New Standards/Levels

[P_Instructor]

I would like to thank all of you for the lively responses concerning this topic. It will be interesting to see the outcome of the changes, although maybe not for a few years. Thanks again!

[HERBIE1]

Do you think PAs and NPs work completely independent or are subject to a "supervising" or "collaborating" physician? To say that EMS doesn't and won't ever practice completely independent in the US misses the point that there are only an extremely limited number of health care professionals outside of MD and DOs that practice independently.

That was my point- I KNOW PA's and NP's need physician oversight, although they are still more autonomous and can provide more "independent" care than 99% of other allied helath professionals.

I was responding to the issue of education and expanding the role of an EMS provider. We can have a PHD in EMS but unless someone ELSE(MD) is comfortable with AND is willing to allow us- to go beyond our current scope of practice, our future is limited. That's why I think that at least in the short term, we need to try to effect change within the boundaries we currently have. Being a cynic and a realist, I look at what organizations are in the forefront of legislation and initiatives. EMS issues are being dictated primarily by a group who's primary function is NOT EMS because they have the political clout, the numbers, the organization, and the money. The IAFF is the primary adversary here but for those who have been around for awhile, they are well aware of groups like the ENA and other nursing organizations that have a vested interest in this. Any time you propose something that is traditionally the domain of someone else- like home health- you are stepping on another group's toes and taking money and jobs from their members. They have and will continue to push back. We do not have the political capital to push back, and honestly, I wonder if we ever will.

Think of all the resistance EMS saw just 20 years ago- often times we had open hostilities with ER RN's. Yes, this has changed, but as anyone who deals with old school RN's knows, there are still some hard feelings. They do NOT like the intrusion into their domain.

Food for thought-

Once EMS starts branching out into areas like public health initiatives- vaccinations, public inoculations, home health, hospice and palliative care, etc- can we still be called EMERGENCY medical services? Won't we morph into something very different? From a fiscal standpoint, would a local government love to see EMS providers participate in these things traditionally reserved for nurses? Of course, especially when at this point, an EMS provider is not paid the same as an RN.

[JPINFV]

I was responding to the issue of education and expanding the role of an EMS provider. We can have a PHD in EMS but unless someone ELSE(MD) is comfortable with AND is willing to allow us- to go beyond our current scope of practice, our future is limited.

Here's the million dollar question. You're the medical director. Outside of exceptional circumstances (e.g. "advanced practice paramedics" like seen in Wake County) you're going to have one set of protocols for each level. Let's say that you have a 900 hour paramedic and an associates degree medic in your service. Who are you going to design protocols around since they both are going to work under the same set of protocols?

[HERBIE1]

Here's the million dollar question. You're the medical director. Outside of exceptional circumstances (e.g. "advanced practice paramedics" like seen in Wake County) you're going to have one set of protocols for each level. Let's say that you have a 900 hour paramedic and an associates degree medic in your service. Who are you going to design protocols around since they both are going to work under the same set of protocols?

Not trying to be evasive, but it would depend on multiple factors- financial, political, logistical, etc.

What is the area I serve look like? Rural or urban, or a combination of both? Large city, small city? Volume of calls? Transport times? Funding issues? Capabilities of local hospitals- teaching, research, university, private, etc? Specialty centers- stroke, STEMI, trauma, burn, bariatric centers, OB? How many outpatient facilities are there- ie free standing MRI facilities, dialysis centers, rehab facilities? How many comprehensive ER's will EMS be transporting to? What is the future of the area- is a dedicated revenue stream likely? Would your area be involved in FEMA type disaster preparation, mutual aid, etc? What type of providers do you have- 3rd service, fire based, hospital based?

As medical director, you can develop protocols any way you see fit, but the skills you want your providers to have need to match the needs and capabilities of your area. Certainly you would be aiming high- and hoping to build a service for the future but you need to be realistic about what you can accomplish.

We could assume that the associate degree program is the "better" program, but that is not always the case. Each program is mandated by the DOT to meet minimum standards. So what are the major differences between a 900 hour and an associate degree program? In this area, the major difference is the general education classes you must take to receive your 2 year degree- there are no additional classes related to EMS. If you are talking about a 2 "certificate", the gen ed requirements aren't as stringent, so you may get a few extra EMS related classes.

Intuitively you would assume someone who takes more education is more committed to the profession, but that is a pretty big assumption and there are far too many variables to give you a simple answer.

Let's put it this way-in a perfect world, if I am medical director and I have the money and resources, I would require a skills assessment of anyone before they worked in my system. Not only would they need to pass a system entry exam to test their knowledge of local protocols, I would want them to be able to demonstrate their skill set via preceptors(MD's, RN's, and EMT's,) in simulations, as well as clinical situations.

