Increasing Education from a perspective of system management

[PRPGfirerescuetech]

Interesting thought just occured to me when reading the posts.

follow me on this...

From a perspective of system management, we need X number of EMT's and X number of paramedics to staff X number of ambulances to move X number of patients each day. Correct?

Many people on the board, myself included are for increasing educational levels for all providers and weeding out the idiots of our profession.

that being said, if we were to increase the educational levels for all providers, and weed out said idiots, wouldnt we lose a fair amount of EMT's and Paramedics?

So, therefore, when decreasing the level of idiots in this industry, we therefore shortchange ourselves on the number of providers needed to handle the workload in the country.

We are at critical shortages already. Do we really want to make that worse? It strikes me that their is a balance that has to be maintained...but reallly, the question remains,

can you really weed out providers, when you already dont have enough?

Im curious of the consensus...

Apologies for the scatterbrained nature of the post, im reaaalllyy....reaallllyyy...tired.

Warm Regards and Happy Holidays to all,

PRPG

[AnthonyM83]

I think the theory is that people will stay in the field longer, decreasing turnover rate, if it's harder to get into the field.

Another theory is that if you have to put a lot into becoming an EMTB, you're more likely to go all the way and become an EMTP, so the Basic to Paramedic ratio might change (would ambulance companies want to pay more paramedics than emts?)

I think there's just so many factors, we need to see what the most successful states and/or counties are doing and adopt their model, slowly to work out stuff.

[vs-eh?]

Inform the public and government officials of the current state of EMS...

Do they want a period of time (say several years) where the possibility will exist that they may not get a "rapid response" to their apparent emergency. Yet, they will have more educated and competent EMT's and Paramedics?

Or will they settle with the current system where epi pens apparently are a sticking point in scope's of practice? :roll:

Honestly, public education on what exactly is an emergency and when an ambulance is required, as well as telling people you don't need an ambulance (necessarily) for chronic or minor problems would go a long way.

Patient - "I cut my finger"

Me - "Ok, sir, you live like down the street from the hospital"

Patient - "But, there was a lot of blood"

Me - "It's not bleeding now...looks like you may need a stitch and certainly a tetnus shot...Save yourself some money, we're not going to be doing anything for you...Your buddy there has a car? Take a little trip."

Patient - "You think I need to go to the hospital?"

Me - "Well, you called 911, so I assume you felt it was serious enough to warrant a hospital trip"

Patient - "So you think I should go?"

Me - "If it was me, no. But I'm not you...would you like to come with us, or will you make your own way to the hospital?"

Patient - "Ummmmm, ummmmm, ummmmm I think we can walk down there"

Me - "Good plan, here is a band-aid, peace."

[PRPGfirerescuetech]

So were going to strip down the staffing levels across the country so we can higher educate all,

,...but then we lower staffing levels, and put providers in a faster pace (to attempt to meet demands), which will stop them from being able to treat patients to the higher level you just trained them at?

[vs-eh?]

When Ontario initiated the move from 1-year full time PCP program to the 2-year program, the system didn't collapse.

I realize this isn't an entire country...but you can see the comparison.

[PRPGfirerescuetech]

When Ontario initiated the move from 1-year full time PCP program to the 2-year program, the system didn't collapse.

I realize this isn't an entire country...but you can see the comparison.

I see the comparison, but it didnt go from a one month to one year course, with things as in disarray as they are.

[Ridryder 911]

I am not too worried about this problem. I just found out they are developing a trial program : "super EMT/I " (ETT. IV, Narcan, HHN nebulizer tx, epi; SQ) in my state to allow them to administer meds.... now this is supposed to be fill in at large metro' FD in lieu of Paramedics. Hmmm .... because they can administer med's until the EMS unit arrives?.... sounds fishy & looks fishy to me, especially it is endorsed by the Ambulance Operators. (Can we say cheap labor on the rise?)

Again, those not directly involved with client care is making the decisions. Worse most field medics are not aware of this program nor do they care, as long as they get a check. The problem with the apathetic attitude is it will affect them, maybe not today, but later as the raises goes down and the need of Paramedics are all of sudden not needed. Since medicare does not recognize the difference between Intermediate care & Paramedic care, I have actually heard EMS administrator's describe it would be cheaper & about the same to deliver Intermediate care (IV, ETT advance only). In administrator's eyes the reimbursement is the same, with the costs of business drastically reduced.

So the age question until we can get $$ changed in payment ratio, EMS administrators are not going to endorse any increasing in education . Why should they? More education should = more raises & higher salary, in which lies our problem.

It is known fact that some of the larger companies prefer to have a turn-a-around of medics in less than 1-2 years, to prevent paying benefits.

As most of you know I am definitely in favor of higher education of Paramedics to at least associate level as an entry point.

However, until we change the "whole system" we are chasing our own tail. Reimbursement ratio should be increased to Paramedic Life Support, and with this distribution to medics for higher rate of pay. Then we can require educated Paramedics. But, for now we need to be careful and be sure "multiple levels" are not invented to short change & replace costly medics. This is not fair to the patients and to Paramedics as well as EMS system in whole.

I know I am going to monitor the development of the "new program"... and be sure that it is truly warranted, and not a replacement in lieu of Paramedics.

Be safe,

R/R 911

[ERDoc]

No matter how hard you try, you will never be able to weed out the idiots. Let's take a look at doctors. We have idiots graduating from medical school all the time and have learned how to deal with them. You will need to develop a place where their exposure to pts can be minimized. In the hospital, we have developed such a place. We call it the OR. :wink:

[AZCEP]

I am not too worried about this problem. I just found out they are developing a trial program : "super EMT/I " (ETT. IV, Narcan, HHN nebulizer tx, epi; SQ) in my state to allow them to administer meds.... now this is supposed to be fill in at large metro' FD in lieu of Paramedics. Hmmm .... because they can administer med's until the EMS unit arrives?.... sounds fishy & looks fishy to me, especially it is endorsed by the Ambulance Operators. (Can we say cheap labor on the rise?)

This is actually very similar to the way that the EMT-I 99 has been put into use. Many places, Arizona included use this as a step between EMT and Paramedic, but then legislate it so the step from I to P is a full paramedic course. The only difference in the levels of care is the central vascular access, but the so called "Qualified IEMT" is still a lower level of care.

Where this becomes an issue is with staffing and with other providers. It is very common for the QIEMT to come on scene and think that they are educated to the same level as the paramedics that are already there. Administrators use them as substitutes for paramedics when no one else wants to work, and they can do it for less than a medic will cost.

I will now repeat the mantra that I have heard for so long, "Eliminate the Intermediate, and strengthen the Paramedics!"

[Dustdevil]

Anthony is spot on regarding any shortage being short lived and self limiting. The development of the profession will change the demographics and career patterns in such a way to minimize and/or eliminate shortages. Yes, we are likely to still have a hard time keeping rural EMS well staffed just like we have problems keeping rural hospitals well staffed with nurses. But not nearly as profoundly as the nursing problem.

And of course, another factor that will minimize shortages is the ultimate need to properly define EMS as Emergency Medical Services, and not apply the same entry level standards to horizontal taxi services. They can run their transfers with 120 hour EMTs for all eternity. I don't care. That way they won't have any shortages. Transfer costs won't increase. Wankers will still have jobs. EMS ambulance demand will drop. And EMS will maintain an adequate supply of acceptably educated medical professionals. Everybody wins.

Whoever suggests eliminating I's is out of their minds. It's EMT-B's that need to be eliminated.