How do we fix it?

[AZCEP]

Over the last few weeks, I have noticed that a trend seems to have been forming. It seems that every post that discusses the right/wrong of patient care/management leads back to the shortcomings of the current educational process that providers go through.

I have noticed that this trend doesn't really cut along the BLS/ALS lines either.

My question is, "How do we fix the problem?"

Just so you get a feel for where I am coming from, I have been the program manager of the local hospital's paramedic program for the last three years. 32/40 students successfully passed their NREMT exams, and most (maybe 26/32) I would not have a problem letting to treat my family.

Give me some ideas, so I can start to improve the system in my little corner of the world.

[Ridryder 911]

Hopefully, you are able to "teach above the national standards". Many of the teaching institutions fail to remember that. They are worried with enrollment numbers, cost, and time. They fail to recognize, former students that complain that they were not prepared for entry level, will kill their program by word of mouth.

I believe we need to re-evaluate our standards again. Hopefully, this can be done after EMS finds a new home in administration. We have diluted the basic EMT training so much ( do too outside pressure groups concerned about rural & volunteers not being active or involved) that the EMT is no longer prepared for Paramedic education.

Maybe the time has come for the EMT to be separated from the Paramedic program. Since most Paramedic instructors have voiced they are either teaching the basics or re-teaching the basics again. This is like the LPN/LVN program with the RN program. Does one really need to be

a basic EMT first ? Yes, oh yes, they need experience, but; that can be done with true provisional programs. Assigned graduate Paramedics a year before officially releasing them. This would not also gain an insight on their career but, give them a chance to increase their skills.

The other choice is to have proper screening and pre basic education. Making sure that these students do know how to study, write, and perform priority time management skills. A good basic science of anatomy and physiology, along with other science courses should had been in place. This would allow more class room time for treatment modalities.

As well as placing computer based testing (for written examinations) since the NREMT will be going to this in 2006/7. This could be done outside the classroom as well allowing again more time for practicing skills and performing staged scenarios, to help prepare them for real life events.

Just some of my thoughts,

Be safe,

Ridryder 911

[emtp269]

My response will not do justice to the question but I will try. We need to get out of the mind set that we have about the role of paramedics. Paramedics are not just 911 junkies looking for the next great story to share with their next partner. We are expanding and increasing the roles we play in public health. Paramedics are becoming force multipliers in an ever shrinking health care provider population. We are performing vital roles in keeping health care institutions open as we fill positions formerly held by other members of the allied health teams that extend the care people need.

That being said we can only raise the bar and ensure we are up to the task, mentally and educationally. We must realize and ensure minimum standards are adopted in our paramedic programs. Paramedics should have a formal A&P education from a biology professor, english from an english professor, and so on. We should ensure our instructors are experienced and remain so. Professional development for instructors should include time allotted for practicing what they teach in the street in real time to real patients. Student should earn admission and meet minimum entrance requirements to get into programs and I think the should be EMT basics with ride time experience and at least 500 hours of patient care prior to starting a paramedic program. We have all learned things from one teacher that was re-instructed by another and that will probably never change.

i think the prior exposure and pre-requisite would convince the candidate of their sincerity and motivation which they will surely need.

The bar needs to be raised and we are the ones to raise it. We should all embrace technology that provides definitive positive patient outcomes and reduces the cost to us all for the overall treatment of our patients. CPAP, Capnography, 12-lead interpretation should be our standards and we should embrace interventions to come. At a recent seminar I discovered that their are many advancements in EMS that will be field ready in the near future. We will be doing things that will require our profession to be better trained, better educated, and better prepared to function in the field and make the difference in the lives of those who call us because they can not afford to be seen be any one else. The minimum standards are what you stand your program on the program standards are what you want your students to be.

It should be a goal to become a paramedic, a lofty goal, and it should be harder to be a paramedic than it is to become one.

[windsong]

I like for a change to read a story about the fundementals of a ever changing career, the most advanced career on the face of this planet, paramedic. It is the most sought after career, very difficult one to attain, yet can be so rewarding.

Your protocol calls for different measures, the policy and guidelines.

Each state or province teaches differently, so I'm wondering why this is, all accidents, ppl bleed, code die the same, why is this so different? Again policies and guidelines must be adhere to.

I believe being a Paramedic does not get the right gradification it so decidedly deserves, you are not a Ambulance driver, this is NOT what you studied for. For those of you out there, whether you were 6 or 9 in passing marks, so you're not the top marksman of your class, at least I can say, at least you passed and now can be known as a professional.

You are actually 1 steps down from a doctor, even though you know the routine, you know the drug aspects, everything a doctor knows, so if that's the case, why then would you need to dispatch one to ask if the medication you want to administer to your pt be ok. It's like saying Yes your a medic, you have more knowledge than some guidelines require you to do and yet you still can diagnose and prescribe/give.

I like what was said above, that we can obviously can discuss about certain protocals and work out scenarios without trying to verbally nialate each other for wrong practices.

[DwayneEMTP]

AZCEP,

From the outside looking in, a few questions.

What are the prereqs for your program now?

If you chose to raise the required prereqs for your program, is there a threat of losing students to others that would not share that higher standard? ( I guess my question it, what is the pressure to eliminate prerequs to attempt to keep the seats filled?)

If you raised the prereqs, would that possibly make your grads more hireable, leading to your program growing due to it's increased placement possibilities?

Of course, all this assumes the program needs to make money, and I don't know if that's always the case, but it seems if we're to end the educational stagnation (in general) it has to follow the money...right?

I'm sorry if I misunderstood what you were looking for...these were just my thoughts...