[VentMedic]

We could assume that the associate degree program is the "better" program, but that is not always the case. Each program is mandated by the DOT to meet minimum standards. So what are the major differences between a 900 hour and an associate degree program? In this area, the major difference is the general education classes you must take to receive your 2 year degree- there are no additional classes related to EMS. If you are talking about a 2 "certificate", the gen ed requirements aren't as stringent, so you may get a few extra EMS related classes.

Actually the major differences are college level A&P from college level reading books, pharmacology and pathophysiology. Believe it or not even the general education classes like math and some writing class are of importance. Becoming more literate and being introduced to various journals will help one read real medical journals and not just look at the pretty pictures in JEMS.

Also, with a degree, you have bargaining power which you don't with tech school hours of training.

But then again, those who have not acheived higher education may not understand what they are missing. At least cosgrojo posed well written posts for his argument but then he did have a Bachelor's degree. However, it is kinda ironic that one goes the extra time in class to get a Bachelor's degree to run a restaurant and not for saving lives. But, he has chosen to follow his true passion in the restaurant business. Those who have a passion for saving lives should take the same ambition and be prepared for a career and not just a job.

Let's put it this way-in a perfect world, if I am medical director and I have the money and resources, I would require a skills assessment of anyone before they worked in my system. Not only would they need to pass a system entry exam to test their knowledge of local protocols, I would want them to be able to demonstrate their skill set via preceptors(MD's, RN's, and EMT's,) in simulations, as well as clinical situations.

Other professions teach their health care practitioners when, what and why before the "skills" are ever introduced. If not, you end up with a FAIL as in what happened in Collier County. They argued for the "skill" of giving a med but when asked to apply it in theory on a test that didn't ask simpe "tech" questions, they were clueless. But then they are not the only ones as there are those who still believe "lido numbs the heart". So yes they may be able to do the "skill" of pushing a med or even intubating but do they really know when and why or why not?

[HERBIE1]

Actually the major differences are college level A&P from college level reading books, pharmacology and pathophysiology. Believe it or not even the general education classes like math and some writing class are of importance. Becoming more literate and being introduced to various journals will help one read real medical journals and not just look at the pretty pictures in JEMS.

Also, with a degree, you have bargaining power which you don't with tech school hours of training.

But then again, those who have not acheived higher education may not understand what they are missing. At least cosgrojo posed well written posts for his argument but then he did have a Bachelor's degree. However, it is kinda ironic that one goes the extra time in class to get a Bachelor's degree to run a restaurant and not for saving lives. But, he has chosen to follow his true passion in the restaurant business. Those who have a passion for saving lives should take the same ambition and be prepared for a career and not just a job.

LMAO

Arrogance, bluster, and a few links thrown in for good measure. Then you ignore and twist a poster's words to suit your soliloquy. Nice touch.

It seems you have managed to fool quite a few folks around here- good for you.

Just a little advice-

Do yourself a favor and bone up on logical fallacies. Apparently as you were amassing your massive education, you missed that topic.

[Jwade]

Vent,

Just to play devils advocate with you for a minute, I am confused as to your statement above, Why is is so IRONIC that Cosgrojo chose to get a BS in a non-ems related field....?

I have been in EMS since 1992, moved up through the ranks from EMT-Basic, EMT-I, EMT-P, FP-C blah blah blah, I am 36 now, and just finishing a Double Masters Degree in NON-EMS related fields. MBA / MHA . I have always loved saving lives just as much as the next person, but honestly, we have to truly look at the statistics I think to understand we are rarely saving lives anymore, and have become for the most part expensive taxi rides, and primary care providers.

I always teach and preach having to understand the " WHY" your doing something as opposed to knowing you have to do something, just yesterday in my ACLS class, I had to sit down and explain Cerebral Perfusion Pressure and why a CPP of 42 is bad in an adult. I am PRO education for paramedics, and I agree with 99% of what you say, I just don't see why it is so IRONIC for people such as Cosgrojo and Myself to pursue advanced degrees regardless if they are EMS related or not......

One last thing, CAREER versus JOB debate, these lines are becoming more and more blurred today, society has changed dramatically over the past 50 years and people are no longer willing to be subject to society dictating they MUST pick a career and work it for 30 years, retire, and move to Florida....:-) I read a recent study that showed, todays teenagers will likely have 3 different substantial " Careers" during their adult working life.....I personally regress against the thought that someone must stay in a chosen career field just because they like to do something.....I have multiple passions in life, HEMS, Aviation, Fishing, Cars, and I would be happy to be working in any of them.....

