New Standards/Levels

[cosgrojo]

So are you saying that those working in the hospital don't need none of that there book learnin' stuff?

Why is it that EMS seems to attract those that are so incapable of seeking education and use everything they can as an excuse.

If you ever get a college degree, it is something to be proud of. Those who have yet to obtain that accomplishment usually make statements like yours.

That first sentence is a gross misinterpretation of what Herbie actually wrote. At no time did Herbie state that hospital staff don't need no edumacation. Where are you coming up with this stuff?

I agree that the higher the standards, the higher quality of individuals will be attracted to the Industry... provided that compensation and benefits are comparable to other industries with similar standards. Before you misinterpret that statement, let me say that I am not looking for any handouts, and I am not making excuses, just stating that people don't go to school for 4 years expecting to make 14-16 dollars an hour. It may happen, but it is not a decision many people will make on purpose. To attract the people you want we will have to offer appropriate compensation for the level of education you want to require.

Your last statement quoted is both equally pompous and assumptive. Why must you assume everyone with an education would have similar ideas, and make similar statements? People don't always fit into the narrow rubric you have provided.

paramedicmike- In order for this educational change to take place we first must organize as a profession, agree upon what the education will entail, and make sure that our organization is strong enough and influential enough to force the changes we suggest. That is not easy, if it was... it would have happened already. If it is your position that you think that if we all individually get Bachelor degrees in pre-hospital medicine (which, by the way do not exist everywhere) then the industry will magically bend to our will over time... well... let's just say that I disagree.

Without a National presence that exerts influence and mandates change inside and outside of the Industry, I do not see the widespread educational changes that we all so desire.

[VentMedic]

Vent, I think you are naive about the IAFF, and also are applying standards from a hospital setting here. Inappropriate.

You also misconstrue and misinterpret what I said. First, simply getting a degree will NOT change the problems in EMS. You need to understand the underlying reasons why EMS is struggling for respectability and recognition. The vast majority of IAFF members have nothing more than a high school education or a GED. They may have multiple classes in HazMat, technical rescue, but their baseline education is the same. Some places require various levels of college education to advance within their ranks, but in most areas, an entry level FF does not NEED a college education.

Since my background is as a FF and an educated one, I think you haven't seen all FDs to speak in such general terms. I graduated with an A.S. degree in 1979 with a degree in EMS. I then finished another A.S. and B.S. degree while working in the FD. Not once did they try to stop me. In fact, the degree was highly encouraged and there were many community colleges that offered it during the 70s and 80s. The private ambulances had just as big a part as the FDs in encouraging medic mills. EMS had every opportunity to have the 2 year degree as standard even before nursing if it had not been for the greed of the private ambulance services. FDs had yet to start taking them over.

Fire Fighting is largely a tech job. However, that does not mean there are not degrees offered in it also. Welding and plumbing are tech jobs also and now there are degrees offered for them. However, do you really want to compare the complexities of the human body to fire fighting, welding and plumbing?

I will admit I do not like the way the FDs have gone with making every FF a Paramedic. But then, the low education standards have allowed them to do this. Face it, at as little as 600 hours to be a Paramedic in some states, it is just a "cert" like all of the others they "train for". Now that there are more studies such as the intubation one from Miami which acknowledged some FF/medics only get 1 tube a year if that, I think they might, hopefully, start to rethink the way they choose those for the EMS part.

Just like any of the other health care professsions, once the degree was made mandatory for entry level, that is what it took to get the license. Period. Hospitals probably didn't like it either when the LVN was forced to upgrade to RN or be bannished. LVNs are cheap labor. But, the hospitals adjusted. I also had an RT manager tell me he saved $250,000 by only hiring certified and not RRTs. Of course that department wasn't that much to brag about either. Guess what? He had to change his budget and get creative just like all the other RT departments had to find that budget. His department finally came to life and acquired the technology and took over services to exceed what they needed to maintain budget once everyone was RRT.

Again, all of the health care professionals that work at small rural facilities have had to get educated. Don't expect the IAFF or anyone to spoon feed you. I personnally find this whole discussion and reluctance for education just a tad weird. My parents started saving in the early 1960s for me to get a college education to have more opportunities than what existed in a small town. Myself and my friends all started saving for our kids' education shortly after they were born. This was not just for a "cert" but at the very least a Bachelor's or Masters' degree. If any of them wanted to be FFs and/or Paramedics, they could do it with an education just as easy as without one.

