" Where is the future of this profession heading?"

[tniuqs]

Sounds like a stupid-ass question to demand of someone who isn't even in the field yet. Just my two coppers.

I can't disagree with that, how can one know where the future of a profession is going unless one is IN the profession. On the other side of the coin some research by that the "candidate" is not a really a bad thing to demonstrate not only desire but a realistic evaluation of the industry before committing lots of time energy and of course pesos jumping in with both feet into the muskeg.

Comment on the UK .. the information I get re: Supermedics is very positive .. to bad the ROW "rest of the world" is not riding the wave.

cheers

[Mark the O]

Seems to me that EMS is painfully but rapidly growing as a profession. (been a paramedic for five + years). I look at the two professions that we are most related to and I see that we seem to be growing at a faster pace than they did.

One: The fire department is more structured and looked at as more of a profession than EMS, but fire has had more than a hundred years to establish itself as a field and to become what it is today. EMS has been "organized" in the USA as far as I know only since the 70's.

Two: Nursing has been around even longer and has established itself as a strong well paid profession. Nursing has evolved a lot in the hundreds of years it has been needed. Key point.......lots of time....

My point: EMS is still so young as a proffesion and just like fire and nursing when they were young, EMS has to establish itself in the minds of the public as a needed, profesional, organized feild. I think that we have come a long way in the mere 30-40 years that the feild has been around. We have gone from driving as fast as we can to the funeral home to treating anything from medical to trauma with hopes of actually improving the person. Im looking forward to seeing what EMS will become in the next 30-40 years. As someone else mentioned in a previous post, we (the people in the feild now) will decide where this feild goes as a profesion.

OK OK the rambling is done.

[cynical_as_hell]

I feel that the standard of education needs to be higher. Some of the programs I've seen in my area are so focused on just pushing people through because it's their buddy rather than stating " Hey you didn't make it." that people who are truly not qualified are being certified. I also think that the public needs to be educated on what our capabilities are. They need to be reminded of what truly is an emergency and what isnt. We are not a taxi service and I agree with previous statements that some patients can be left at home. Just because someone calls 911 doesnt mean they need our services and therefor we should be allowed to leave them at home. Time after time after time our services get abused and our resources drained because there is no cure for stupidity. I also feel that if it is a medical call that fire needs to stay at their station and let us do our jobs. More time is spent on scene than needed because fire feels they have some obligation to do something rather than turn over care and allow us to be on our way with the patient. EMS will never truly get the respect it deserves or the recognition as long as fire continues to accompany us on calls.

[Kiwiology]

My point: EMS is still so young as a proffesion and just like fire and nursing when they were young, EMS has to establish itself in the minds of the public as a needed, profesional, organized feild. I think that we have come a long way in the mere 30-40 years that the feild has been around. We have gone from driving as fast as we can to the funeral home to treating anything from medical to trauma with hopes of actually improving the person. Im looking forward to seeing what EMS will become in the next 30-40 years. As someone else mentioned in a previous post, we (the people in the feild now) will decide where this feild goes as a profesion.

I politely disagree, well about EMS being "young" anyway. It's been around for four decades and in that time has failed to really intergrate itself into the public minds as a profession worthy of true respect. Why? Education and professional standards is your answer.

Now this is not true in all parts of the world; in Australia ambo's enjoy a very high reputation both from the public and other health professionals, same here (although to a slightly lesser degree) and in the UK. These are nations with by-and-large very high education and professional standards which run Ambulance as a core activity of the health system generally at a state level; Australia is by state and the UK well, don't ask me how the NHS works!

While in times gone by it was possible to get away with "weeks" or "hours" of training, many nations now require a Bachelors Degree or higher which basically excludes all the whackers, firefighters and volunteers thus raising the standard in terms of provider and the care they provide. By comparison New Zealand requires a Diploma (Associates Degree) if you want to be a volunteer and at least Bachelors Degree if you want to be a Paramedic or higher (read: get paid, start IVs and give drugs). While I quibble about some of the Diploma content it will only do good things for the service and it's image.

Lets see, what doesn't do do good things for the image of Ambulance Officers (no, no, me excluded) ....

- 120 hours of training minimum

- No requirement to get any higher education or even take an anatomy class to get certified

- Vastly different standards; 600 hours in Texas vs. 3,000 hours in Seattle (try taking a TX cert to Mike Copass in Seattle)

- People who drive round with lights, sirens, air horns and decals all over thier personal cars

- A plethora of different titles and levels

- No real interest in moving beyond the "emergency" sphere of jobs

- Fire services trying to justify tax dollar sucking budgets aimed to keeping things on the downlow so it's patch factory won't close

- Lack of industrial and political leadership and representation

.... and once again, we seem to have centred on .... the United States

Where is EMS heading? In the US, nowhere, never has, never will, rest of the world .... somewhere interesting and for the better.

