EMS CErtifications

[Alex Woo]

Below is an emil and content was mailed to NYS DOH Bureau of EMS. Please provide any comment regarding this, even if your in another state. Please let me know the system there.... Thannks for the viewing...

To Whom It May Concern,

I'm emailing you a thought I've had for years but did very little to say or do anything about. I've been a NYS EMT since 1996 and a NYS EMT-P since 1998. I've not been around for that long but I've been in the field for enough years to know that EMS care needs to progress faster.

I've worked in the proprietary and volunteer services as an EMT and also as an EMT-P. I've worked in the Voluntary Hospital EMS as a EMT-P & managed an EMS Department. 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 at a proprietary service ever since. I've been in EMS and AHA education for numerous of years. I've seen positive and negative changes in EMS; which whether I agree with, is irrelevant. I'm asking for EMS certification restructuring with elimination of some EMT certifications.

The EMT is the foundation of EMS care. However, the diseases have become even more complex and patients need more than BLS care. The EMT needs to have more hours added, not taken away; skills can't just be added without formal training. The EMT needs to be an 8-9 months long course with Intermediate Training. The EMT-I certification will be eliminated. The EMT-B will be the EMT-I. The EMT-CC will have to certify as an EMT-P but the EMT-P will be an A.S. program with CCEMTP training. A B.S. program must be developed and incorporated; maybe a M.S. program can be on the table. The EMT-CC will be eliminated. Whether this is better care, is not the issue; on paper it will be.

Let's look at Nursing; CNA, LPN, RN, NP, & DNP with degrees ASN, BSN, MSN, & PhdN. Its amazing how nursing has really progress from the beginning of modern nursing during the Cremean War. EMS care in NYS can be the blueprint for this change and it will spread 50 states. The EMT program will be an intense 8-9 month long & college equivalent of 6-8 credits. The EMT-P will incorporate CCEMTP training, only available as an A.S. and B.S. degree program in Emergency Medical Paramedicine.

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. The EMT-CC who can't complete the new EMT-P program will become EMTs. 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.

My proposal with make the bridge from EMT to EMT-P closer. The CCEMT-P will be able to handle any setting and if one decides to further themselves in healthcare; the new CCEMT-P education will make it easier and with the degree, the prerequisite courses will have been almost met. These changes for the current EMS Providers, will be paid for by NYS Education Fund.

This is an idea which can be modified but I hope I will see this 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

NYS EMT-P #214355

[DwayneEMTP]

Hey Alexander, Welcome to the City!

I believe that those are all great ideas. But how do you get them implemented as long as the fire services are participating in EMS?

Dwayne

[fakingpatience]

EMS care in NYS can be the blueprint for this change and it will spread 50 states. The EMT program will be an intense 8-9 month long & college equivalent of 6-8 credits. The EMT-P will incorporate CCEMTP training, only available as an A.S. and B.S. degree program in Emergency Medical Paramedicine.

Not meaning to nit pick here, BUT where I took the EMT-B course, it was already 10 collage credits (not in NY). NY should first focus on catching up with the rest of the nation, and accepting national, rather then trying to restructure the entire program. The national standard for EMT-B is already about 1/3 longer then the NY standard.

[paramedicmike]

Well, first things first. Welcome to the City. You will find a lot of very knowledgeable people here with a wide breadth of experience.

With regards to your post, I feel I should say this now because something tells me you might not get to the end. I think I see where you're headed with your thoughts. I'll even go so far as to say that I like what you're thinking. However, please tell me you haven't sent this yet.

If I were to receive an email like this (if this is, in fact, exactly what you sent) I would delete it without a second thought. I probably wouldn't even have read it in its entirety. The grammar and spelling mistakes alone are enough to do away with any credibility this piece of correspondence may have had. There are also some very basic and fundamental construction issues that are blatantly absent. Without this foundation, anything you write is worthless.

Before reading on just remember, you asked for feedback.

Below is an emil and content was mailed to NYS DOH Bureau of EMS. Please provide any comment regarding this, even if your in another state. Please let me know the system there.... Thannks for the viewing...

To Whom It May Concern,

I'm emailing you a thought I've had for years but did very little to say or do anything about. I've been a NYS EMT since 1996 and a NYS EMT-P since 1998. I've not been around for that long but I've been in the field for enough years to know that EMS care needs to progress faster.

