I can do that !. & you thought some of us were crazy !

[Ridryder 911]

I Can Do That

First, I’m one of the biggest advocates for EMS that you’ll encounter. I’ve devoted more than 30 years of my life to EMS and its people. But it still concerns me that people believe that this profession can advance without education. When somebody mentions improving educational standards, people start to squeal, “I’ve been a paramedic for 10 years. I know what I need to do. I don’t need any more education.” Or they begin to lobby for “grandfather clauses” that grant them credit or advanced standing. Then, you see posts on various internet lists inquiring about where one can obtain paramedic certification in two months or complete the whole program online. Would you go to a physician who completed just one year of college and did half of it online?

A common phenomenon occurs about two years into work as a paramedic. The paramedic becomes proficient and even excellent at what they do. They go to the ED and see the RNs starting IVs, giving medications, and similar procedures and say, “I can do that.” Then starts the call for allowing EMS personnel to practice in the ED on parity with the RNs. However, this is when the issue of education really comes to the forefront. Our society has determined that certain educational levels are necessary for a skill or trade. Some levels, because of the unique fund of knowledge, are called professions. Medicine is a profession and has high standards because mistakes can result in injuries or death. That’s not the same as the guy who tiles your bath room.

I went from being a paramedic to being a physician, and I see the importance of education. For example, once in the ED, we were discussing the role of paramedics in the ED (of which I am in favor — with added education). The conversation basically was that the paramedics could do anything that the nurses could do. About this time, a new graduate nurse brought some lab reports to me and said, “His BUN/creatinine ratio is 62. Should I increase his IV rate?” I asked the paramedics what they thought. They admitted they didn’t know what the GN was talking about. Granted, an experienced motivated paramedic may learn lab data and such, but in the nursing program, this was a part of the initial education. I’ve met many self-taught paramedics who were sharper than many nurses (or doctors). But I have met some who self-taught themselves the wrong information and were, in fact, dangerous.

On my shelf here in my study are 15 books from Pearson Education (the main company that owns Brady — my textbook publisher). The books include Pearson’s package for the two-year associate degree nursing programs, plus books on anatomy and physiology, medical surgical nursing, human development, pharmacology, medical math, psychiatric nursing, pathophysiology, ICU nursing, public health, nutrition, obstetrical nursing and more — all to become the lowest level RN!

Paramedic instructors moaned when we found the science behind EMS so massive that we decided it best to be put into five books instead of one (or publish the whole damn thing on Bible paper). Several programs were indignant and changed to the competition — a single volume book — simply because it was a single volume and cheaper. When this became a problem, we had to counter it with an abridged single-volume book of our own.

Solve this conundrum: How can paramedic education equal the lowest level of registered nursing education when the nursing program requires 15 books and 65 semester hours and the paramedic program requires one book (if that) and 700 clock hours.

There are paramedic programs that rival nursing education. But attending these is hard to justify given the promise of 56-hour work weeks and just $28,000 a year. That’s why the National Scope of Practice is such a bad document. The movers and shakers in EMS had the opportunity to move the profession along. But much of EMS in the U.S. is fire-based, and we can’t have any EMS education affecting fire suppression activities or education. The fire services complained, and politics prevailed. So the minimum standards for EMS have remained stagnant. As for us, we push the science to the next level with cutting–edge books (and I mean books). Some programs will use them, others will not. I surmise we will also publish low-end books with lots of pictures for low-end programs.

So, in answer to the often-asked question as to how EMS can get a seat in the house of medicine, I say — education. This is inevitable. Fortunately, a few EMS educational programs throughout the country will continue to push the envelope and enhance the education of EMS providers. Then, the resultant dichotomy among paramedics will force employers to seek those with the better education. In the end, Darwin will be right again — evolve or die.

Dr. Bryan E. Bledsoe, DO, FACEP, is an emergency physician in Texas

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All I can say to that is AMEN !

R/r 911

[JakeEMTP]

I beleive Dr. Bledsoe hit the nail right on the head with this one. Again, we are our own worst enemy!

[buckeyedoc]

I know when I started as a medic in the ER, the whole lab values thing was new to me (as being a new medic). Fortunately, my girlfriend (now my wife) was an RN/CEN and helped me understand the lab values. We get "bad labs" calls from nursing homes all the time. Most of the medics turn up their nose and bitch about the run. I approach it from a different angle. If I see someone with a BNP of 633, I know that we're dealing with CHF. If I see a pt. with a K+ of 7.4, then I know I better get a monitor/12-lead on this patient. That is what working in the ER has taught me...among other things. I have learned to get as many CE courses I can. Not only do I get updated information, I'm not scrambling around re-cert time for CEU's.

