NYS EMS Certifications

[Alex Woo]

I can't speak for up-upstate but I worked NYC, Westchester, Rockland, & Orange Co as a paramedic. As the newly elected gov; he wants to consolidate govts. No more hamlets, towns, villages. What that means is decrease spending & proper spending. I believe that the 3 most important things we need in the US is edu, healthcare, & defense. I'm working on 2 of the 3...

Wondering where this is going? Resistance means that someone is listening. We all want better healthcare; many of us..... I worked areas where there is only 1 nys trooper covering 50 square miles. No village pd afterhours; taxes are the highest in NYS. There is a commissioner for every service; they're highly paid. Yet the fd and ems services are unpaid; responding from home; some come onscene in pajamas. Save a live; they gotta do what they gotta do to save a live. Kudos but what does that say about our piorites? In rockland; clarkstown pd my almost $100K to start. Ramapo pd make $85K. Fd chiefs have suv's; newest fire apparatus; electric stretchers; ferno stair chair; supplies; etc. They're is money for the vollies but the towns really cared then vollies will receive $$ for services render. Portion of taxes or taxes increased by .5% in sales can pay for this.

I'm asking for better care for ppl. I have to start somewhere; vollying is great but is it fair? I think all 911 services should be paid. This has nothing to do with volunteering.

Yes some EMTs will not be able to complete the upgrade. If you know something wrong with your local EMT course; say something but nys doh ems isn't helpful. I know a course in Bx and Qns who accept you w/o HS dipolma. One allowed students to miss classes they were suppose to attend as a result of their challenge exam. One allowed students to continue even though they failed exams and practicals. The state has been silence on these issues; emails sent w/o response.

This is messed up; restructuring is what we need. Many will lose their certs; if this plan was incorporated; but this job is not for everyone....

[Lone Star]

As a former NYS EMT, I agree, the standards need to be improved. However, the classes need to be taught to the least common denominator, if you know what I mean. As I have said in the past, I think before EMS in the US undergoes any substantial changes it will need to be taken under the wing of an established organization such as ACEP. To gain any respect the standards are going to need to be brought up to college level. With the flux that medicine as a whole is in right now, I don't see that happening too soon.

Doc,

Do you think that is part of the reason that EMS isn't making much progress....because it IS catering to the 'least common denominator' instead of weeding them out?

I'm sure that you've seen some in EMS that you've thought in the back of your mind, "This person has no business treating patients!".

Let's be brutally honest here for a minute; we've all come across providers that make us wonder exactly HOW they passed the course, let alone any state testing.

I had a partner in Detroit that was trying to palpate a patient's blood pressure (mainly because he forgot his stethescope in the truck). The problem is that he was attempting to palpate the radial pulse on the dorsal aspect of the patient's wrist, and inflating the B/P cuff while idly glancing around the room.

This is the same guy that stuffed 15 LPM via NRB in a COPD patient's face who showed no signs of cyanosis, no difficulty breathing and had a SPO₂ of 96% on 2lpm via nasal cannula. When he was asked WHY, his answer was "It's my patient, and I will treat them however the hell I want to!".

I'm not going to continue because this isn't going to become a 'bash your partners thread'. You get the idea.

I'm sure we would all agree that EMS doesn't need providers of this caliber. This is why I personally think that there should be a 'minimum level' that needs to be inplemented. If you can't score above this 'minimum level', you should be excluded from the field....

It's my understanding that there are similar tests for nursing, lawyers and I would presume even for medical school. Why should EMS just take any 'warm body' that wants to get into the field for the glory and 'hero worship'?

[FredG]

I can't speak for up-upstate but I worked NYC, Westchester, Rockland, & Orange Co as a paramedic. As the newly elected gov; he wants to consolidate govts. No more hamlets, towns, villages. What that means is decrease spending & proper spending. I believe that the 3 most important things we need in the US is edu, healthcare, & defense. I'm working on 2 of the 3...

Wondering where this is going? Resistance means that someone is listening. We all want better healthcare; many of us..... I worked areas where there is only 1 nys trooper covering 50 square miles. No village pd afterhours; taxes are the highest in NYS. There is a commissioner for every service; they're highly paid. Yet the fd and ems services are unpaid; responding from home; some come onscene in pajamas. Save a live; they gotta do what they gotta do to save a live. Kudos but what does that say about our piorites? In rockland; clarkstown pd my almost $100K to start. Ramapo pd make $85K. Fd chiefs have suv's; newest fire apparatus; electric stretchers; ferno stair chair; supplies; etc. They're is money for the vollies but the towns really cared then vollies will receive $$ for services render. Portion of taxes or taxes increased by .5% in sales can pay for this.

