In Your Opinion, What Is Holding USA EMS Back?

[VentMedic]

Quotes by WANTYNU

Yes I have, and these are customized per patient, by the treating doctor, they are not based on a RN or RT diagnosis , as I stated earlier, only the doctor can make a diagnosis in a hospital. However Paramedics are required to do so, outside the hospital (this is a crucial difference).

You will never find I don’t argue that a nurses job is grueling, but again, this is palliative care under the scope of definitive care, we provide emergency care I believe there is a difference.

What amazes me most about the EMS profession is the total isolation from the rest of the medical field. Yet, I know every day on BLS/ALS transfer trucks and in the ED they see/meet many people. I also have made suggestions that EMTs and Paramedics venture into some of the many classes that the hospital offers on various clinical things like assessing different central line ports, pacemakers and new medications on the market. More often than not, I get a screech from them like I asked them to venture into enemy territory.

Other health care professionals have evolved over the last 30 years because they saw the need to provide a higher level of care as patient needs, technology and the inadequacies of the healthcare system changed. Medicine and roles are changing.

RNs and RRTs have greatly expanded their roles. Rapid Response Teams, teams to intervene in providing emergent care when physicians are not available or don't "call back", have been around for almost 20 years. However, it has been just within the last 5 that a national awareness has been made of them in terms of their success with promoting these teams throughout the country. This are well educated RNs/RRT who have an entensive set of protocols to work with as established by a medical director.

Also inside every progressive (and even those that aren't) hospital, RNs/RRTs can have impressive protocols to where calling a physician is not necessary. Yes, some are diagnosis driven and some fall into critical care medicine to which there are many different pathways to take. If you actually look at the Paramedic protocols, many of them are generic. They can be applied to many different situations. Inside the hospital, we do use different information to guide the protocols. Different vasopressors are used for different problems such as sepsis. Sometimes we have a lactate level and sometimes we don't but may initiate the sepsis protocol based on assessment. RRTs (and RNs) don't wait for a physician to intubate or give meds in a code or respiratory failure situation. Nor do they need to wait to initiate their own specific ARDSnet protocol which involves both RNs and RRTs.

In CVICUs/CCUs/MSICUs/NICUs/PICUs there are extensive protocols for almost any situation that arises even when we don't have "definitive" diagnoses. Yes, there are emergencies in the hospital also. A doctor is still the only professional that can make a medical diagnosis. Paramedics and other professionals make a working diagnosis for their own scope of practice. RNs/RRTs can in may situations make a more specific working diagnosis due to the clinical data available to them which also allows access to many different protocols. Usually a patient is admitted to the hospital under many diagnoses until more clinical data is available or because in adults it is rare if only one body part affected. Inside the hospital, many different aspects of care and the long haul must also be taken into consideration.

And then, you have the many specialty teams inside the hospital and the specialized transport teams. The professionals, RNs and RRTs, on these teams have extensive education, training and skills that are truly impressive. They definitely do not fit under the "palliative care" blanket statement.

One of the reasons I chose to get another degree in another medical profession was to expand upon the education I had an a Paramedic. In my early years as a Paramedic, I also thought nurses were just hand holders who had to call a doctor for everything. I definitely got an education on how wrong my stereotyped view of these professionals were when I started to pay attention to what was going on around me when I did a transport into the hospital or an RN/RRT accompanied a patient on my ambulance. Once I began working in the hospital, I realized just have many healthcare professionals there were and how each played an important role with their own protocols and scope of practice.

Maybe because people in EMS consider themselves different and isolated is also why other professionals don't always recognize what EMTs and Paramedics do. By stereotyping other professionals, EMS workers have built their own wall and have also allowed their profession to become stereotyped.

There are also many Paramedics who are licensed but don't work on a rescue truck. I know many that haven't intubated or done an IV in 10 years. Many that hold Paramedic certificates may never run a code. If they are the paramedics another healthcare professional knows then there might be a misconception about what a paramedic can do.

If you do not truly know another profession's capabilities, don't stereotype all the professionals within that profession. If you do make blanket statements about some other profession then don't get upset when the same is done to your own profession.

WANTYNU, please don't take offense to my statements. Your comments gave me fuel for a little rant that also goes along with a couple of other recent threads on the forum.

[spenac]

VentMedic wrote "I also have made suggestions that EMTs and Paramedics venture into some of the many classes that the hospital offers on various clinical things like assessing different central line ports, pacemakers and new medications on the market. More often than not, I get a screech from them like I asked them to venture into enemy territory. "

I wish more hospitals would invite EMS inside. It could be beneficial for both sides to get a better understanding and could lead to better working relationships.

VentMedic wrote " By stereotyping other professionals, EMS workers have built their own wall and have also allowed their profession to become stereotyped. "

Very true. Any time we attack another we cause division. We do not fully understand what each other does and sadly we build dividers that instead of making things better lead to more problems.

[WANTYNU]

What amazes me most about the EMS profession is the total isolation from the rest of the medical field. Yet, ….

RNs and RRTs have greatly expanded their roles. …. This are well educated RNs/RRT who have an entensive set of protocols to work with as established by a medical director.

…..Also inside every progressive (and even those that aren't) hospital, RNs/RRTs can have impressive protocols to where calling a physician is not necessary. Yes, some are diagnosis driven … If you actually look at the Paramedic protocols, many of them are generic. They can be applied to many different situations. Inside the hospital, we do use different information to guide the protocols. ….. RRTs (and RNs) don't wait for a physician to intubate or give meds in a code or respiratory failure situation. ….

In CVICUs/CCUs/MSICUs/NICUs/PICUs there are extensive protocols for almost any situation that arises even when we don't have "definitive" diagnoses. Yes, there are emergencies in the hospital also. A doctor is still the only professional that can make a medical diagnosis. Paramedics and other professionals make a working diagnosis for their own scope of practice. ….The professionals, RNs and RRTs, on these teams have extensive education, training and skills that are truly impressive. They definitely do not fit under the "palliative care" blanket statement. .....

If you do not truly know another profession's capabilities, don't stereotype all the professionals within that profession. If you do make blanket statements about some other profession then don't get upset when the same is done to your own profession.

WANTYNU, please don't take offense to my statements. Your comments gave me fuel for a little rant that also goes along with a couple of other recent threads on the forum.

Vent, first don’t worry about me, I have had far worse beatings on this site, then a little ranting from an experienced point of view.

Second I have done and continue to do CC transports, so I don’t consider myself all that isolated from what happens on the floors (as opposed to the ED, which admittedly many EMS providers never get past).

You and I may have advanced training and degrees, but I looked back and this was a discussion of education for paramedics compared to other disciplines, and I still maintain a 2 year degree is, a 2 year degree, and even suggest that a medics 2 year may be superior to that of a basic intro LPN, because the latter’s education basis is palliative care.

I make no argument that there are individuals that are better trained and have more authority than their counterparts with the same title, take the Nurse PRACTITIONER who can write limited scripts as an example, but again the foundation of their training evolved from a different route of medicine then say a PA (who has the same script writing privileges).

The unfortunate part of this discussion is in the noted limitations of “Paramedicine” as a career (btw which is not an “official” designation in Emergency Medicine).

I work in a busy urban environment, at a very progressive hospital; I admittedly do not possess the viewpoint of what the majority of this country’s EMS face and deal with, case in point a one Doctor ER…

As always IMHO.

Be Safe,

WANTYNU

[Dustdevil]

You and I may have advanced training and degrees, but I looked back and this was a discussion of education for paramedics compared to other disciplines, and I still maintain a 2 year degree is, a 2 year degree, and even suggest that a medics 2 year may be superior to that of a basic intro LPN, because the latter’s education basis is palliative care.

But see, even that basic contention is still wrong on every level except mathematically. Yes, 2 years trumps 1 year mathematically. No doubt about that. But you're comparing apples to apples. Two completely different professions. You might as well be comparing paramedics to x-ray technicians. Although, that too would be an unfair comparison that we would lose embarrassingly. But, if you insist on comparing numbers, you can go back to the silly old "skills" argument that medics are so fond of. We still lose. The skills manual for an LVN is about five times as thick as a skills manual for Paramedics.

The point is that numbers alone do not tell the story. And we get no extra points because of the glory factor. The truth is that we are no better or no more important than nurses. In fact, we are far from it. And simply adding college hours without regard to content won't level the level playing field. It's about quality, not quantity.

[siren_man]

ok here we are. the simple facts are this, what is holding EMS back is that we are not recognized as healthcare providers. we are public safety. there is no consensus where we as Paramedics and EMT's fit in to the healthcare system. Of course we're also not part of Fire or other public safety either. I think Paramedics and to some extent EMT's provide care comparable or exceeding that of nurses so how to get that fact into the general knowledge of the public? When I know that I'll be famous ( ha-ha ).

[Dustdevil]

That's a surprisingly impressive, quality post from someone who calls himself "Siren Man"!

Welcome aboard! :thumbright:

[WANTYNU]

That's a surprisingly impressive, quality post from someone who calls himself "Siren Man"!

Welcome aboard! :thumbright:

Hey Dust, I’m confused, it seems that Siren Man basically reiterated what I have been saying, so to me your previous post to me did not entirely make sense.

I guess at this point a couple of things should be noted here.

First I listened to you on EMS solutions http://ems-safety.com/audio.htm , great job, I thought you were very articulate in your responses, the essence of your thoughts were well verbalized.