Dwayne

[Asysin2leads]

I say we need to do more to attract the right people to paramedic school. We need to do more to recruit from the serious college students. Anyone ever seen that movie "Higher Learning"? Lawerence Fishburn has a great line, "College is here to teach you how to learn." Being a serious student is not easy. It takes hard work, patience, and determination. That's why I like associate's degree programs, if you do a year of prereqs, you weed out a lot of the boneheads, especially if you put in grade restrictions (I.e. you must have above a 2.5 GPA to go on to the core courses). If you can do well in A&P, and you can do well in English Composition I and II, and you can do well in Biology and Chemistry, you'll have a good student coming into your paramedic class. Now, whether they can hack it in the field is another story, of course, but you will have at least the basis for something to work with.

[Asysin2leads]

I say we need to do more to attract the right people to paramedic school. We need to do more to recruit from the serious college students. Anyone ever seen that movie "Higher Learning"? Lawerence Fishburn has a great line, "College is here to teach you how to learn." Being a serious student is not easy. It takes hard work, patience, and determination. That's why I like associate's degree programs, if you do a year of prereqs, you weed out a lot of the boneheads, especially if you put in grade restrictions (I.e. you must have above a 2.5 GPA to go on to the core courses). If you can do well in A&P, and you can do well in English Composition I and II, and you can do well in Biology and Chemistry, you'll have a good student coming into your paramedic class. Now, whether they can hack it in the field is another story, of course, but you will have at least the basis for something to work with.

[emtp269]

Asysin2leads, you are right on.

The paramedics I get have completed pre-requisites and have prepared to enter the classroom ready to study and learn.

We do have a unique program that provides the student the opportunity to prepare for the intensity of the didactic portion of our program. I have been fortunate to have all of my students find gainful employment and pass their certification exams very quickly after graduation.

[FormerEMSLT297]

Good question:

There are many problems and here are some on them IMHO.

1. EMS is a job, not a career. Most Medics stay for a few years and go on to MD, PA, or RN, or they leave the profession totally and go into something else. One of my former partners is an Attorney, another a police Sgt, another was a fire Lieutenant, etc... Why does this happen?

Because the EMS jobs in general unless they are attached to a Fire Service don't have the salary, benefits and retirement that "traditional Emergency Services" i.ae. Police and fire have.

Until not to long ago, NYC*EMS EMT's and Paramedics did not even have 25 year retirement, and Garbage men, NYC Sanitation workers made more money, still do,, and had a better retirement.

Slowly, these things are changing. Some of the other problems are the career path for senior Medics who don't want to or can't carry patients down multiple flights of stairs after years of service (the back starts to go, the knees etc.)

I also think some of the problem can be societal changes. Hear everybody saying EMT's aren't what the used to be. Medics aren't what they used to be. Well I speak with friends that are cops and regardless of the department, they say unequivocally, cops aren't what they used to be. I think to some extent, it is generational. They are in it to learn the basics get by do the LEAST amount of work possible and get a pay check. And the least amount work also translates into the LEAST AMOUNT of knowledge.

I remember when I left NYC and came to this area, I was speaking with a medic and I asked him why Thiamine was not in the protocols for Unconscious hypoglycemic patients and the replied "Thiamine What's that..??????" I was agast. I started to explain Wernicke's encephalopathy, in chronic alcoholism patients, etc. He shrugged his shoulders and said he NEVER HEARD OF IT.. And he was a NREMT-P, college program educated, with an associates degree..

So I dunno. When I became a medic and I came across a patient or situation I had never seen I followed up. I asked Dr's, Nurses, found text books, looked things up in medical dictionaries... and I followed up. checking on the patients in the hospital finding out if my treatments should hae been any different.

And i dont see many medics doing that anymore. They drop the patient off and go on to the next assignment.

I've even heard medics say they don't care what the patient outcome is. Hmm,, not a whole lot of compassion there..

And before all the responses start I'm young and new and I care. I am not saying EVERYBODY. What I's saying is as a generation I see less caring, compasionate and concerned EMT's and Medics than I have 10 and 20 years ago. This generation is all about ENTITLEMENT. Not what they can do for the job but what the job can do for you.

I see a lot of people come on a job, be it Police, fire or EMS and it's "they need to give me this or that" or I need this shift or that. I need this special training. Whatever.. and Its O.K. if you've been on for a while but I'm seeing it with brand new employees. I remember being a new EMT and later a new Medic, you sat there and did as you were told. Tried to absorb, learn digest the system.. You didn't walk in to your supervisors office and demand this of that shift, or day off or a specific partner.

That being said, I also see a lot of great EMT's and Medics leaving the system for higher paying jobs with better retirements and benefits.

The other thing is that as long as EMS is attached to the Fire Service and people just get medic cards so that they can get hired, work a few years on an ambulance before getting into the fire side. NOT A WHOLE LOT WILL CHANGE.

EMS should be a cadre of concerned caring 3rd service providers with good career paths and good benefits, in line with professional firefighters and Police officers.

Just my humble opinion, my thoughts do not represent my agency or department.

Former.

[Medic2588]

About 10 years ago in NJ, they did away with the EMT-A curriculum and instituted the EMT-B curriculum. In my opinion, it's a seriously dumbed down version of the EMT-A. EMT-A (and I hope it was the same across the country) actually taught you to think about the patient's problem and understand medical conditions. Because it was "too hard" they decided to go with an easier version. I think we need to forget about making things "too easy" and pumping out more EMTs and focus more on developing better thinking EMTs from the beginning.

Devin