NYS EMS Certifications

[Alex Woo]

I thank you for the moral support... I know its going to be tough.... Many are resistant to change. Upstate will be the same fight... I want this fight; I'm prepared and we'll see where EMS Magazine will take this. I hope JEMS contact me soon. Thx & Happy Thanksgiving to you & yours....

[Alex Woo]

Now JEMS contacted me about running something about this. This is an awesome end of year surprise; EMS Mag & JEMS looking to publish my proposal. I've read all your comments & thank you all for it. In addition, I've sent this idea to all of the NYS elected officials, the US DOT, NHTSA, NAEMT, NEMSMA, & NASEMSD. See the update letter sent:

To Whom It May Concern,

I'm asking for NYS EMT Certification Restructuring with elimination of some EMT certifications, with the advancement of the remaining certifications. I've sent letters and emails relating to this issues to the NYS Legislative Officials, NYS Governor, US DOT members, and various EMS publications & sites. ?My concern is for the patients receiving Prehospital Care. Are the EMTs & AEMTs coming out from school trained adequately to render lifesaving care? I believe the EMT & AEMT programs need to be more advance and more selective.

Who am I? Do I have the background to spark this change? I'll let you decide. I've been a NYS EMT since 1996 and a NYS EMT-P since 1998. During my career I've worked in various Proprietary Services and volunteered as an EMT. I've worked in various NYC Hospital Based EMS and Surburban Solo & Dual Fly-Car EMS Systems. I served as a EMS Manager in a NYC Hospital Based EMS Ambulance Department but soon after the Berger Commission Report, I was eventually forced out of my position due to the closing of the hospital. I've been a Supervisor & Operations Manager at a Proprietary Service ever since. I've been in EMS and AHA Education since 2002. With all my experience in various EMS Regions & Services; I've seen positive and negative changes in EMS; which whether I agree with, is irrelevant. I've been in the field long enough to know that EMS care needs to progress faster. We all believe healthcare is for the good of the patient. I feel that the patient deserves the best care possible & currently the NYS EMTs & AEMTs do not do so.

The NYS EMT curriculum provides very basic medical knowledge. Medicine is an iceberg; even the most seasoned EMT-P barely scratches the surface. I feel I have a proposal which will address these concerns. The EMT is the foundation of EMS care. However, the diseases have become even more complex and patients need more than BLS care. The prerequisite should entail the candidate to be over 18 years old and obtained a High School or a General Equivalency Diploma. There's some EMT Programs in NYC who do not require a HS Dipolma or a GED to enroll (That's another topic for another time). However, the EMT needs to have more didactic hours added, not taken away; skills can't just be added without formal training (Aspirin, Albuterol, and Epi-Pen/Jr). The rotation hours need to be increased; one rotation with a choice of ER or Ambulance is unacceptable. The EMT course needs to be an 8-9 months long course with Intermediate Training & more hours on rotation from the ER to Ambulance. This will eliminate the EMT-I certification. The EMT-B will replace the EMT-I. In addition, the EMT-CC will have to certify as an EMT-P; there can be a bridge program to accomplish this. However, the EMT-P will be an A.S. program with CCEMTP training. It will only be available in Universities or Colleges; a B.S. program must be available in several areas in every State. Even a M.S. program should be on the table. The EMT-CC will be eliminated. Current EMT-Ps must take the CCEMTP but the Degree can be waived for them; if they choose not pursue it. The NYS EMT or Nationally Registered Certifications will be only the EMT-B and EMT-P. Whether this is better care, is not the issue; on paper it will be. If the provider can't complete the upgrade they'll downgrade to the lowest level; so, the EMT who can't complete the EMT-I training will forfeit their certification. The EMT-I will be an EMT; there is no upgrade for the EMT-I (It depends on whether it will be the EMT-I 85/99). The EMT-CC who can't complete the new EMT-P program will become an EMT. The EMT-P who can't complete the CCEMTP course will downgrade to an EMT. There will be a specific time given to complete the upgrade and at no cost to the candidate.