[NRPinNEPA]

I wrote a big thing but firefox crapped out on me. Here's the reader's digest version...

1. Make EMT a one-year CS or move it to a first responder role and replace it with AEMT or EMT-I as a one year CS

2. Make paramedic a minimum of an AAS

3. Do away with PHRNs and instead create a REAL critical care paramedic level (a bachelor's)

4. Make bachelor's the minimum for paramedic/supervisor.

5. Get EMS away from fire departments

6. Drop "EMT" from EMT-Paramedic

7. Do away with volunteers

8. More anatomy, more physiology, more pathophysiology, and more clinical time

9. Rigorous QA/QI

10. Adhere to the national standard

[WelshMedic]

3. Do away with PHRNs and instead create a REAL critical care paramedic level (a bachelor's)

Whilst I have no objection to the creation of a Batchelor's qualification for EMS personnel, I do wonder why it's necessary to abolish the PHRN. PHRN's do have a role in EMS, albeit a different one in the US.

Here in the Netherlands we are all RN's in EMS. We are not in some kind of Utopia because we have our issues too (pay and retirement benefits being just an example). However because we hail from a far older profession we are accepted as fully paid up members of the healthcare team. Autonomy to practice is essential to the development of any profession. How do you acheive that? By education.

One of the nice things about my job is the fact that we aren't just looking to transport but arranging the most appropriate care pathway for our patient. Taking the elderly and/or vulnerable into a hospital ER teeming with all sorts of bacteria isn't always the right thing to do. However, in order to acheive this, I need to have a good system of primary care that can be relied upon to look after my patient after I've left. In order to do that those patients need to be insured for healthcare. Which is why it disappoints me to see that the US healthcare reforms are looking likely to strand.

Sorry for making this a little political, but my point is that in order to modernize EMS (at least in the US) factors outside of EMS' sphere of influence also need to be adressed.

WM

[NRPinNEPA]

Whilst I have no objection to the creation of a Batchelor's qualification for EMS personnel, I do wonder why it's necessary to abolish the PHRN. PHRN's do have a role in EMS, albeit a different one in the US.

I'm specifically referring to EMS in the United States. In the United States, PHRN serves as nothing more than a way for nurses to obtain paramedic skills, come into the field with authorization to use more drugs than a paramedic, and take paramedic jobs. Instead, I say give that qualification and education to a paramedic and make them a real critical care paramedic with an actual expanded scope of practice. I'm a firm believer that paramedics belong pre-hospital and nurses belong in the hospital... two different worlds, two different mindsets.

[scott33]

I think ambo generally fails to recognise that HELP does not always require an ambulance or transport.

There are some interesting concepts being developed that could prove to be quite uselful

Indeed.

I like the idea of utilizing alternate referral pathways, but it will never work in the US. Below is one example of how they are used in the UK at ECP (MSc) level.

http://www.paramedicpractitioner.com/downloads/WAS-ECP_Guidelines.pdf

[Mark the O]

Wow, my mind is full of thing to write. I wish I had time to write it all. I will later hopefully. I have not leared much of EMS outside of the US. Is it really that different? Gotta say im impressed. I wanna hear more.

[WelshMedic]

I'm specifically referring to EMS in the United States. In the United States, PHRN serves as nothing more than a way for nurses to obtain paramedic skills, come into the field with authorization to use more drugs than a paramedic, and take paramedic jobs. Instead, I say give that qualification and education to a paramedic and make them a real critical care paramedic with an actual expanded scope of practice. I'm a firm believer that paramedics belong pre-hospital and nurses belong in the hospital... two different worlds, two different mindsets.

Of course you would defend your profession, you are a medic student and therefore competing with a PHRN. However, a blanket statement like nurses belong in a hospital doesn't help your case. Have an argument but make sure it's a reasoned one.

Maybe that's why nurses are paid and respected more

No, strike that; it's unkind. I'm sorry. However, the point I am trying to make is that a paramedic does not have the god given right to pre-hospital care. There are other models that work just as well.

WM

Wow, my mind is full of thing to write. I wish I had time to write it all. I will later hopefully. I have not leared much of EMS outside of the US. Is it really that different? Gotta say im impressed. I wanna hear more.

Mark,

Here is a copy of the presentation I gave in 2008 to the paramedic students at the Montgomery County Public Safety Education Campus in Conshohocken, PA.

Here

Don't hesitate to mail me if you want to know more....

WM

PS: the cautionary tale mentioned at the end is

Edited February 3, 2010 by WelshMedic