When I sign with my alphabet soup, I put my highest education level first and then the licenses or specialty certs if they apply. The reason the education is listed first is because it is the one thing nobody can not take away from you. Certs/Licenses can expire or be revoked and jobs can be terminated or changed.

Your last statement quoted is both equally pompous and assumptive. Why must you assume everyone with an education would have similar ideas, and make similar statements? People don't always fit into the narrow rubric you have provided.

If you ever get a college degree, it is something to be proud of. Those who have yet to obtain that accomplishment usually make statements like yours.

You have just proved my point with your statement.

Changing the minds of those who oppose education but do not have an education to know exactly what they are opposing may never happen.

[cosgrojo]

You have just proved my point with your statement.

Changing the minds of those who oppose education but do not have an education to know exactly what they are opposing may never happen.

Since I am not opposing education, and have at every step implored people to get the best education that they can... I continue to be befuddled by your statements. I suppose it is evidence of your vast superiority to me. I will just agree with you then... and nonsensically tap the +1 tab at the bottom of your posts.

[VentMedic]

Since I am not opposing education, and have at every step implored people to get the best education that they can... I continue to be befuddled by your statements. I suppose it is evidence of your vast superiority to me. I will just agree with you then... and nonsensically tap the +1 tab at the bottom of your posts.

Your statements led me to believe you did not read my posts as I did not say the 4 year degree should be the entry level. Associates will do to start.

that people don't go to school for 4 years expecting to make 14-16 dollars an hour. It may happen, but it is not a decision many people will make on purpose. To attract the people you want we will have to offer appropriate compensation for the level of education you want to require.

Teachers don't make much more than that and they make their decision to go to college on purpose. Many entry level professional jobs in the working world start out low. Health care just happens to be in demand and those that meet the requirements desired by the insurances will gain.

Do you honestly think a higher wage is going to encourage some to go to school? Why should they if the money is flowing in?

Again, review the history of EVERY other health care profession including nursing to see how they have accomplished their status. EMS is now well over 40 years old and other professions have made their stance noted, with education in as little as 15.

[HERBIE1]

Since my background is as a FF and an educated one, I think you haven't seen all FDs to speak in such general terms. I graduated with an A.S. degree in 1979 with a degree in EMS. I then finished another A.S. and B.S. degree while working in the FD. Not once did they try to stop me. In fact, the degree was highly encouraged and there were many community colleges that offered it during the 70s and 80s. The private ambulances had just as big a part as the FDs in encouraging medic mills. EMS had every opportunity to have the 2 year degree as standard even before nursing if it had not been for the greed of the private ambulance services. FDs had yet to start taking them over.

Fire Fighting is largely a tech job. However, that does not mean there are not degrees offered in it also. Welding and plumbing are tech jobs also and now there are degrees offered for them. However, do you really want to compare the complexities of the human body to fire fighting, welding and plumbing?

I will admit I do not like the way the FDs have gone with making every FF a Paramedic. But then, the low education standards have allowed them to do this. Face it, at as little as 600 hours to be a Paramedic in some states, it is just a "cert" like all of the others they "train for". Now that there are more studies such as the intubation one from Miami which acknowledged some FF/medics only get 1 tube a year if that, I think they might, hopefully, start to rethink the way they choose those for the EMS part.

Just like any of the other health care professsions, once the degree was made mandatory for entry level, that is what it took to get the license. Period. Hospitals probably didn't like it either when the LVN was forced to upgrade to RN or be bannished. LVNs are cheap labor. But, the hospitals adjusted. I also had an RT manager tell me he saved $250,000 by only hiring certified and not RRTs. Of course that department wasn't that much to brag about either. Guess what? He had to change his budget and get creative just like all the other RT departments had to find that budget. His department finally came to life and acquired the technology and took over services to exceed what they needed to maintain budget once everyone was RRT.

Again, all of the health care professionals that work at small rural facilities have had to get educated. Don't expect the IAFF or anyone to spoon feed you. I personnally find this whole discussion and reluctance for education just a tad weird. My parents started saving in the early 1960s for me to get a college education to have more opportunities than what existed in a small town. Myself and my friends all started saving for our kids' education shortly after they were born. This was not just for a "cert" but at the very least a Bachelor's or Masters' degree. If any of them wanted to be FFs and/or Paramedics, they could do it with an education just as easy as without one.

When I sign with my alphabet soup, I put my highest education level first and then the licenses or specialty certs if they apply. The reason the education is listed first is because it is the one thing nobody can not take away from you. Certs/Licenses can expire or be revoked and jobs can be terminated or changed.