Respectfully,

JW

Just in case anyone was wondering about Fallacies..........

Logical Fallacies

An Encyclopedia of Errors of Reasoning

The ability to identify logical fallacies in the arguments of others, and to avoid them in one’s own arguments, is both valuable and increasingly rare. Fallacious reasoning keeps us from knowing the truth, and the inability to think critically makes us vulnerable to manipulation by those skilled in the art of rhetoric.

What is a Logical Fallacy?

A logical fallacy is, roughly speaking, an error of reasoning. When someone adopts a position, or tries to persuade someone else to adopt a position, based on a bad piece of reasoning, they commit a fallacy. I say “roughly speaking” because this definition has a few problems, the most important of which are outlined below. Some logical fallacies are more common than others, and so have been named and defined. When people speak of logical fallacies they often mean to refer to this collection of well-known errors of reasoning, rather than to fallacies in the broader, more technical sense given above.

Formal and Informal Fallacies

There are several different ways in which fallacies may be categorised. It’s possible, for instance, to distinguish between formal fallacies and informal fallacies.

Formal Fallacies (Deductive Fallacies)

Philosophers distinguish between two types of argument: deductive and inductive. For each type of argument, there is a different understanding of what counts as a fallacy.

Deductive arguments are supposed to be water-tight. For a deductive argument to be a good one (to be “valid”) it must be absolutely impossible for both its premises to be true and its conclusion to be false. With a good deductive argument, that simply cannot happen; the truth of the premises entails the truth of the conclusion.

The classic example of a deductively valid argument is:

(1) All men are mortal.

(2) Socrates is a man.

Therefore:

(3) Socrates is mortal.

It is simply not possible that both (1) and (2) are true and (3) is false, so this argument is deductively valid.

Any deductive argument that fails to meet this (very high) standard commits a logical error, and so, technically, is fallacious. This includes many arguments that we would usually accept as good arguments, arguments that make their conclusions highly probable, but not certain. Arguments of this kind, arguments that aren’t deductively valid, are said to commit a “formal fallacy”.

Informal Fallacies

Inductive arguments needn’t be as rigorous as deductive arguments in order to be good arguments. Good inductive arguments lend support to their conclusions, but even if their premises are true then that doesn’t establish with 100% certainty that their conclusions are true. Even a good inductive argument with true premises might have a false conclusion; that the argument is a good one and that its premises are true only establishes that its conclusion is probably true.

All inductive arguments, even good ones, are therefore deductively invalid, and so “fallacious” in the strictest sense. The premises of an inductive argument do not, and are not intended to, entail the truth of the argument’s conclusion, and so even the best inductive argument falls short of deductive validity.

Because all inductive arguments are technically invalid, different terminology is needed to distinguish good and bad inductive arguments than is used to distinguish good and bad deductive arguments (else every inductive argument would be given the bad label: “invalid”). The terms most often used to distinguish good and bad inductive arguments are “strong” and “weak”.

An example of a strong inductive argument would be:

(1) Every day to date the law of gravity has held.

Therefore:

(2) The law of gravity will hold tomorrow.

Arguments that fail to meet the standards required of inductive arguments commit fallacies in addition to formal fallacies. It is these “informal fallacies” that are most often described by guides to good thinking, and that are the primary concern of most critical thinking courses and of this site.

Logical and Factual Errors

Arguments consist of premises, inferences, and conclusions. Arguments containing bad inferences, i.e. inferences where the premises don’t give adequate support for the conclusion drawn, can certainly be called fallacious. What is less clear is whether arguments containing false premises but which are otherwise fine should be called fallacious.

If a fallacy is an error of reasoning, then strictly speaking such arguments are not fallacious; their reasoning, their logic, is sound. However, many of the traditional fallacies are of just this kind. It’s therefore best to define fallacy in a way that includes them; this site will therefore use the word fallacy in a broad sense, including both formal and informal fallacies, and both logical and factual errors.

Taxonomy of Fallacies

Once it has been decided what is to count as a logical fallacy, the question remains as to how the various fallacies are to be categorised. The most common classification of fallacies groups fallacies of relevance, of ambiguity, and of presumption.

Arguments that commit fallacies of relevance rely on premises that aren’t relevant to the truth of the conclusion. The various irrelevant appeals are all fallacies of relevance, as are ad hominems.

Arguments that commit fallacies of ambiguity, such as equivocation or the straw man fallacy, manipulate language in misleading ways.