Alex,

I applaud any attempt to improve patient care, but I must say that you have a very "downstate" point of view on things. My county is over 1400 sq mi and at night we have 2 trooper cars on for the entire county, with a couple of villages that put their own cars on the road as well. The county sherriffs up here start at $24K per year. The Paramedics running R/M flycars up here are getting paid just over $9/hour. My town's entire budget for Fire and EMS is under $150,000. And that's for 2 ambulances, 2 Engines, 1 squirt, 1 Rescue, and a brush truck. There are no electric stretchers and the building is over 40 years old. Heck, the dept can't get a larger Squrt because the ladder won't clear the building and there's no money or plans for a new building or even a rehab.

Look at the tax rates by county as a percentage of home value: http://www.taxfoundation.org/research/show/1888.html

My county is 9th on the list, nationwide! Property taxes on an $80,000 property come out to about $2600. when you look at Rockland county, it is 89th on that same list. Yes, taxes there are a higher dollar amount, but the salaries are also higher. Having a .5% increase in the budget of a densely populated county like Rockland can provide a decent amount of money towards better fire and EMS, but adding .5% to the budget of a rural county like when I am now would bring in an extra $225,000 per year....not even enough to pay for 1 24x7 dual EMT ambulance (based on 8.6 FTEs)...and that would need to cover over 1400 sq miles. My town is currently involved in an EMS consolidation feasibility study between 3 different volunteer ambulance services. The results should be reported sometime by middle of next month. That study is only covering a portion of the county, about 150 sq miles, currently covered by 4 ambulances. I would be happy to share the results with you, once we get them.

Now, look at the problems facing hospitals when they try to hire doctors and nurses. Facilities across the country are understaffed. But, it is worse in rural areas due to lower revenues, etc. By bringing EMS up to a college standard, you may inadvertantly affect many rural areas throughout the state. Talk to the members of the State EMS Council and see what they say. Find out what the current volunteer response times are and look at potential response times for fewer (but paid) units, look at surge capacity for major incidents (how long will it be before additional transporting units can be on scene of even small scale MCIs). Then look at the payor mix differences between rural and urban environments (or in our case upstate and downstate NY), and compare the un-insured and under-insured rates to look at financial feasability.

Like I have said, I am all for improving EMS and increasing training standards, but we have to ensure we are doing that without making a negative impact on the services that are already available. I also think there's also a huge room for improvement in the current system, as one poster earlier pointed out regarding the lack of consistency between EMS class providers. Problems like that need to be fixed first before we go to a higher educational standard and expect colleges to take our educators and students seriously.

[Alex Woo]

Changing the EMT & EMTP Programs is a start. Money issue is a problem for all & its a result of inappropriate spending but that's neither here nor there. That's something our elected officials: local, state, & federal need to do. As I said the 3 most important services in the country is: Healthcare, Education, & Defense; the govt on every level spends very little for healthcare & education compared to other services. Is this fair? I'm not here to figure out budgets; that's the elected officials responsibility; which they've done really poorly with. My idea has & will meet resistance but the idea is about improving heathcare. Everyone who has argued it, hasn't stated why a more trained EMT & EMT-P will be a bad thing for the patient. Opposition states it hurts the budgets & vollies. It nothing that can be done. Its too much to ask from the EMTs. How is the State going to afford this? This will cost too much. I know but its for the good of the patient & that's what healthcare is about. If the govt on all levels paid/gave more (they did for fanny mae, gm, aig, etc), it wouldn't be a problem; that's why I've sent it to many elected officials. The NYS Assembly & Senate Members, the outgoing & incoming Governors, both the US Senators from NY, the outgoing & incoming Representative for Congressional District 19, the House Chair for Heathcare Commitee, the outgoing & incoming House Speakers, the President & Vice President; all received a summary of my proposal. My proposal for change is for the good of the patient.

Let's blame NYS EMS for not policing these courses. Let's blame the corrupt NYS Legislative Branch for the lack of monetary support. Let's blame NYS Medicaid & local wellfare services for allowing someone to collect both who has a Benz and a 52in Plasma. Let's blame the uninsured for crippling the healthcare system. Let's blame the NYS Education system for not putting Paramedics into a Degree program. We can blame everone and everything; my proposal for change isn't looking at that; it looks to advance someone's education thus advances healthcare. Anytime you try to advance it cost money. We'll always be in debt as long as the govt continues to spend without just cause. Also, we need to restructure the spending and taxes but that's not my topic.

Someone plz let me know this will be a bad thing for the patient. I can't concern myself with $ because then my proposal will not be looked at. I will prove the need and the use it will to patients..... Thank y'all....

