Young ride alongs and EMT's

[akroeze]

...like Saved?

*claps*

[paramedicmike]

Are you saying that you believe allowing minors to do ride-alongs goes against patients' rights and privacy? How do you figure?

Well, for starters, minors can't sign the patient privacy/confidentiality agreement. Why? Because they're underage. And as such, they cannot enter into a legal agreement (which is what most of these agreements are). And since they can't legally agree to keep their mouth shut about what they see, they are violating that patient's right to privacy. So, at the very least, there's a legal reason as to why kids don't belong on ambulances.

I'm not saying you should allow anyone to see any procedure or treatment, what I'm saying is that minors who are simply trying to observe should not be discriminated against solely because they are minors. In other words, I don't think you should allow a 34 year old rider who's curious about EMS to see something but you wouldn't allow a 16 year old in the same circumstances (no training, signed waiver, knows what they're getting in to) to see the same thing.

Ummm...no riders period. If you're not in school for EMT or Paramedic then you have no business being on an ambulance.

The rest of your post seems to be talking about minors as EMTs, which is not what I'm talking about.

Then what are you talking about? Minors as ride alongs is the same thing as minors as EMTs. Neither belongs in the back of an ambulance.

I suggest you do a perusal of the forums to see the previous threads where this has been discussed. Unfortunately, I think you're too young and immature to understand where everyone else is coming from. But at least you'll see more indepth discussion and reasoning as to why what you're proposing is simply idiotic.

-be safe

[Michael]

Are you saying that you believe allowing minors to do ride-alongs goes against patients' rights and privacy? How do you figure?

Patrick, enjoying your enthusiasm, dedication, and your obvious ability to think clearly, may I ask you: Do you think there should be any age requirement of a non-practitioner for whose inspection a suffering patient should be obliged to be strip naked as the sole alternative to refusing all medical attention in an life-threatening situation? If so, what age do you think that minimum should be, and why?

[PatrickW]

Forgive me if I don't have alot of respect for your medical director. The fact that he allows sixteen year olds to work under his license is a testament to the quality of your system and a blow to EMS being a recognised/respected profession.

I'll respond to this first. Did you read my posts? I clearly stated that I was talking about observational ride-alongs, not minors treating patients. In fact, it is specifically called out in the ride-along waiver that riders (all riders, minors are not treated any differently other than needing parental consent) are not to touch or treat patients.

Now, to the rest...

We do, everytime we introduce ourselves to the patient and ask if they want our help. Its called consent.

That is consent to be treated. You don't first close your eyes and ask if you have their consent to view them "at their sickest". Observation is not the same as treatment, and as I've said many times the ride-alongs around here are observational only.

If you wern't eligible to work on an ambulance until a proper age then at the age of fifteen there would be no need to commit to anything.

I started dual-credit classes at a local technical college at the age of 16. Because I was able to go on the ride-alongs and make my decision at that time, I knew what classes to start taking right away to get a head start towards the academic EMT-P program I am currently in, two years later.

If you are comparing what we see on the streets to what you are watching on cops then you don't have a clue about what goes on in EMS.

Of course it's not the same, it's on network television. If you really want a better example, how about an uncensored documentary similar to "Cops", available on video. Since it's uncensored, the minor would need parental consent to watch, but the same goes for my local ride-along program.

[PatrickW]

Well, for starters, minors can't sign the patient privacy/confidentiality agreement. Why? Because they're underage. And as such, they cannot enter into a legal agreement (which is what most of these agreements are). And since they can't legally agree to keep their mouth shut about what they see, they are violating that patient's right to privacy. So, at the very least, there's a legal reason as to why kids don't belong on ambulances.

Not in my case, it's not. The minor and a parent sign the agreement, and the parent is legally responsible.

Ummm...no riders period. If you're not in school for EMT or Paramedic then you have no business being on an ambulance.

I disagree, I think as long as the rider is well-informed and is not causing trouble (and following patient privacy rights) or riding for entertainment, it shouldn't be a problem. I can see how it could get overwhelming, though, and why a service may choose not to allow the general public to ride for that reason.