Arguments that commit fallacies of presumption contain false premises, and so fail to establish their conclusion. For example, arguments based on a false dilemma or circular arguments both commit fallacies of presumption.

These categories have to be treated quite loosely. Some fallacies are difficult to place in any category; others belong in two or three. The ‘No True Scotsman’ fallacy, for example, could be classified either as a fallacy of ambiguity (an attempt to switch definitions of “Scotsman”) or as a fallacy of presumption (it begs the question, reinterpreting the evidence to fit its conclusion rather than forming its conclusion on the basis of the evidence).

Edited October 19, 2009 by Jwade

[itku2er]

Just in case anyone was wondering about Fallacies..........

Logical Fallacies

An Encyclopedia of Errors of Reasoning

The ability to identify logical fallacies in the arguments of others, and to avoid them in one’s own arguments, is both valuable and increasingly rare. Fallacious reasoning keeps us from knowing the truth, and the inability to think critically makes us vulnerable to manipulation by those skilled in the art of rhetoric.

What is a Logical Fallacy?

A logical fallacy is, roughly speaking, an error of reasoning. When someone adopts a position, or tries to persuade someone else to adopt a position, based on a bad piece of reasoning, they commit a fallacy. I say “roughly speaking” because this definition has a few problems, the most important of which are outlined below. Some logical fallacies are more common than others, and so have been named and defined. When people speak of logical fallacies they often mean to refer to this collection of well-known errors of reasoning, rather than to fallacies in the broader, more technical sense given above.

Formal and Informal Fallacies

There are several different ways in which fallacies may be categorised. It’s possible, for instance, to distinguish between formal fallacies and informal fallacies.

Formal Fallacies (Deductive Fallacies)

Philosophers distinguish between two types of argument: deductive and inductive. For each type of argument, there is a different understanding of what counts as a fallacy.

Deductive arguments are supposed to be water-tight. For a deductive argument to be a good one (to be “valid”) it must be absolutely impossible for both its premises to be true and its conclusion to be false. With a good deductive argument, that simply cannot happen; the truth of the premises entails the truth of the conclusion.

The classic example of a deductively valid argument is:

(1) All men are mortal.

(2) Socrates is a man.

Therefore:

(3) Socrates is mortal.

It is simply not possible that both (1) and (2) are true and (3) is false, so this argument is deductively valid.

Any deductive argument that fails to meet this (very high) standard commits a logical error, and so, technically, is fallacious. This includes many arguments that we would usually accept as good arguments, arguments that make their conclusions highly probable, but not certain. Arguments of this kind, arguments that aren’t deductively valid, are said to commit a “formal fallacy”.

Informal Fallacies

Inductive arguments needn’t be as rigorous as deductive arguments in order to be good arguments. Good inductive arguments lend support to their conclusions, but even if their premises are true then that doesn’t establish with 100% certainty that their conclusions are true. Even a good inductive argument with true premises might have a false conclusion; that the argument is a good one and that its premises are true only establishes that its conclusion is probably true.

All inductive arguments, even good ones, are therefore deductively invalid, and so “fallacious” in the strictest sense. The premises of an inductive argument do not, and are not intended to, entail the truth of the argument’s conclusion, and so even the best inductive argument falls short of deductive validity.

Because all inductive arguments are technically invalid, different terminology is needed to distinguish good and bad inductive arguments than is used to distinguish good and bad deductive arguments (else every inductive argument would be given the bad label: “invalid”). The terms most often used to distinguish good and bad inductive arguments are “strong” and “weak”.

An example of a strong inductive argument would be:

(1) Every day to date the law of gravity has held.

Therefore:

(2) The law of gravity will hold tomorrow.

Arguments that fail to meet the standards required of inductive arguments commit fallacies in addition to formal fallacies. It is these “informal fallacies” that are most often described by guides to good thinking, and that are the primary concern of most critical thinking courses and of this site.

Logical and Factual Errors

Arguments consist of premises, inferences, and conclusions. Arguments containing bad inferences, i.e. inferences where the premises don’t give adequate support for the conclusion drawn, can certainly be called fallacious. What is less clear is whether arguments containing false premises but which are otherwise fine should be called fallacious.

If a fallacy is an error of reasoning, then strictly speaking such arguments are not fallacious; their reasoning, their logic, is sound. However, many of the traditional fallacies are of just this kind. It’s therefore best to define fallacy in a way that includes them; this site will therefore use the word fallacy in a broad sense, including both formal and informal fallacies, and both logical and factual errors.