Second, I’d personally like to move on with this debate, I have been involved with training in various fields for many years, and although not involved with “professional” EMS for anywhere as long as you and many of my counterparts on this site, I do think I come to the table with a valid yet different perspective.

I went into corporate America as soon as I finished college and realized I was not going onto medical school, however I have held an AHA BLS card since 1977 and was trained in wilderness first aid and rescue in 1975.

My point about 2 year degrees, is that they are just that, and when compared to other professions must be view within the context of their subject matter. I form this opinion from many discussions I have held with someone I teach with a well as a close friend of mine who is also the Assistant Dean a one of NY’s preeminent nursing schools. In other words I am not completely ignorant about the world of nursing education.

Law school and most Masters are only two years; however you need a 4 year as an entry point. I am by no means drawing any parallel here to an associate’s degree.

My statement comparing LPN and Paramedic 2 year was the only entry requirement was high school, and in fact I believe most medic 2 year programs require an EMT cert prior to entry (which, however little it may be, is still an additional education requirement).

In the end, our “Profession” (and I use the term very loosely), is faced with a dilemma, how do we progress without alienating ourselves from the folks that have spent their professional lives justifying our existence, the public service sector, and yet incorporate ourselves into the true arena we should be included in, the hospital system itself, since we are clearly the middle men (and women) who form the bridge?

It is my personal view we must radically raise the bar, of both education and professionalism, and (I’m sure you’ll like this next thought) if that means some blood must be spilt, so be it.

As always IMHO

Be safe,

WANTYNU

[Dustdevil]

Hey Dust, I’m confused, it seems that Siren Man basically reiterated what I have been saying, so to me your previous post to me did not entirely make sense.

Well, one of us is misunderstanding his post then, because I didn't really see it as paralleling yours.

What I found wrong with your post was specifically the attempt to play the numbers by saying a 2 year paramedic was better than a 1 year LVN. It's simply not even a valid analogy. Beyond that, we are really on the same page with all of this. I just thought that was a poor example to illustrate your point.

But my praises to Siren Man were because it's just always nice to see a n00b come along and post something of quality right out of the chute like that. Especially somebody with a name that makes you think he's going to be a whacker.

Glad you liked the interview. Thanks for listening!

[Medic117]

RN is not a mix, because it is a very different field. RN's are trained in long-term care, and in working under a doctor's orders. I don't see any difference in my area as to the skill and "level of training" from RN vs. Paramedic...many of us on both sides just forget that they are two completely different fields.

BS entry level training I highly support...but this change has to be gradual, and allow those working to increase to that level, as they did in 1999 curriculum. And, you have to have enough BS programs in place for this to happen....the one BS-Paramedic program in my area just began in 2007. Remember that not all RN's are BS level, either...though it is becoming more popular.

The greatest thing holding EMS back is our own lack of professionalism. Too many EMS providers live the "trauma junky" mentality, and have no sense of professionalism in patient care. Many of us have lost our compassion, and do not treat people in a professional manner. Then there is the overwhelming fear of lawsuits....but many of those will be eased with a professional outlook on everything we do. Jumping out of an ambulance with only a clipboard and cup of coffee with a wad of chewing tobacco in your mouth, and shirttail hanging out does not scream "healthcare professional" to the public eye. All of the ideas listed are important...but it must start with us, and deciding that together, we will become a better profession.

As for the structure, we should be set up as a separate, but similarly structured system as Fire. The problem with Firemedics (not that there aren't some who are great medics) is that most of them are not really interested in quality medical care. Staying current on the latest EMS advancement is something that takes serious dedication to this. I think the volly services need to stick to a support role, and keep career EMS professionals responding to the scene.

[medic2005]

In Illinois, I think a couple of major things hold back EMS.

Continuing Education- Nurses in IL and many other states renew their licenses yearly and require no.. I REPEAT NO continuing Education, and they are in an ever changing field just as much as EMS.

EMS requires 120 Hours every 4 years. That is 3 weeks of training. It becomes hard to come up with it for the volunteer, or those who work full time jobs and leave EMS. I think there has to be a better way. I don't get it out a nurse shouldn't have to have it, but doctors, and EMS have too, heck even some levels of first responder have to. (FR-D)

I also think that in IL it is the volunteer vs. paid EMS. Alot of rural areas have continued to keep volunteer on call providers, instead of dedicating a full time staff, this leads to many areas having longer response times, I hear complaints all the time, but where do we focus the tax dollars? Police and Fire..... Fire Departments usually have fire districts which receive funding from their taxes, while as Police are funded by the local government and federal dollars. EMS is one of the unique public safety groups that can charge for their services and yet, everyone thinks they make money. Being probably one of the least profitable.