Then what are you talking about? Minors as ride alongs is the same thing as minors as EMTs. Neither belongs in the back of an ambulance.

Observation and treatment are profoundly different.

I suggest you do a perusal of the forums to see the previous threads where this has been discussed. Unfortunately, I think you're too young and immature to understand where everyone else is coming from. But at least you'll see more indepth discussion and reasoning as to why what you're proposing is simply idiotic.

-be safe

Insults aren't going to help me understand where you're coming from. And I don't think I'm really sure what you believe I'm proposing. Allowing minors to observe EMS on the condition that they understand and follow patient privacy rights, and if they piss anyone on the crew off they're gone? What I've described is not my own original idea, it is happening in at least one county in the USA.

[SuperKoopa]

Here in Carson City you have to be 18 and sign an agreement of sorts to ride along with EMS or the police.

[PatrickW]

Patrick, enjoying your enthusiasm, dedication, and your obvious ability to think clearly, may I ask you: Do you think there should be any age requirement of a non-practitioner for whose inspection a suffering patient should be obliged to be strip naked as the sole alternative to refusing all medical attention in an life-threatening situation? If so, what age do you think that minimum should be, and why?

No minimum age...I believe that non-practitioners should leave if the patient asks them to, life-threatening or not.

[Michael]

No minimum age...I believe that non-practitioners should leave if the patient asks them to, life-threatening or not.

No minimum age? So, 12, 11, 10, 8, 6? Please pick a number or reiterate that by no you mean no.

[UMSTUDENT]

I hate to say it, but you're all lifting your profession to way too high a standard.A smart, well-adjusted 16 year-old is perfectly able to handle the job of being an EMT. I started when I was 16 and I was probably a better EMT than 80% of my peers by 17. I'd say by 18 I was probably making better operational decisions than 40% of my peers at the ALS level.

I think we sometimes forget that the EMT curriculum is meant to be performed by someone with an 8th grade education. We make it as easy as possible, write acronyms to assist with basic patient assessment, and teach the class in vo-tech settings designed to get you to pass the test. Honestly, EMT doesn't need to be any longer that it is now. Given the proper amount of clinical exposure and a well-adjusted, intelligent applicant the course is relatively fine. I'm not neccesarily convinced that we should be adding hours to the EMT curriculum anymore. Sure, the argument that these students should be taught based on scientific medicine is great, but adding 100 hours of simple A&P isn't going to fix the problem. Instead, you'll have EMTs trying to make decisions based on a half-assed knowledge of the body. There is a reason that doctors go to medical school to make decisions that will inevitably effect someone's life.

I think western society puts a little too much emphasis on medical education sometimes, and this is coming from a professional student. Granted I've found my education to be invaluable, but at the same time I wonder how much better it would be if we just took out all the BS. The UK is a shining example of this. Physicians in the United Kingdom are taught at the undergraduate level (14 allow an applicant to complete this training in 4 years should they possess a previous degree), eventually specializing in their fields, and by all accounts their system beats ours in almost every statistical marker of quality. What is the difference? I'm not entirely sure, but I imagine it has to do with educational methods. The United States spends so much time creating "scientific doctors of medicine," that I think we often forget the importance of treating a patient. Granted, I believe that our model has its significant advantages, but I think a better cost benefit analysis should be made when determening how we educate all of our medical professionals. This includes paramedics.

Don't get me wrong. I'm the first person to say that paramedics need to experience significantly more time in an academic setting. Personally, I wouldn't be opposed to it being lengthened to the Bachelors level. I think the level of medicine we're practicing in the field is too complex to be left to a one year certificate program and some honed "intuition." We're doing RSI in the field now; a skill that was kept from emergency physicians for years by anesthesiologist. Honestly, the difference between an ER physician and a highly skilled paramedic should be minimal at best when it comes to background knowledge.

