" Where is the future of this profession heading?"

[scott33]

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.

Interesting.

[WelshMedic]

Thank you..I think.

[BushyFromOz]

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

Ah now not quite true. The desire is there, so is the pilot program, the money however, does not exist

Damn broke ass government!

[PND14]

In South Africa we have a similar ECP program to that of the UK (as a matter of interest the prototype was actually developed as joint venture sometime back between the Brits and Safers and the Brits ran with it, we playing catch up now...but it looks very promising).

The future of EMS in S.A. well....as of the the near future (end 2010), all short course training (BLS, ILS and ALS courses) will cease and all those who wish to pursue a career as a EMS professional will have to complete one of two tertiary courses (or both):

1. A 2 year National Higher Certificate in Emergency Medical Care(aka: Emergency Care Technician - ALS level practitioner with a protocolised scope)

2. A 4 year professional degree Emergency Medicine and Rescue (ECP - Autonomous clinician, etc).

Thereafter on can continue on with a MSc, Mphil, etc in Emergency Medicine.

There is talk of extending the degree by another year and the introduction of an community service year due to our 'lock' practitioners into assist in our massively overburdened health sector (but lets talk facts, and we'll wait and see about the rest).

As has been mentioned by a few members earlier, prehospital emergency care and rescue is a relatively young profession. Which has devloped out of a 'bastardisation' of various medical fields, giving use the mixed bag we have today. It is however, our 'mixed bag' profession, and we start unmixing ourselves (the analogy just popped into my head, just go with it).

The tendency for us to fall into the shadow of nursing teachings or medical school teachings, etc and even other EMS system teachings are all too apparent/convenient (remember what works in a rural African province, might not in a metropole in Europe). Now, I'm not saying that these teachings are bad, cross pollination and diversity is certainly required to develop a well rounded and educated practitioner, However, we really do need to create our own research and own body of evidence to start being taken seriously.

It still surprises me that in a lot of places of the world, Paramedics/ECP's/prehospital professionals, etc still 'practice' under a medical supervisors licence. Whats more, some people believe its a good idea cause then we can 'be safe' in our practice and less likely to get sued or whatever....I realise each system is different, and there are still leaps and bounds to make in this profession. But c'mon....

To the 'noob' who is dealing with the assignment, I would offer this; Do not pose the question of "Where is this profession heading?" but rather, "Where are we taking our profession?"

We need to take responsibility for ourselves, and I believe autonomy as clinicians and extensive education form a substaintial part of whether we will remain glorified ambulance drivers or specialists in our field.

Anyhow, use it don't use....

Thats my rant, I'm new and this seems like a cool site. Thanks.

Be safe out there guys.

[PND14]

Please excuse the shocking grammer and spelling errors.

[NRPinNEPA]

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.

A nurse might take the attitude that a paramedic doesn't have a god-given right to pre-hospital care, but one could flip it around and say that a nurse doesn't have a god-given right to hospital care. One could also say that paramedics may not have a god-given right to pre-hospital care, but neither do nurses, especially since there are interventions that paramedics can perform but nurses can't (unless they're a PHRN). It's convenient that nurses have been given a way to function in a paramedic role, but there is no such bridge for paramedics without becoming nurses.

As far as a reasoned argument goes, what's yours? What is the rationale for a PHRN in the United States other than putting paramedics out of work?

[scott33]

Ah now not quite true. The desire is there, so is the pilot program, the money however, does not exist

The pilot program started in 2002 and lasted < 2 years - ECPs have been practicing since then, and are very much an integral part of the ambulance service in England - not so much in the rest of the UK just yet.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564336/

http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/research/ec_practitionerstudy/ecp_exec-sum-2.pdf

Edited February 4, 2010 by scott33

[WelshMedic]

A nurse might take the attitude that a paramedic doesn't have a god-given right to pre-hospital care, but one could flip it around and say that a nurse doesn't have a god-given right to hospital care. One could also say that paramedics may not have a god-given right to pre-hospital care, but neither do nurses, especially since there are interventions that paramedics can perform but nurses can't (unless they're a PHRN). It's convenient that nurses have been given a way to function in a paramedic role, but there is no such bridge for paramedics without becoming nurses.

As far as a reasoned argument goes, what's yours? What is the rationale for a PHRN in the United States other than putting paramedics out of work?

First of all, my reasoned argument would be that nurses are better educated, better trained to look at the whole patient (holistic approach)and better, generally, in communicating with patients (we do that class from day 1).

As far as the flip side argument goes, I agree that paramedics could work in the hospital setting. In fact they do, as ER techs, as I'm sure you know. But what would a paramedic know about cytostatic regimes on an oncology floor? Not that I can remember much either but then I didn't choose oncology. I chose pre-hospital nursing. After trying ER nursing. The clue here is that a nurse is more broadly educated, opening more doors. A paramedic is trained in pre-hospital care, and does it fantastically. But that's where the door shuts too in almost all cases.

WM

[Kiwiology]

God I wish we could stop using the term "pre-hospital" I really don't like it anymore, I feel that it ties one into transporting somebody to the hospital and is alsmost as bad as the term "life support".

What I feel there is a need for is to swing the pendulim a little further towards "care" and away from "life support" more towards a PA/RN focus than a "Paramedic" focus. 90% of the patients ambo gets are not dying and in need of "life support" they need "care" which I don't think is provided well.

Why is it not provided well? Because there is often a limited range of options beyond going to the hospital and that needs to change! I don't feel there is a lot of need for an expanded scope but rather expanded pathways.

[NRPinNEPA]

First of all, my reasoned argument would be that nurses are better educated, better trained to look at the whole patient (holistic approach)and better, generally, in communicating with patients (we do that class from day 1).

As far as the flip side argument goes, I agree that paramedics could work in the hospital setting. In fact they do, as ER techs, as I'm sure you know. But what would a paramedic know about cytostatic regimes on an oncology floor? Not that I can remember much either but then I didn't choose oncology. I chose pre-hospital nursing. After trying ER nursing. The clue here is that a nurse is more broadly educated, opening more doors. A paramedic is trained in pre-hospital care, and does it fantastically. But that's where the door shuts too in almost all cases.

WM

Better educated? That's what critical care medic would be for.

Better at a holistic approach to medicine? I'll have you know that yesterday I transported a terminal cancer patient to comfort care who was sedated and, just like his daughter asked, I held his hand the whole way just so he would know somebody was there. I never lie to my patients or their families and I keep their promises. I do everything in my power to make them comfortable. Why? Because it's my job.

Better at communicating with patients? I've gone on two and a half hour transports and talked with the patient the whole way, laughing, telling stories, etc.

What would a paramedic know about cytostatic regimes? Plenty if they were taught about them.

As far as paramedics working in the hospital setting as "ER techs", you mean "go for"s and CNA replacements? Because that's all they seem to amount to over here in the states aside from the rare hospital that might let them get a little close to their scope of practice... let them put a little IV in to keep them happy and keep them from thinking they're a slave for grunt work.

My simple argument is that there is no need for pre-hospital registered nurses, or at least there wouldn't be if some places bothered to educate their paramedics.

Edited February 4, 2010 by EMTinNEPA