Clearly you have a personal bias here and seem to love taking things out of context.

You also cannot directly compare prehospital care with allied health care in a hospital setting for the reasons I outlined previously- apples and Buicks.

Once again, save the sanctimonious, holier than thou attitude. Make a comment, engage in a debate, but don't pretend your opinions carry any more weight in this area than those of a brand new EMT. The initial topic was about new standards and levels of certification, which means anyone is qualified to state their opinions- regardless of where they work.

On several occasions you are stating that I am bashing education or reluctant to endorse it. I am not, and I dare you to cite where I said otherwise. I said that simply mandating a certain level of education will not solve the problems faced by EMS, and in some instances it may actually make things worse.

I have news for you- someone who holds an MBA and starts out working at Starbucks makes the same as someone with a GED. Their career paths may soon diverge, but their pay is the same for doing the same job. Unless that education is mandated and increased compensation is specifically awarded for that education, it's only for someone's personal edification.

If you are impressed with someone's alphabet soup, you should become an academic. Those folks are highly educated, but many have a hard time discussing anything outside their area of expertise.

The attitudes about FF and education ARE changing, but in most cases, the basic requirements for the job have not. You do NOT need a 4 year degree to fight a fire, but to become an effective officer or chief, you do need to learn about far more than just combustion and the behavior of fire- there are far more concerns these days to be aware of. If a FF so desires, they can remain a FF their entire career, with no worries of licensure or Con Ed hours.

Hospitals still employ LPN's, CNA's, and patient care techs. Why shouldn't they also be required to have increased education?

Everyone plays a role in health care, and the role of EMS is certainly evolving, but to say something like a 4 year degree is a magic bullet to improving EMS is contrary to common sense.

This is about organizational culture, traditions, and the power structure of public safety. Education allows us to better understand why things are, but doesn't automatically mean they will change.

[P_Instructor]

Holy buckets, Batman, the bucket is overflowing with responses. Alright, this intro just to lighten the discussion a bit. I greatly appreciate the viewing (over 1000) and the responses to the topic I brought forth. I knew that this would have great debate, and all responses whether positive or negative were followed by me. For members who have viewed and not responded, please do so. Your input would be greatly appreciated. This from a practicing provider and also an instructor (for an accredited and degree program).

Thanks!

[46Young]

I attended the ABLS course today at my FRD, given by 3 RN's and an MD from MedStar. When we were reviewing for our practicals, the MD asked us what RSI med ought to be avoided for the burn pt. and why. Nothing but blank stares from the class. Here's the answer:

http://www.medscape.com/viewarticle/452569

I also overheard a comment about how the course content doesn't really apply to 911 prehospital care (it certainly does). Knowledge of how a pt may be managed in a burn center will improve your assessment to look for what the burn surgeon may need to know, and will also allow you employ best practices when you go above your protocols when seeking authorization from OLMC.

The 911 only medic is incomplete. Many cert programs place their main emphasis on the 911 side only, only giving token gestures towards IFT or in hospital considerations. A degree program should ensure that the medic has the knowledege base to see the big picture, how our actions affect the pt's in hospital Tx course. More importantly, it provides the base for a legitimate progression to CCEMT-P or flight.

[HERBIE1]

I attended the ABLS course today at my FRD, given by 3 RN's and an MD from MedStar. When we were reviewing for our practicals, the MD asked us what RSI med ought to be avoided for the burn pt. and why. Nothing but blank stares from the class. Here's the answer:

http://www.medscape....warticle/452569

I also overheard a comment about how the course content doesn't really apply to 911 prehospital care (it certainly does). Knowledge of how a pt may be managed in a burn center will improve your assessment to look for what the burn surgeon may need to know, and will also allow you employ best practices when you go above your protocols when seeking authorization from OLMC.

The 911 only medic is incomplete. Many cert programs place their main emphasis on the 911 side only, only giving token gestures towards IFT or in hospital considerations. A degree program should ensure that the medic has the knowledege base to see the big picture, how our actions affect the pt's in hospital Tx course. More importantly, it provides the base for a legitimate progression to CCEMT-P or flight.

I'm not sure what you mean by "911 medic" here. Nurses have tons of specializations and extended credentials- critical care, mobile intensive care nurse, Trauma Nurse specialist, surgical nurse, critical care nurse, etc- all beyond the scope of their initial nursing training. Nobody would think it was odd that an RN or even a BSN could not function in any nursing capacity or think the RN curriculum was somehow deficient because they could not. Same for a doc- they receive even more training, yet nobody would think a cardiologist should be able to function as a neurosurgeon. Why not the same for paramedics?

