What to Expect in Paramedic Classes?

[BillKaneEMT]

Quick question -- Are you sure? Because I remember a time when the UK medics were very excited that some of them were going to start making more than £20,000 / year (at the time, around US$ 42,000, now about US$32,000 due to the utter collapse of the UK financial system). They didn't seem particularly highly paid. But perhaps this has changed?

My impression (from afar) has been that the pay (and quality) of US systems varies greatly across the country, with some places playing twice as much as others.

I can tell you that starting medics with their nremt-p make slightly over 12 dollars an hour at my company. Perhaps 13 or 13.50 at a few other places in this area (we're on the low end). Basics make 9 and a bit, which might be dropped soon. Wanna take a stab at how many hours you need to work at 9 bucks and change to make your mortgage payment? ;-D I get less than 60-70 per week (between both jobs) and I get evicted. Better hope no one cuts back the hours. And thank goodness I'm just renting, if I was stuck owning I'd be screwed. One of my coworkers just took his nremt-p practical in Iowa(there was no nremt-p practical in IN at the time), and apparently basics and medics make a significantly higher wage in Iowa than they do in Indiana. He's thinking about moving there. I may do so as well after I finish medic school. I like my company but I'd rather not go to school for 2 years (at 6 grand a year) and come out making 12 and change an hour. We shall see.

[systemet]

I like my company but I'd rather not go to school for 2 years (at 6 grand a year) and come out making 12 and change an hour. We shall see.

That sounds rough, and I can see why you wouldn't want to invest 2 years of your life doing that when you could spend the same time, come out as a diploma RN and make twice as much. No matter how I say this, it's going to sound rude, but you have my sympathy and my respect for working EMS for that sort of money. I mean that honestly.

That being said, the JEMS salary survey suggests that the average medic wage is US $49,000, which seems a lot more than I was lead to beleive that the UK paramedics make.

http://www.jems.com/sites/default/files/Download%20JEMS%202011%20Salary%20Survey.pdf

[Kiwiology]

The only places I know who pay anywhere close to that are the Fire Departments or maybe one or two of the extremely well run systems but by and far most American Paramedics I have met make somewhere on the poor side of $15 an hour, some I know qualify for food stamps because their pay is so low, most work two or three jobs or pick up extra shifts to make ends meet. I'm not talking like we do an extra day during a down cycle to pay off the house quicker or because we had an attack of the drunken internet shopping I'm talking about the ability to pay the rent sometimes depends on working another job.

We must not only look at what you get in your hand to take home but that most employers (as is the increasing case not just in EMS) have severely curtailed or simply no longer provide pension, health and/or life insurance or other benefits which are standard in the UK, AU and NZ.

It makes me so sad because the US is such a great place with such nice people; from the Fire union controlled Republic of Kandahalifornia to the Great Nation of Indiana which must never be spoken about negatively and lets not forget New Arizomexas

Kiwi sad now ... and also haz hankering for artery clogging fast food, for this is America! to the drive thru!

Edited June 18, 2012 by Kiwiology

[JakeEMTP]

The only places I know who pay anywhere close to that are the Fire Departments or maybe one or two of the extremely well run systems but by and far most American Paramedics I have met make somewhere on the poor side of $15 an hour, some I know qualify for food stamps because their pay is so low, most work two or three jobs or pick up extra shifts to make ends meet. I'm not talking like we do an extra day during a down cycle to pay off the house quicker or because we had an attack of the drunken internet shopping I'm talking about the ability to pay the rent sometimes depends on working another job.

For this reason alone would it not make sense to increase education to an AAS degree as minmum entry into EMS? It wasn't that long ago that nursing paid crap. Once the educational standards were increased, so did the compensation. Coincidence? I think not. I know it helps to have a organization like the ANA to speak on your behalf. That is but one of the problems in EMS, but is another topic.

Chbare, I'm having a hard time locating anything that you would consider hard evidence that increased education makes for a better provider, and as others have stated, I don't think it exists. One of the reasons I can't find it from other Countries is, a degree is the minimum and there is nothing to compare it to. As long as "The Brotherhood" has control of the majority of EMS in this country, sadly the educational standards here will never increase.

[Kiwiology]

I now I am being a bit hypocritical on this one but does it not stand to at least the test of empiricalness that advanced education means a greater scope of professional autonomy so the patient is able to receive treatment sooner than if we have to piss around ringing up on the ambo phone and arguing with the Medical Control Physician to authorise it?

For example Paramedics here have unlimited opiate (morphine or fentanyl, their choice) plus ketamine all which can be administered IV, IM, IN (fentanyl) or orally (ketamine) and can dish out enough as they need for the patient to not be in pain. No ambophone and warangling with a Doctor they might not even know required.

Of course "protocols" vary greatly within the US I accept that but most places are reasonably restrictive i.e. a max of 10mg morphine before needing to call for orders for more is pretty common. I've seen people put 40mg into an old bloke one night and we put 20mg into Nana without batting an eye lid.

Then there's those Los Angeles Fire Department Paramedics (with their weeks of training at PMTI) who gave some lady frusemide for back pain, and this is documented somewhere in the medical literature cos clearly back pain is a symptom of cardiogenic pulmonary edema

[EMS Aficionado]

If you want proof that longer programs equal better outcomes, then here it is: Physician Assistant programs in the United States typically last 27 months of full time study. When PAs graduate they are capable of assessing patients, writing prescriptions, and performing minor surgical procedures. The only background prior to their very intensive 27 months of medical training are pre-requisites in the basic sciences. They are competent enough that Physicians take them on as colleagues and compensate them very well.

The key component with this example is that Physician Assistant students are in the classroom and clinical settings for more than forty hours per week for the 27 months of their education. They also study a great deal out of class and typically only work part-time, if at all.

Paramedic students typically work full time and spend 16-20 hours per week on classroom time and clinical training. Is it any wonder that we learn so little by comparison?

[Kiwiology]

Well said sir, remember also that what a Paramedic learns regarding basic biomedical science is pretty bare bones to non existent compared to nursing or any other allied health profession. its not just hope long you learn for but what you learn as well

[chbare]

PA school is probably not the best example. Virtually all PA programmes in the States are graduate level. This means you need to have an undergrad degree with a pre-med like load of classes before considering putting in an application. Additionally, many will require a decent GRE score. This is significantly different from an AAS/AS for entry into practice. Also, the PA fills a very different role.

Edit: "."

Edited June 19, 2012 by chbare

[EMS Aficionado]

You are correct that many PA programs are now graduate level degrees, but there were still associate degree level PA programs as recently as within the past twenty years. PA programs now also frequently require more pre-requisites than MD/DO programs.

PA programs raised their standards for admission by moving towards graduate level education and yet there are currently more interested applicants than available program seats. Increased competition among applicants results in the public gaining a higher level of service from graduates.

I disagree with the idea that EMS education should descend to the ability of the student, rather than require the student to rise to the level of the education.

[systemet]

If you want proof that longer programs equal better outcomes, then here it is: Physician Assistant programs in the United States typically last 27 months of full time study.

That's not proof, that's anecdote. Proof, well, "evidence" would be a better word, would be a number of research studies published in peer-reviewed journals, consistently showing that care by a physician assistant improves "outcome X" versus care by a paramedic. These studies don't exist.

The only background prior to their very intensive 27 months of medical training are pre-requisites in the basic sciences.

These "pre-requisite in the basic sciences" seem to be at least two years of university biological sciences, and a reasonable MCAT score, right? So that's already a length of study that exceeds many paramedic programs just to put yourself in a chair on day one. I think we're comparing apples to oranges.

The key component with this example is that Physician Assistant students are in the classroom and clinical settings for more than forty hours per week for the 27 months of their education.

Are they? I've never taken a PA program, but I have taken a science degree from a reputable university. I remember having 3-5 hours of lectures a day, for 5 days a week, and maybe a few hours of labs spread out over the week. The actual instructional time was maybe 20 hrs / week. But you can bet I spent another 20 + (perhaps even 40+) studying after class to make sure I knew the material.

They also study a great deal out of class and typically only work part-time, if at all.

This would describe many people in my paramedic program.

I disagree with the idea that EMS education should descend to the ability of the student, rather than require the student to rise to the level of the education.

I agree with this. The logical course of action is to then increase the educational requirements.

I now I am being a bit hypocritical on this one but does it not stand to at least the test of empiricalness that advanced education means a greater scope of professional autonomy so the patient is able to receive treatment sooner than if we have to piss around ringing up on the ambo phone and arguing with the Medical Control Physician to authorise it?

For example Paramedics here have unlimited opiate (morphine or fentanyl, their choice) plus ketamine all which can be administered IV, IM, IN (fentanyl) or orally (ketamine) and can dish out enough as they need for the patient to not be in pain. No ambophone and warangling with a Doctor they might not even know required.

I won't defend restrictive medical control, because it is a nightmare to reach some arbitrarily defined maximum dose of morphine and have to get on the phone to a physician and say, "I've given 20 mg of MS, my patient's still in pain from their 28% BSA partial-thickness burns, can I give more?".

However, I would argue that medical consultation isn't always a bad thing. Sometimes it's in the patient's best interest for the provider to run a situation by someone with more education and training and either get some advice or a second opinion about something.

For example, I had a palliative care patient once with breakthrough pain. Sick, cachexic, on lots of opiates. It seemed reasonable that this person had some tolerance issues, and I was thinking that 10 mg of MS IVP would probably be a good starting dose. Not being 100% sure about how the patient would deal with MS, as they were currently receiving dilaudid, and being concerned that they might have had issues with prior morphine toxicity, etc. I called up their palliative care physician. You know what I got for orders? 30mg of MS IVP.

I'm not saying I'm awesome, because I'm not. But there's something to be said for recognising your limitations and seeking advice when you feel it might benefit the patient. If I'd have gone with 10mg IVP, I'd have waited 5, 10 minutes, maybe given 5 mg, or perhaps another 10mg, and eventually in 30-45 minutes, I might have got up to 30 mg, and started to get the situation under control.