. Now, most see how lacking we are with just a mere 2 year degree in the world of medicine.

Edited October 15, 2009 by VentMedic

[fireflymedic]

Unfortunately, I can easily give an example is the world of HEMS.....You take type A medical people, put them on a helicopter or airplane for 1 year, and all of a sudden they are experts on METAR's, Cloud Ceilings, Prognostic charts, Approach plates, and last but not least, think they can fly the aircraft if ever needed in an emergency.....I see it all the time.....This is why you have the inherent in fighting between pilots and medical crew.....It makes for a bunch of second guessing....However, you never see a pilot lean over and say, " Did you really need to Intubate that patient?"

Again, a little bit of knowledge is the scariest thing alive!

To the first comment - I'll state let pilots do their jobs, medics do their and while I can definitely appreciate your input from both sides of the fence I have no qualms about telling a pilot I'm not going anywhere if they are pushing weather minimums or I feel my safety jeopardized. I'm sure the vast majority feel the same way. Safety issues addressed, it's their aircraft, and their job to fly it, just as it is my patient, and my job to treat it. I am definitely in agreement though in that the more advanced certifications the better educated you are the more it helps. I have absolutely no argument with that at all. I know it helped me.

Second point - when released from class the first thing I was told - "you know just enough now to kill somebody"...didn't think it at the time, but later realized how very, very true it was.

[Kiwiology]

It kind of hurts me to say this but ...

Your system is a piss poor joke that gets laughed at around the coffee table down at the station here. We have had some American ALS medics come over and go straight back down to BLS level until they learn to operate without talking to a doctor.

Add to that the fact state is different, you have the Fire Department rallying to keep education as low as possible, and you still seem to be stuck in the days where things like GTN. glucagon and salbutamol are still "advanced' procedures (National Scope of Practice)and they have gutted a good chunk of the cardiac module out of I99 so they are no longer allowed to manually defibrillate or acquire an ECG.

Oh did I mention the EMS Agenda for the Future (p 24/25) still advocates those skills for EMT/A-EMT which can be performed with "limited training"... WTF ... now do you see why we kind of look at the US and shake our heads?

Over the past 10-15 years we have liberated much of what was the traditional very strong boundaries between basic, intermediate and advanced care. Our BLS level now includes nitro, IM glucagon, salbutamol, zofran, aspirin and supraglottic laryngeal masks while we have upgraded our ILS level to include cardioversion, adrenaline, anti-emetics, IV analgesia and naloxoe.

When we moved from our old more-theoretical BLS qualification to the new "practice" based one with less theory I bitched something fierce because they were removing a good deal of the micro level A&P around cells and tissues. They have now moved to a system-level method of teaching yes, 5 out of the 11 body systems (cardiovascular, resp, nervous, digestive and endocrine) ... don't ask an Ambulance Technician here what renin and angiotensin are and how blood pressure is effected by a guy on ACEIs coz he sure as fuck won't know! That makes me kind of angry. The argument here was "it is too complex for the rural volunteers". #*$*@($*!!!

From 2011 all services are looking to remove BLS and move to the ILS Paramedic level (for all paid staff -- they do about 80% of our national workload) and preserve our BLS level for the volunteer staff as a reasonable alternative. There is one of our services here which by that time will be a totally ALS service where all staff will hold Bachelors Degree or Post Grad qualifications.

Edited October 15, 2009 by kiwimedic

[fireflymedic]

For EMS at the national level, "we have 50 plus different certs and for the Paramedic level the training starts at 500 hours and one state does require a degree".

I think it would be rather interesting to get someone from Oregon's perspective on this topic as they are the only mandantory degree state. I would also be curious to hear how their pay rate stacks up to the rest of the U.S.

[spenac]

....However, you never see a pilot lean over and say, " Did you really need to Intubate that patient?"

Actually I hear pilots complaining all the time that the Paramedics and nurses should or should not have done something. It's human nature to see something and start thinking we know it all. It is only after we are educated that we can look back and see how little we actually did know.

[Kiwiology]

Now that would be very interesting. I know it may be a drastic over-generalisation but it does worry me that you allow people with ~500 hours of education or a six month course to practice advanced life support. I know they have to approved by the service medical director but I'm not sure if that is an adequate protection in itself; I've heard stories about services where the medical director is a faceless signature and doesn't even meet a new hire.

We're looking at making the two levels that will require a Bachelors Degree or higher (ILS and ALS) into regulated health professions under our Health Practitioners Competency Assurance Act. They would be issued a license that allows them to practice independant of a medical director because it would issued by a professional body analouge to the nursing, RT, physiotherapy council etc.

We may even go one-step further and dissolve the notion of "medical direction" for these levels of practitioner.

I find the notion that Ambulance must somehow always be overseen by a physician a little odd; no we are not doctors, but does a nurse or a nutritionist have to be overseen by a doctor, no they can pracitce within thier scope of practice because they have legal ability to do so.

Watch this space over the next few years and I think you may see a radical transformation in how we do business down here and maybe set somewhat of an example for the world to follow; a little bit may be my own personal aspiration of what EMS here will become but I don't think it'll be far off if everything goes to plan.

Oh and did I mention an ALS medic here makes on average, over forty thousand USD a year without penalty and overtime for 42 hours a week?

[cosgrojo]

Why do you put so little faith into education? Do you think all the professions I mentioned were wrong and they just got their nice salaries out of the blue for no good reason? Their education made them marketable.

Something must be getting lost in translation here Vent. I am not discounting a good education, and I implore all that have the financial wherewithal to get the best education available, to get the best education available (no matter what endeavor it is toward). I was not making the argument that the IAFF is holding us under their thumb. I was saying that the IAFF has a successful marketing machine, and we do not. I, unlike others, do not hold the Firemonkeys responsible for our position, I think we should blame ourselves for allowing it to take place, if the role were reversed, we would do the same to them. We are scattered in EMS, we do not have an organization that has the power to enforce change unilaterally, and then benefit from it by being our national mouth piece. As you mentioned, it is difficult to address EMS in legislation because of the numerous definitions of an EMS provider. It is going to take more than personal decisions to make the change to Nationally recognized profession. We can all choose higher education, but unless we have an organization behind us, we will not truly benefit from this education. I have not really been arguing against you Vent, I have been trying to add the supplementary pieces to your argument that will make your education mean something.

I've been to "higher education," Vent. I have graduated from Higher education, I have been to town meetings, I have been involved in the legislative process. So stop making assumptions about my experiences based on your own beliefs, and that if I have done these things then I would understand the complexities of which you speak. I'm sure that you didn't mean those is a derogatory fashion, and you probably were using the "you" as a general term for those who haven't done those things. But it is still possible to have similar experiences and draw dissimilar conclusions, and that does not decrease the validity of either. The only reason that I am still in EMS is that I enjoy it. I truly love my job. I can't do it forever, and I am slowly devising an exit strategy, I will not be in EMS when it finally makes it's jump to a recognized profession, but I would like to think that I helped clear the path for some.