I've worked in the proprietary and volunteer services as an EMT and also as an EMT-P. I've worked in the Voluntary Hospital EMS as a EMT-P & managed an EMS Department. 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 at a proprietary service ever since. I've been in EMS and AHA education for numerous of years. I've seen positive and negative changes in EMS; which whether I agree with, is irrelevant. I'm asking for EMS certification restructuring with elimination of some EMT certifications.

You're asking for a complete restructuring of EMT certifications but you have not outlined why. You have failed to demonstrate there's a problem. By failing to demonstrate a problem you have essentially demonstrated to the reader that there is no point in reading further. All you have done is outline your resume which has absolutely nothing to do with asking for certification restructuring

The EMT is the foundation of EMS care. However, the diseases have become even more complex and patients need more than BLS care.

Really? This is news to me. Do you have any information to support this claim? How are diseases more complex? Why do patients need more than BLS care? How do you counter skeptics who have studies to back up their claims that EMS doesn't do a whole lot?

If you do have resources to support your claim, failing to include your references pretty much removes any credence to any argument you may be trying to make. The reader is free to assume that you're just shooting from the hip and have *nothing* to back up anything you're saying.

This is another reason to immediately delete what you've sent.

The EMT needs to have more hours added, not taken away; skills can't just be added without formal training.

Is this a problem in NY? Are skills being added with no formal training? How does that work? Since you've not cited any specific example to justify your claim why should anyone continue to take you seriously?

What's more, why the concentration on skills? Medicine is not about skills. Medicine is about knowledge and skills are an add-on. Perhaps a focus on EMS education instead of EMS skills would help.

The EMT needs to be an 8-9 months long course with Intermediate Training. The EMT-I certification will be eliminated. The EMT-B will be the EMT-I. The EMT-CC will have to certify as an EMT-P but the EMT-P will be an A.S. program with CCEMTP training. A B.S. program must be developed and incorporated; maybe a M.S. program can be on the table. The EMT-CC will be eliminated. Whether this is better care, is not the issue; on paper it will be.

Again, why? You have no argument presented nor do you have examples citing why you believe these changes are important.

Let's look at Nursing; CNA, LPN, RN, NP, & DNP with degrees ASN, BSN, MSN, & PhdN. Its amazing how nursing has really progress from the beginning of modern nursing during the Cremean War. EMS care in NYS can be the blueprint for this change and it will spread 50 states. The EMT program will be an intense 8-9 month long & college equivalent of 6-8 credits. The EMT-P will incorporate CCEMTP training, only available as an A.S. and B.S. degree program in Emergency Medical Paramedicine.

You started with something potentially useful by trying to compare nursing with EMS. Where you run into problems is comparing the two with no common link established as to why EMS should model nursing. Nor have you demonstrated *if* EMS should model nursing.

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. The EMT-CC who can't complete the new EMT-P program will become EMTs. 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.

You have failed to demonstrate why this is necessary. You have also failed to demonstrate why people should listen to you.

My proposal with make the bridge from EMT to EMT-P closer. The CCEMT-P will be able to handle any setting and if one decides to further themselves in healthcare; the new CCEMT-P education will make it easier and with the degree, the prerequisite courses will have been almost met. These changes for the current EMS Providers, will be paid for by NYS Education Fund.

What bridge from EMT to EMT-P? This is the first time you're mentioning this. How will obtaining a CCEMT-P certification help make the transition in health care easier? Again, you've provided no examples to support your point. Prerequisite courses? What prerequisite courses? You've mentioned nothing about how any degree program would offer prerequisite courses that would even come close to satisfying requirements for other degree programs. Do you plan on including all the schools that offer EMS education in your certification revamping process? What about, like Dwayne astutely noted, all the other outside interests that claim a stake in EMS? What about fire based EMS systems? What about municipal third services? What about all the private services that aren't going to want to pay a higher wage for a college educated paramedic?

This is an idea which can be modified but I hope I will see this 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

NYS EMT-P #214355

What idea? You've offered a half baked solution to a problem you haven't identified. What's more you haven't provided examples of why whatever it is you view as a problem is, in fact, a problem. Are you asking for a job? Did you send your resume with this letter?

Before anyone can say I'm not offering any help, please consider the following:

Dear Sir/Madam: (This would go even better if you had a contact name so it could be formally addressed.)

Paragraph 1: Identify yourself and your experience.

Paragraph 2: Identify the problem you see and how you came to see this particular issue as a problem.