Let's look at how Nursing has progressed. In Nursing there's different licenses: CNA, LPN, RN, NP, & DNP with degrees ASN, BSN, MSN, & PhdN for the RN. The NP and DNP are healthcare practitioners who can prescribe medications and diagnosis conditions. Its amazing how nursing has really progress from the beginning of modern nursing during the Crimean War.

EMS care in NYS can be the blueprint for this change and it should spread to all 50 states. The EMT program will be an intense 8-9 month long & it shall receive college equivalent of 6-8 credits if one chooses to go to College and pursue a degree in Paramedicine. The EMT-P will incorporate CCEMTP training, only available as an A.S. and B.S. degree program in Emergency Medical Paramedicine.?? My proposal with make the bridge from EMT to EMT-P closer. Currently many of the Paramedic Students, I've come across in my years of teaching, many are lost in the first half of the course. Whether because its too much information or their EMT course didn't provide the necessary information during the course; I do not know. 

The EMT will be more trained and if they decide to go further in healthcare; they'll have a strong education background. The CCEMT-P will be able to handle any setting; from emergencies to transfers. In addition, if the CCEMT-P decides to further themselves in healthcare; the new CCEMT-P's education will make it easier and with the degree, the prerequisite courses will have been mostly met. These changes for the current EMS Providers, shall be funded  by NYS Education Fund by the NYS Government. This is an idea which can be modified but I hope I will see this kind of change in the near future.

I'm going down the path, in which I would like to see happen. Its a long process but it can happen. I'm available to assist in any way I can.???

Regards,

Alexander G. Woo, EMT-P

NYS #214355

[Lone Star]

Whether this is better care, is not the issue; on paper it will be.

If the whole purpose behind this campaign isn't to be able to provide better patient care, then just what IS the purpose of the restructuring of NYS EMS?

The whole purpose of EMS is to provide the BEST emergency care that we can until we can deliver the patient to more defiinative care than we can provide. Changing the names of the providers ISN'T the answer, better EDUCATION is!

If I went solely by that line I quoted, it looks like nothing more than an attempt to look more impressive on paper, and thats all. Titles aren't what keeps our patients alive. It's the skills we develop through more and more education.

[Alex Woo]

Absolutely right. Its not the title but if EMTs rec'd more hours and were able to give life saving meds other than what than can now, advance airway not ET, IV with fluid resuscitation then maybe EMTs wouldn't be so lost in Medic school; maybe lives could have been saved. Instead of racing to the ER with the pt on O2 and supine/trenden because the BP is low and HR hi; skin cool, pale, diaph; AMS or wait for ALS; yes it will be bad. If my idea went thru and it became 8mon course with 170hrs of classtoom time & 8-10 rotations, instead of 110 and 1 rotation; this will be bad. If seasoned EMT-Bs were EMT-Is during their career; then they'll have more knowledge. Ask an EMT-B now who's in the EMT-P program; how much more didatic information there is, how there's so much reading, & so much more rotations; so why is that? My proposal will bridge the gap bet the 2; closer.... If its all about seasoned EMT-Bs; then why are there AEMT-Is (85/99), in NYS AEMT-CCs, & AEMT-Ps. We wouldn't need them. Plz really read the whole message; if you did, you wouldn't respond this way... If you've worked in EMS; you wouldve have met an idiot RN, PA, NP, & MD; you may have said, "how did this person pass school?" On paper the healthcare providers are for the better; it may not happen but on paper it is showing better care. Remember ppl are imperfect creatures who destroy a perfect plan... Hence, malpractice.... Thanks for your response...

All MDs are not the same. Some good, some bad but on paper they're MDs... All DOs are not the same. Some good, some bad but on paper they're DOs... All PAs are not the same. Some good, some bad but on paper they're PAs... All NPs are not the same. Some good, some bad but on paper they're NPs... All RNs are not the same. Some good, some bad but on paper they're RNs... I'm trying to make it better on paper; its up to you, me, & others to make it good... Will you help me make it good?

Its going to be tough; vollies will make it hard, with many who have political ties. But this proposal is like a lawsuit; you ask for more, so you get something. If I get something then it will be great. Can I get something?

Thanks for your response, Lone Star....