Currently, the largest difference between the two professions is held at a steady constant almost entirely by a technological gap. First, our inability to maintain a steady, safe, sterile environment complicates our ability to do many procedures in the field. Secondly, we lack the most recent advancements in medical diagnostic testing. Both of these gaps will slowly change as time goes on. Holographic viral and bacterial load indicators are coming, iStats are here, and just as your PC's processor decreases in size, so will the ability to change the size of imaging technology. Physicians know this. Why else do they work so diligently to depress our profession?

Medicare billing hasn't changed recently and I doubt it'll budge in years to come. What you have is a simple economic equation: As cost increase in the hospital environment, and whereas technology becomes more readily available in the field, a time will come when most, if not all, of the procedures currently performed by ER Physicians will be available in the field with a heavy reduction in cost. This will occur primarily because of EMS' ability to effectively operate within historical budgetary restraints.

Reasons this will occur:

1.Hospitals are horribly managed from a purely business perspective.

2.American medicine is extremely wasteful. Physicians, especially newer ducklings, are notorious for running hundreds of exams, costing thousands of dollars to the patient and insurance company. They prescribe drugs with minimal benefits to those of OTC drugs. Purple pill anyone?

3.Inability to adapt. When was the last time you saw a physician do his own CAT scan or run his own ABGs? Hospitals employ thousands of people to perform the "lower" task of basic medical care. Nurses are neccesary solely because of this. Even if physicians themselves learn to adapt to changing technologies, these thousands of workers will be hard to simply "let go" accross the medical spectrum. Nurses, like paramedics, will advance in scope of practice and physicians will be forced to retreat to complicated, non-primary care specialities. This is a trend already being seen in medicine. Residents continually choose increasingly complex specialities out of job security. Why else did you spend 8 years in school? To be a super-duper paramedic or nurse?

4. Greed. Many people go into higher medicine not to save lives, but instead to make money. Pharmaceutical reps exist solely because of this.

Basically, while our country as a conscious can sometimes be termed "mentally retarded" or even "slow," when it comes to making healthy decisions for our future, it doesn't take a rocket scientist to see which is a better option. You can either choose to pay doctors to perform simple primary, preventive maintenance, or you can pay a better educated generation of paramedics to perform these procedures in the field or in clinics. You can choose to employ a practice of 5 physicians that can see 50 patients a day or a practice of 100 paramedics and nurses that can see 1000 patients a day. This has an even better chance of occurring simply because of the state of our nation. The US is desperately trying to find a way to create an affordable national healthcare system that can be supported with little additional tax revenue. In 30-40 years, when these technologies will most likely exist, our nation will be at a breaking point in regards to healthcare.

So, my suggestions? Fight now to increase the education of paramedics before this time comes. Realize the limitations of the profession in its current state and recognize that younger people are our future. Just as doctors will find themselves extinct in our realm (prehospital medicine) one day, so has the traditional view of adolescents. This newer generation is smarter that we ever were at that age. They have access to vast amounts of knowledge at younger and younger ages with a simple keystroke, and educational methods have improved over the last 60 years. My much younger brother was learning advanced algebra at 12. He'll probably start calculus as a freshmen in high school. Video games, TV, and the times we live in have matured them well beyond their years before they ever reach 16. So my point is, if they have an interest, let them take a dumbed-down EMT class. Get them involved early and they will forever be better than any of us. They will master our profession and seek more. Old paramedics die hard...

Many of the best EMTs I've ever dealt with are young kids. They are pliable and much more willing to learn that most adults. They haven't really experienced life yet and as such, sometimes handle death and destruction better than the adults around them. Stress innoculation and appreciation for the human condition are invaluable lessions that modern society has all but taken away from our youth. Strong children make stronger adults.

Just my $.02.

[PatrickW]

No minimum age? So, 12, 11, 10, 8, 6? Please pick a number or reiterate that by no you mean no.

I mean no. If someone is a non-practitioner, therefore not essential to the patient's care, and the patient asks for them to leave I believe they should, regardless of age. Within reason, of course, I'm not going to jump out of the back of the truck during a transport if a patient must be stripped and they are uncomfortable with me there, but I'd do whatever I can (look away, most likely).