Paragraph 3: Cite *specific* examples that can be independently corroborated that support your claim that there's a problem.

Paragraph 4: Identify your idea that would serve as a solution for the problem you've identified and supported by way of examples.

Paragraph 5: Briefly outline details of your solution and how they would benefit the involved parties.

Paragraph 6: (optional) Discuss potential pitfalls or roadblocks that would stand in the way of successful completion of your plan.

Paragraph 7: Close by summing up everything you've outlined so far. Close by saying, "Thank you for your attention."

Regards:

Alex Woo

Yes. This is a lot of work. But progress of the kind I think you're shooting for doesn't come easy.

Good luck.

[Alex Woo]

Remember that this a summary of change. A letter too long will not draw readers... Ex resumes are suppose to one page; not many pages... This is just an overview; there's so much you can put in a letter... Then additional letters can be sent; as time goes on.... My backgrd suggests my understandin of the field; this will let legislative officials know that the message is not from a common joe... This is the beginning phase; remember the message; it will progress in NY.... Thx...

Remember my name: Alexander Woo... NYS DOH EMS will be getting a copy of my proposal; it has everything everyone suggests..... Data, %, sources, etc..... I'll scan in future and post it here....

[Alex Woo]

Thanks Dwayne,

Its going to be tough but we can tell Fire to fight fires. At least in NYC; Fire is not EMS; even though it says FDNY EMS. They are seperate. Thanks to NYC Health and Hospitals for not managing their funds and in 1996, FDNY took over EMS.... In NYC its fine but its the upsate bureaucracies that makes it even more troublesome with the volunteer corps. Don't get me started with Long Island with the cop ambulances....

I mean no disrespect to services but I am for positive change and we all say its about the patient; so my goal is for better pateint care...

Thanks EMT City Senior for the advise.... Remember this was an email and the content doesn't need to be fully explained because it was sent to the EMS governing body of NYS.... I have the proposal edited (by a professor), quoted, and cited.... Its going to happen; with the suipport of my peers or not. If I habve to go through this solo, then so be it...

But thanks for the comments....

Thanbks awesome; I know NYS is very slow..... Then I be the one to jumpstart NYS to become more standardized.... So what can EMT-B do in the state you're from? In NYS EMT-Is can start IV, ET intubate, read basic ECG, and give some meds; thats the EMT-I 99... There's an EMT-I 85 and its garbage.... Its ET and IV; thats it.... I want NYS EMT-B to have EMT-I 99 training; will be know as the EMT-B.... I want the EMT-I and EMT-CC (which isn't a NREMT recognize certification) and have only EMT-Bs and EMT-Ps but the EMT-Bs will be able to really assist the EMT-P; EMTs in NYS don't and can't unless they were taught on the road by someone,,,, I still mean no disrespect; I am pushing for change will will benifit the patient anytime the ambulance transports them to the ER...

Like nursing the LPN is 1 year shy of the RN.... The EMT-B is well behind in knowledge and skills than the EMT-P.... To compare to nursing; the EMT in NYS is like the CNA in nursing.... Again, no disrespect.... I want change....

Thank you for the comments....

[ERDoc]

Alex, I have some food for thought and want to play devil's advocate here. I think it is great that you want to improve EMS. I agree that it desperately needs to be fixed. Just so that I am clear, you want to make the EMT-B what NYS currently recognizes as EMT-I? Do you really think this is a good idea with the current state of EMS in NYS? I was a volley EMT in Suffolk for 10 years so I'm pretty familiar with what goes on in the volley world. Do you think trusting such a large number of volleys with the ability to push meds and intubate is a good idea? How much experience do they really get? The VAC I rode for did about 3 calls per day. Is that really enough experience for every EMT in that corps to be able to successfully intubate? Would you want a family member to receive meds and be intubated by someone who runs 1-2 calls per month? I don't think I would be okay with that.

Edited November 14, 2010 by ERDoc

[Alex Woo]

In the 60's there were no EMTs; ambulances had strong men who had the ability to lift & drive... They were phased out; when the EMTs emerged. In the early 70's paramedics were born and the BLS/ALS care were in the beginning stages. Look how 40years have changed EMS; EMTs are giving epi, albuterol, & asa. Medics are giving more drgs & some of the skills performed now were never even heard or thought of... If we make changes now in 10years; there will be EMTs who are Is & even a more trained paramedic.....thx for ur reply....