[Lone Star]

Having been through the EMT-B twice (12 years apart) and in two different states, I can see where the entire EMS program needs to be revamped.

My first course turned out to be 240 contact hours plus clinical rotations. While the second time through was about the same amount of time, the information passed along was far inferior.

In my considered opinion, it IS all about patient care. The more education we get (as opposed to training), the better care we can provide to out patients.

It shouldn't matter what title is on paper, it should matter though about a standardized national scope of practice, a shift of focus from the minimum hours required to a solid knowledge base in order to understand not only WHAT we do, but WHY we do it.

If EMT-B is the 'basic building blocks of EMS education', then there should be more focus on Anatomy & Physiology, psychology, pharmacology, and cardiology at the basic level. This will give the EMT students a more solid footing as they progress through EMT-I and into Paramedic; rather than watch them crash and burn when things like acid/base, basic cardiology and pharmacology are introduced.

There is far too much reliance on 'the book says' in EMS. We need to be able to separate ourselves from 'the book says' and be able to think in terms of what evidence we are presented with on scene. EMT-B is far too reliant on regurgitation of catch phrases and acronyms without actually understanding what they REALLY mean in the grand scheme of things. THIS is where things need to start changing.

Before we can begin thinking of increasing our scopes of practice so that they overlap and there is a seamless integration of the levels of EMS, we need to concentrate on increasing our knowledge levels.

[Alex Woo]

I can only speak for NYS... So you can see how bad the NYS EMT-B is. I want that changed; if the NYS sees my POV; then NYS EMS will be better. NY is not progressive.

If your EMT-B was 240hrs then that state has higher minimum standards. My proposal is to make the EMT-B & P better; there's no need for EMT-Is; when the EMT can learn and become an EMT-I. That's my point; there's 4 levels; EMT-B, I (85/99), P; in NY there's CC's; thanks to Long Island. I don't know how ur state & other states are but NY does not have a good EMS learning system. My idea propels the EMT-B to be a prehospital practictioner not a advance first aide provider; in NY, EMTs are just that with asa, albuterol, & epi pen/jr; I am a mgr & supvr at a private ambulance; the EMTs I have didn't learn it in school; I had to in service them; NYS sent teaching/learning packets to all the agencies; this is not covered in refreshers neither. NY EMS is not good; the letter is directed to NYS DOH EMS; that's my forum & my bill. I want NY to be the best possible. I hope this explains why I'm doing this in NY.

IDK how the other states are but in NY, outside NYC, the volunteer ambulances run 911. There's medic providers but they answer to the vollies of each town. The vollies w/ their stink attitude will question a paramedic on scene & if the EMT doesn't like what the medic did or didn't do; they'll have the medic fired. Many vollies in NY have a lot of poitical influence; vollies are members of the community providing free service; they help the community, which is a great thing but their career is not an EMT; to them its a hobby. I want EMTs to be a profession; not a hobby...

The way the NYS allows its course programs to be so laid back; anyone can be an EMT; even ppl w/o HS/GED; some have criminal records. This is the NYS I fighting. I hope all the EMT City members see why I want change in NYS; my state... That's why I've said that the NYS Gov elect Andrew Cuomo wants to consolidate local govts; this may be a good thing for my idea of a better NYS EMS....

Thank you for ur input, Lone Star....

I'm cool with getting rid of the EMTs and EMT-Is (CC) and incorporate the BLS into the Paramedic Program; have only paramedics with AS, BS, & MS (maybe) degrees & disbanding the private programs. The medic program only available in colleges with CCEMTP training.

I did say all this minus the EMT, getting rid of thing.

So you agree with me; plz really read my comments & the email; I did say all that. My comments are for NYS DOH EMS; so you can't compare.... Thx...

[ERDoc]

Alex, another thing to keep in mind is not to require too much education. If you are going to require someone to get 6-8 years of education to be a paramedic, where is the incentive? With just as much time put in, you can become a PA and make a lot more money. For a few more years you can go to medical school and make a lot more money.