[Callthemedic]

Prehospital and hospital patient care are different. Nurses give nursing care. Medics give medical care. It's in the name. Either profession would have to train in the other to do the job.

Not much of a leap.

One textbook for a para program? I saw the P students books from my booklist for B. It was more like 4-5 I think. More than one anyway. That would have to be one big book.

[medik8]

I completely agree....that's why my nose is ALWAYS in a book or my body is always in a class...I don't feel I can stop learning. I don't even WANT to.....it just seems like the natural thing to do...not to mention the necessary thing to do...

:wink:

xoxoxoxo

8

[Callthemedic]

The more one learns, the less they should feel they know everything.

There is always something. Medicine is dynamic. One of the qualities that attracts me to it.

[Nate]

I remember at the college I took my paramedic course we used the five volume series from Brady along with many other texts. The problem that my college faced was that a "private school" was offering the EMT-Basic in six weeks, the EMT-I in nine weeks, and the EMT-P class in three to six months. It is hard to attract new students when:

[*]your limited by the state at five semesters from EMT-B to EMT-P

[*]they strike really "cheap" deals with city services to send their personal there

[*]there is no one to answer too other then the DSHS

The college was limited in both hours, semesters, and budget. There are 5 major universities in the city of Houston (population 4,000,000); four very large community college chains (with 4 to 10 schools each); and countless small one campus community colleges. By far the best one has to be San Jacinto College, yet they have the lowest enrollment rate compared to the others. Why? Because HFD pays Houston Community College to teach it's paramedics because they just rent space, and HCC coordinates the whole thing. They also happen to have the lowest passing rate of them all. North Harris Montgomery Community College (NHMCD) has several campuses, and they have deals with most of the volunteer departments to provide "reduced" tuition to their programs. Their students do okay, but the minute they leave the safe haven of North Houston and walk into the low income South East Houston they are lost.

Paramedic education is a major problem, it is the reason why we are short staffed at my service. Simply put, we can't find any decent paramedics that can pass the test, make it through FTO, and not get weeded out once on the streets. You would think a paramedic would know better then to fake vitals, yet on his first day of FTO a new hire flat out lied. Why? We don't know.

I've given report to countless crews only to get that ghost look on the face of the crew after I just gave them a simple report. Have you ever noticed that EMS is the one field of medicine that doesn't really use all that much medical terminology? People like to say things like "we can't afford that," or "this is all we can afford out here," and my favorite one is "we just don't have the time to go back to school."

It is funny how almost every rural hospital seems to have RN's there, why can't they get educated paramedics? If so many people are still gung ho about volunteering, then why do they have such a problem conforming. Wouldn't they want to see these changes take place? You know education is an issue when you see a job discription that states the following: "ACLS, BTLS, PALS, preferred..."

[Dustdevil]

The more one learns, the less they should feel they knowing everything.

Oh man! Excellent observation! =D>

That is SO very true! And it holds especially true in EMS, where Doctor Bledsoe's assessment is spot on.

When I took my first ambo job with nothing but an advanced Red Cross card, I thought I knew everything I needed to know.

When I upgraded to EMR, I was appalled that I had been allowed to practise with only Red Cross training.

When I upgraded to EMT, I was appalled that I had been allowed to practise with only First Responder training.

When I upgraded to Paramedic, I was appalled that I had been allowed to practise with only EMT training.

And about fifteen minutes into Nursing school, I was appalled at how little I had really learned in the previous twenty years as a Paramedic.

Everytime I hear a medic (or EMT or PCP or CCEMTP or anybody else, for that matter) mouthing off about how their school was "too long" or even "long enough," or how they don't need or don't have time for more education, or bragging about how many "skills" or drugs they have, or whining about how they ought to have more, I just want to bitch slap them out of the profession.

[Nate]

Truth be told, it would be so much nicer if they just kind of combined nursing and EMS into one degree. That would allow for a smoother flow of patient care IMHO. The doctor wouldn't have to worry about if it was an EMT, I, or P. The nursing staff wouldn't have to look to see who was standing before them (as far as certification). There are a lot of nurses and doctors who still don't understand how we operate. Both fields would benefit from the cross training.

Oh wait, that concept has already been thought up.

[Dustdevil]

Oh wait, that concept has already been thought up.

Meh... originality is overrated.

It's a great enough concept that it remains valid, no matter how many times it has been stated before. :thumbleft: