Intermediate vs. Paramedic

[FireEMT2009]

Hello all,

I would like ya'lls advice on something that I have found to be somewhat immature and more of an ego thing then anything else, but yet it does annoy me. Here it is:

In my region there are intermediates and paramedics working throughout. In our protocols here there is not any differences between the two levels in range of skills. There are a couple drug differences where the P's do not have to call for the orders where an I would have to. The big debate with some people is the fact that an intermediate should not be considered a "medic" since they do not have a paramedic certification. In my opinion I do not believe that to be the case. They can intubate, push all the drugs in the drug box, etc.

What do ya'll think? do ya'll think that their should be noted differences between the two?

Just curious,

FireEMT2009

[Bieber]

A paramedic is not defined by the skills they can do, but by their knowledge and the level of education they have attained which, as inadequate as it tends to be in the majority of the United States, is still substantial compared to that obtained of an EMT-Intermediate. Now, I wouldn't complain if we abolished the term "EMT" and renamed it "paramedic" and clarified the level of care as an addendum to the title (if only among ourselves)--i.e. Basic Paramedic, Intermediate Paramedic, Advanced Paramedic, etc--but as it stands, the way we distinguish the two is with the classical nomenclature of EMT(- , (A)EMT-I, and (EMT-)Paramedic.

Should there be noted differences between the two? Well, yes, because there ARE noted differences between the two. Sorry, man, an intermediate in your area may be able to perform all the same procedures as a paramedic, but they're not the same. I say this as someone who was once an EMT-B, an EMT-I and who is now a paramedic. The amount of education (at least around here, and granted, Kansas requires an Associates to become a paramedic but I don't believe we're light-years away from the rest of the country either) is on a completely different level.

Like I said, I don't care if we rename all EMT's "paramedics" for ease of use and for the general public's sake, but to imply that there is no difference between two providers because they are allowed to do the same skills shows a complete lack of recognition for the fact that we are not what we can do--any monkey can perform the skills we do; hell, a child can intubate. We are what we know and what we have proven we know.

Not trying to be a dick, man, and if I misunderstood something you said then please let me know and I'll redact my reply, but the impression I'm getting from you is that you think the ability to do the same skills makes an EMT-I the same as a paramedic, which couldn't be further from the truth.

Edited June 15, 2012 by Bieber

[Kiwiology]

A barely trained skill monkey technician can shove a tube down somebodies gob or stab them with a drip but it takes a clinician capable of application of complex cognitive knowledge and problem solving to truly understand if, why and when it is appropriate to do so

Back in the late 1990s/early 2000s NZ renamed Intermediate Care Officer to "Paramedic" and Paramedic "Intensive Care Paramedic" but that is a very different thing alltogether

[chbare]

Bieber, many people fail to understand your point. Being a certain type of provider is about having a certain degree of education and competency validation in a specific area. You are absolutely correct that skills are not the bottom line, yet we seem to glorify skills and forget education quite often in EMS. Is a provider with a restricted scope of practice a "lesser" provider than one with a progressive scope of practice?

However, what does concern me about the intermediate level providers is a tendency for skills creep to occur. This is not because my paramedic pride is hurt. I am not a paramedic. However, what does concern me, is having people with limited education performing high risk interventions.

No disrespect to other providers as I hold this standard to all. I do not tolerate skills creep in other professions, but I will not start that conversation on this thread.

[Kiwiology]

As disappointed as I am in the EMS Agenda for the Future hopefully it will address the problem of the "Paramediate" because as I understand it Intermediate must bridge up to Paramedic or down to AEMT and the scope of practice that comes with it

Sounds like New Arizomexas has already implemented this from one of ch's earlier posts

[Bieber]

Bieber, many people fail to understand your point. Being a certain type of provider is about having a certain degree of education and competency validation in a specific area. You are absolutely correct that skills are not the bottom line, yet we seem to glorify skills and forget education quite often in EMS. Is a provider with a restricted scope of practice a "lesser" provider than one with a progressive scope of practice?

However, what does concern me about the intermediate level providers is a tendency for skills creep to occur. This is not because my paramedic pride is hurt. I am not a paramedic. However, what does concern me, is having people with limited education performing high risk interventions.

No disrespect to other providers as I hold this standard to all. I do not tolerate skills creep in other professions, but I will not start that conversation on this thread.

Chris, I agree with you on everything that you said, and it's unfortunate that we in EMS have begun to define ourselves by our skills (or maybe we always did?). While I wouldn't necessarily be opposed to paramedics being able to delegate certain skills to other providers under direct supervision, there should a safety net in direct supervision and delegation in that the decision making remains firmly with the paramedic, and unfortunately that isn't the nature of this tendency for skills creep--rather, intermediates are being given greater autonomy, greater skills, and greater independence without the necessary education to support that additional freedom.

It ultimately comes down to this: when paramedics barely have the education to perform the skills they are allowed to (and in many parts of the country, they don't even have that), the notion of intermediates being given similar freedoms is frightening and has disconcerting ramifications for patient care--and downright terrifying consequences for the future of EMS education and professionalism.

Sorry to go off on that tangent, and I'll leave my views on intermediates at that.

FireEMT, like I said, there is a tremendous difference between an intermediate and a paramedic. And I'm not particular about protecting or sequestering the term "paramedic" for use only by ALS level providers, only about ensuring that the differences in the level of care are respected and recognized--whatever the terminology--because anything less disrespects and diminishes the vastly greater education paramedics hold and simplifies our entire profession into a question of who can do what skills; rather than focusing on what we know and what we've proven we know (or should know), which is the mentality we as EMS providers should be striving for, in my humble opinion.

Edited June 15, 2012 by Bieber

[chbare]

Kiwi, unfortunately I do not see the AEMT changing much. It's the minimum level of education and scope of practice suggested. However, states and municipalities are free to "add" onto this as they see fit assuming they meet the national standards.

[Eydawn]

Yes, there is a difference. Don't get your feathers ruffled, and ignore the "but that's MY territory" bullshit.

Do you have the same education as those other providers? Do you understand the interventions the same way? Given similar critical patients, would you both select the correct interventions and understand the rationale for those interventions (be able to tell a doc WHY you did what you did at the ER)?

If you haven't had the same education, you're not the same provider. In any part of medicine. I bitched and moaned that I couldn't just test for CNA prior to nursing school with my EMT education, but after having had both now, man, they're different worlds. Do we do a lot of the same basic physical interventions - lifting, moving, vitals, basic airway support, reporting to higher level provider? Yes. Should I ever have been allowed to test for CNA, as I was whinging? NO! And no CNA should be allowed to test for EMT without having the education, either... same goes for different levels of paramedicine, PAs vs NPs vs MDs, tele techs vs respiratory therapists... just not the same.

Wendy

CO RN-ADN Student

[FireEMT2009]

A paramedic is not defined by the skills they can do, but by their knowledge and the level of education they have attained which, as inadequate as it tends to be in the majority of the United States, is still substantial compared to that obtained of an EMT-Intermediate. Now, I wouldn't complain if we abolished the term "EMT" and renamed it "paramedic" and clarified the level of care as an addendum to the title (if only among ourselves)--i.e. Basic Paramedic, Intermediate Paramedic, Advanced Paramedic, etc--but as it stands, the way we distinguish the two is with the classical nomenclature of EMT(- , (A)EMT-I, and (EMT-)Paramedic.

Should there be noted differences between the two? Well, yes, because there ARE noted differences between the two. Sorry, man, an intermediate in your area may be able to perform all the same procedures as a paramedic, but they're not the same. I say this as someone who was once an EMT-B, an EMT-I and who is now a paramedic. The amount of education (at least around here, and granted, Kansas requires an Associates to become a paramedic but I don't believe we're light-years away from the rest of the country either) is on a completely different level.

Like I said, I don't care if we rename all EMT's "paramedics" for ease of use and for the general public's sake, but to imply that there is no difference between two providers because they are allowed to do the same skills shows a complete lack of recognition for the fact that we are not what we can do--any monkey can perform the skills we do; hell, a child can intubate. We are what we know and what we have proven we know.

Not trying to be a dick, man, and if I misunderstood something you said then please let me know and I'll redact my reply, but the impression I'm getting from you is that you think the ability to do the same skills makes an EMT-I the same as a paramedic, which couldn't be further from the truth.

Hello, all sorry haven't been on here in a while. I actually am I new Paramedic myself. I just made the long transition from B to P. My bachelors program skipped Intermediate completely to better give us the patho and rationale critical thinking base we needed for our careers.

Anyway, I completely agree with everything being said. I have never been an intermediate nor plan on giving up my paramedic anytime soon that is why I posed this question. I have talked to people that have made the transition through all three and they have stated that it was a lot more pathophys and critical thinking than intermediate was. I posted this to see as what ya'll felt about it. I feel the field is changing in a lot of ways. We now have active lobbying going on in captial hill with "EMS on the Hill" as well as acceptance as a medical profession. I am just looking for good opinions. And Beiber as I said I converted straight from Basic to Paramedic so I never got to experience the joys of an Intermediate class.

[EMS Aficionado]

In my experience, in the eyes of the public, we are all "Paramedics" or "Ambulance Drivers".

The majority of the public probably can't differentiate between an LPN, RN or NP. By the way, they all refer to themselves as nurses, despite each having a dramatically different scope of practice.

Who cares if an EMT-Intermediate calls themselves a "medic"? For that matter, who cares if an EMT calls themselves a "medic"? People in the industry will know the difference in level of training and the general public usually won't.