[FredG]

Better educational standards for EMS will benefit patients. I don't think there is much of an argument there. But, you cannot look at this in a vacuum. Any change to the system will have a ripple effect across the entire environment.

Ok, let's say that NYS decides to implement a degree based certification program. Here are some of the issues that you will need to figure out:

- How will you transition the current cadre of EMS providers into the new system?

- Will there be any grandfathering of older EMTs and Paramedics that have been in the system for 3 years? 6 years? 12 years?

- How long with the transition period be between the current classroom educated EMTs and the College educated providers?

- How will you differentiate, during the transition, between the classroom providers and the college educated providers?

- How many colleges will support this educational program?

- How much will an EMS degree cost on average? Will the state sponsor all or part of the classwork like they do now for EMTs?

- How will recertification be handled?

- How will new curriculum be handed down to the field providers if there is no recertification requirement?

- will there be retesting on a periodic basis to replace the current recertification systems?

- Will Medical Doctors support such a program?

- Will the degree program be recognized nationwide? Can I take this degree and go to a different state and apply for a job without having to challenge against the local certification?

Ultimately, this is the kind of change that a committee made up of Medical directors, EMS providers and financial experts from all parts of the state should be formed to investigate.

[Alex Woo]

The degree is not for EMTs; who'll be EMT-Is & the EMT-I certification will be eliminated. The degrees will be for the EMT-P; it'll be available only as a degree no more certification programs. The EMT-CC will be eliminated; the EMT-P will also have the CCEMTP certification. The degrees available will be the AS; which is already available & BS; which in Mass its available. No more taking just the program.

This will make the bridge closer from EMT to EMT-P; The EMT won't be so lost when they decide to take the medic degree program like many are now. The medic will have a science degree in which they can transfer the prerequisite credits to other allied health, nursing, or medical degrees. That is my proposal. This is a long journey but it can be made. My proposal is not unreasonable. Its for the good of the patients and the practitioners. Please read the topic and beginning comment; I'm staying still on my point.

Remember if its an accredited college then its accepted nationwide. I'm taking & completing nursing from Excelsior College; an adult continuing edu. No classroom; just reading the sent material & taking exams at an outside testing center. There's are ASN, BSN, & MSN degrees available in this format. You can have a nursing degree but not be a RN; just don't take the NCLEX. The degree for Paramedics will be just that; if the person doesn't want to recertify; they still have the degree. Maybe the EMT/EMTP should be CME recertification based. Just like nursing: they don't retake the NCLEX; they attend the required CEs and pay a re-licensing fee. Not all nurses practice; many are educators, writers, administration. Just like many Medics are.

I'm a manager and an educator. I haven't worked as a medic in a year. Since I'm in NYS; I have 80hrs of CME in 3 years but its not good to recertify because I don't have the core hours but my NYC REMAC has been satisfied. So I have to refresh; I would have to take the NYS exam anyway because I'm a CLI but no refresher would have been great. I would have taken just the NYS & NYC MAC exams. This NYS Pilot CME program started 6-7yrs ago. It was new and time consuming but its mainstream for many services in NYS. If my proposal is accept; I will work on changing the CME Based Refresher to lessen the core (because its not easily available & when it is, its an 8hr day; how much can retain from 8hrs of straight edu/cme?) and increase the hours of MD given CMEs.

I hope this is clearer....

[Alex Woo]

The Editorial Director from EMS Magazine emailed me; she wants to do a story on this.... Will keep all you EMT City peeps updated.... I know its going to be tough for things to change that drastically but I'm the guy to do it....

Now I'm waiting for JEMS, all the NYS Assembly and Senate Members; along with the NYS Governor, outgoing and incoming to respond to me and take this serious.... Gov Cuomo may see this as a good thing... On his debate he mentioned he wants to consolidate town and villange governments; to be run by the counties.... He makes sense; he may see my POV.... Thanks y'all.....

[Richard B the EMT]

I wonder how this will affect the 5 counties comprising NYC, and/or the FDNY EMS? I only ask, as I live in NYC, and, while maintaining my EMT "cert", am an FDNY EMS retiree.

[Alex Woo]

Its just a proposal. It seems drastic but if the request for change is abundant; then more will be introduce into the system....

As for NYC; the private ambulance will follow NYS for the most part; FDNY EMS will be a tough one to change....

[ERDoc]

Alex, I wish you the best of luck but in NY you are going to be fighting the volleys. I can't speak so much for upstate, but the volley system is so engrained on the island that it will take the death of the president to force change. They are a huge voting population on LI and because most of the state lives there, they are a huge voting population for the state. Politicians have lost elections on LI because of the volley vote, believe it or not. Be prepared for an uphill battle.