Taxonomy of Fallacies

Once it has been decided what is to count as a logical fallacy, the question remains as to how the various fallacies are to be categorised. The most common classification of fallacies groups fallacies of relevance, of ambiguity, and of presumption.

Arguments that commit fallacies of relevance rely on premises that aren’t relevant to the truth of the conclusion. The various irrelevant appeals are all fallacies of relevance, as are ad hominems.

Arguments that commit fallacies of ambiguity, such as equivocation or the straw man fallacy, manipulate language in misleading ways.

Arguments that commit fallacies of presumption contain false premises, and so fail to establish their conclusion. For example, arguments based on a false dilemma or circular arguments both commit fallacies of presumption.

These categories have to be treated quite loosely. Some fallacies are difficult to place in any category; others belong in two or three. The ‘No True Scotsman’ fallacy, for example, could be classified either as a fallacy of ambiguity (an attempt to switch definitions of “Scotsman”) or as a fallacy of presumption (it begs the question, reinterpreting the evidence to fit its conclusion rather than forming its conclusion on the basis of the evidence).

I just wish I was smart enough to use these Fallacies in an arguement. Me I am just a simple country girl that tells it like it is and dont cover it up with all the hoopla of fallacies.

Btw I am all for More education in any feild or profession don't care if its EMS or whatever. The more you know the better off you are. But I do not think that more education will totally fix the problems with EMS, it will help yes but not totally fix. As long as we have the "Rabbit" type in EMS we will never a totally perfect system.

[RavEMTGun]

[VentMedic]

Vent,

Just to play devils advocate with you for a minute, I am confused as to your statement above, Why is is so IRONIC that Cosgrojo chose to get a BS in a non-ems related field....?

He did not get the Bachelor's degree in business to maitain a job as an EMT-B but rather to pursue other opportunities with the restaurant business.

I believe once you have completed at least a satisfactory level of education in EMS, one can of course then continue higher eduation in whatever benefits their career or interest. However, I feel it is rather odd for someone to put in just a few hundred hours of training into a profession that deals with human lives but will put in several years of education to achieve a degree in something that is totally not related to medicine. While cosgrojo did see a value to education he was not always in agreement a degree is the way to go. Yet, there is probably no disagreement that the Bachelor's will help him in business. Also, many Fortune 500 companies want their mailroom clerks making a poverty level wage to have a minimum of a Bachelor's degree and few if any will put up any argument against that even though there is no cert or license requiring it. Rather, the employer just makes a recommendation.

My Associates degree is EMS/Paramedic. My Bachelor's is in Cardiopulmonary and my Master's degree is in the college of education in Exercise Physiology. Most are related to medicine although some would argue the education classes in my Master's are a waste for EMS since only a few hours of training are needed to be certed as an EMS instructor.

LMAO

Arrogance, bluster, and a few links thrown in for good measure. Then you ignore and twist a poster's words to suit your soliloquy. Nice touch.

It seems you have managed to fool quite a few folks around here- good for you.

Just a little advice-

Do yourself a favor and bone up on logical fallacies. Apparently as you were amassing your massive education, you missed that topic.

herbie, I do owe you an apology since I realize you probably did not know what my statements about Collier County meant. However, if you do a search for Collier County on this forum you will find several discussions that will get you up to speed.

EMS has put much emphasis on skills and hours of training to where they have come to believe the education part can be side stepped. Thus when you have continued to measure EMS training in "hours" and emphasized "skills", I can see how you may actually not see a problem with this because that is the norm for you and much of EMS. Medical Directors should look at more than just a "skill" to measure his/her employees' competency. But then this is what Doctor Tobin did in Collier County and was greatly criticized by the FFs who thought is was just horrible that they had to know the hows and whys of their "ALS skills".

I have posted that paragraph again now that you have a little history on Collier County.

Other professions teach their health care practitioners when, what and why before the "skills" are ever introduced. If not, you end up with a FAIL as in what happened in Collier County. They argued for the "skill" of giving a med but when asked to apply it in theory on a test that didn't ask simpe "tech" questions, they were clueless. But then they are not the only ones as there are those who still believe "lido numbs the heart". So yes they may be able to do the "skill" of pushing a med or even intubating but do they really know when and why or why not?

herbie, it is obvious that I or no one here will ever convince you that even the Associates degree will ever be of benefit to EMS. You seem firmly rooted in the skills aspect of the job. While they are important, knowing the hows and whys would be even better.

Now back to the levels, if you were to read some of the posts on the forums that cater primarily to EMT-Bs, you might see where 120 hours of training is NOT enough and the AEMT might be some improvement although probably not near enough.

Edited October 19, 2009 by VentMedic