Despite what a certain poster thinks, I am PRO education, but I do not think that increased education is the answer to most of the problems of EMS as a whole. I am very grateful for the years I spent working in a busy urban Level 1 trauma center. It allowed me to see the "other side" as you say, and it certainly has helped my understanding of how EMS fits into the whole process of providing heath care. Is it good to know why a certain medication is contraindicated in the RSI of a burn patient- sure, but what if you are not allowed to use that skill? I am better able to explain to patients what is likely to occur once they arrive at the hospital- possible tests and procedures that may be needed, based on their complaints. Is this mandatory for me to do my job? Nope, but I do think it makes me a better provider.

On the other hand, if I am a flight medic, then I darn well better understand the physiologic differences of providing care in pressurized and unpressurized environments and would need additional training for that. When I was a flight medic(eons ago), I received no additional training other than what I learned on my own. I admit that I did not feel adequately prepared for what I was doing. Granted, they were not critical care transports, but I did have a few hairy situations.

As for the comment about something not being applicable to 911 medics, I have heard the same thing. It depends on the context of the remark- was this a mandatory class, or something they took for their own benefit? When I hear a similar comment- usually while taking a mandatory class, I shrug and say that it is something that is good to know. Problem is, just like those who only want to be a "plain ole firefighter", or "only" a med/surg nurse, some EMS people are perfectly content not challenging themselves or doing anything more than the bare minimum for their job. Sad, but true.

Edited October 16, 2009 by HERBIE1

[Kiwiology]

I attended the ABLS course today at my FRD,...

Nothing personal mate but I find the whole idea you guys get caught up in so many "advanced _____ life support" or alphabet soup clases run over a weekend nothing more than a farce to be laughed at.

We had an American trained guy come down here; he proudly spouted out he had ACLS, AMLS, ADLS, PALS, PEPP, ATLS, PHTLS etc etc and how he could practice all those down here too if he got our version of them. Boy did he get the shock of his life when we told him not only 1) do we not have any of those (except ACLS) but 2) we don't require them and 3) they are of no value because a weekend course is not adequate education.

Our system does subscribe to the international consortium's on various topics (like ACLS and PHTLS) but we do not do the weekend certification classes instead we build the underlying principles and established best practice into our education programs and whatever updates our Clinical Management Group feel we should incorporate get updated in our Clinical Guidelines or in the case of the Universities who offer the Paramedic degree they would incorporate whatever changes into their education cirricula.

...when seeking authorization from OLMC.

Again it drives me spare the way your system works; I have never spoken to a doctor about how to treat a patient, never have, never will and we hope it stays that way as we have no desire to change it.

[HERBIE1]

Nothing personal mate but I find the whole idea you guys get caught up in so many "advanced _____ life support" or alphabet soup clases run over a weekend nothing more than a farce to be laughed at.

We had an American trained guy come down here; he proudly spouted out he had ACLS, AMLS, ADLS, PALS, PEPP, ATLS, PHTLS etc etc and how he could practice all those down here too if he got our version of them. Boy did he get the shock of his life when we told him not only 1) do we not have any of those (except ACLS) but 2) we don't require them and 3) they are of no value because a weekend course is not adequate education.

Our system does subscribe to the international consortium's on various topics (like ACLS and PHTLS) but we do not do the weekend certification classes instead we build the underlying principles and established best practice into our education programs and whatever updates our Clinical Management Group feel we should incorporate get updated in our Clinical Guidelines or in the case of the Universities who offer the Paramedic degree they would incorporate whatever changes into their education cirricula.

Again it drives me spare the way your system works; I have never spoken to a doctor about how to treat a patient, never have, never will and we hope it stays that way as we have no desire to change it.

This supports what I was saying. Your policies are dictated by your medical directors or whatever you call them in your area. You are able to provide care and use skills based on whatever they allow you to practice, REGARDLESS of how many initials are behind your name or how many certifications you hold.

As for talking to a doctor- we call AFTER care has been provided and only get advice in unusual situations- rare. It's a courtesy call to the receiving hospital- which is often not the one at the other end of the radio- to allow them to prepare for a critical patient, to simply free up a bed (vast majority of the time), or to gauge what resources they may need for your patient when you arrive.