[Alex Woo]

Of course not. I have a AS in Paramedics. I'm getting AS in Nursing. I'm not asking for candidates to get a BS; I'm asking for all candidates that want to be EMT-Ps; it will only be available as a AS degree; no more private programs. There must be a BS degree in Paramedics avaliable in all states. Not just in MA. MS can be developed. This is mirroring a RN's degrees; AS, BS, MS, PhD.... Minus the PhD..... Thx for your input ERdoc....

[EMT155]

Alex,

First of all, for the record, I don't disagree with the concept you put forth.

That being said, I have been certified for over twenty years, with a year at the Intermediate level and 3 at the CC level. I live and work in Central NY. I have spent almost all two decades as a volunteer EMT and currently am the Director of operations and Recruiting for a volunteer agency. I work full time for a paid ambulance service now as a basic EMT. I only point this all out to let everyone know where I'm coming from.

The biggest hurdle you are going to have is that here in Central and Upstate NY, the vast majority of prehospital providers still rely primarily on volunteer members. This is especially true in the more rural areas of Upstate (north of Oswego and Watertown). By requiring more education than we already do, you are taking people away from their families for even more time without any real compensation to them. Eventually, these people are going to get out of the business, and more people will be dissuaded from starting due to the length of schooling. On top of that, it's difficult to find a paramedic level class that is covered by the state. I'm signed up for the closest paramedic class I can locate, and I have to shell the money out of my own pocket, and I don't know of any agencies locally that will reimburse for it. I've been in regular contact with SUNY Upstate and several other local groups that have access to class schedules, and at this time, no one here is offering the class at a state covered level.

I'm sure that downstate EMS providers make somewhat more than we do up here, but being a homeowner and parent, having to pay more to keep up my certifications is difficult financially as well as in time. For those of us that get a fiduciary return on our educational investment (and Herkimer community College offers the pilot program, which trades off CME's for recertification, bringing the paramedic level closer to licensure than certification.)

While I've rambled about the topic a bit, the point I'm trying to make is that, while ALS providers as the lowest level is good from the patient's perspective, we can never forget that BLS comes first and foremost before ALS, and if we ramp up the requirements too much, we'll end up with less people trying to do more work, leading to more burn out, injury and general loss to attrition. This would not be good for the patient in the long run.

While, from a practical point of view, I think we can eliminate/upgrade the I, CC and P levels to provide higher levels of care in the prehospital setting, I think that the basic EMT level as it is, is already where it needs to be to make sure that there is always going to be adequate coverage for the rural areas of the state.

The other thing to bear in mind is that in upstate, we have other classes that we take as a compliment to our certification, FarMedic being one of those. I doubt that you would see much in the way of farm accidents and injuries south of Westchester county. Not that it's a bad thing, just a geographical one. This is also why we have multiple regional RMSCO's different areas have different needs, types of calls and transport times.

I'm not sure where you deal with the vollies you mentioned, but here in CNY, vollies and paid get along well and work together for the benefit of the patient.

In closing, while I agree with your proposal in principle, in practicality, it needs some more latitude to work for the Upstate regions.

Best of luck, and hope we can all find something that will benefit the patient without putting undue strain on the people who make it work outside of the city.

Jim

[Alex Woo]

Jim, I want thank you for your comments. I do agree that upstate NY is a lot different than NYC & the neighboring counties. I agree that the EMT-I is an important part of ALS care in real rural areas of NYS. I appreciate your words and I totally understand. The reason my stance is so strong for vast change; is for the sake of the patients. BLS is important but as a Paramedic; I can't just BLS all my patients; not only is it against protocol but I'll get sued & lose my certification. I feel with extra training the EMT can be a big part in early ALS care; it will be an EMT-I; like yourself. You're able to provide more care than an EMT-B; that's awesome for your patients. I know I will never be able to get this through but if all the organizations who have major influences in EMS would just take a few of my ideas & hear me out; EMS will be a better system with very good healthcare providers.

My main concern is the Paramedic; I would like it to be an A.S. Degree program only. No more private programs & I would like the CCEMTP incorporated into the program. I want the EMT-B to have more rotation & didatic hours (re)added back on. That is the real basis on this most controversial movement.

Remember this proverb:"When you ask for more; you get some. If you ask for less; you get none." Alexander Woo

I wish you luck in your endeavors too.

A. Woo