Oh, Oh here we go again, new NAEMSE draft to replace DOT

[stcommodore]

Maybe this is a little extreme but do we have nurses that take some extra classes and can do chest tubes and central lines? No, probaby not. There are advanced nursing areas with masters and doctorate degrees but we still can't get our field to agree to an associates level education.

[flight-lp]

Maybe this is a little extreme but do we have nurses that take some extra classes and can do chest tubes and central lines? No, probaby not. There are advanced nursing areas with masters and doctorate degrees but we still can't get our field to agree to an associates level education.

Valid point about education levels, but there are plenty of RN's performing those procedures. Look at most Flight Nurses (and Flight Paramedics for that matter).

[VentMedic]

Maybe this is a little extreme but do we have nurses that take some extra classes and can do chest tubes and central lines? No, probaby not. There are advanced nursing areas with masters and doctorate degrees but we still can't get our field to agree to an associates level education.

Yes, both nurses and RTs can do these "skills" in many different settings depending on the hospital's needs and specialties as well as transport situations. Both professions are a minimum of a 2 year degree.

EMS got its start by a group of doctors betting that they could teach a few advanced "skills" to just about anyone at any education level. This "skills" mentality has stuck. Every time someone wants to make a change or advance the profession, they add a "skill". Every certification or license in EMS is based on "skills". We have state certifications called just by the "skill". For example, Washington State has 6 different certifications; EMT-B, IV Technician, Airway Technician, IV/Airway Technician, IV Intermediate Life Support Technician (ILS), and finally Paramedic.

As with most states, the education concerns itself primarily with the skill. Shifting around the skills to make a hodge podge fix for what is truly lacking seems to be the only answer EMS can come up with. But yet, EMS personnel have supported this by "they're doing it, why can't we?" "They have a new gadget, we want one too." For healthcare, I prefer the professionals that master the gadgets they have through education and demonstration of clinical expertise. Just because you can doesn't always mean you should.

Reading through the threads on anything from oxygen to chest pain, the difference in education levels is fairly obvious. In many areas, the training for paramedic level lacks many fundamental principles of A&P and critical thinking. Many paramedics rely on "because we can, it's in our protocols" when questioned in the ED. The "attitude" is defensive leading the ED staff to believe whatever of these EMS professionals. The doctors and nurses may just be wanting additional input other than the cook book reguritation of data. Yet, for some, discussing the BASICS as mentioned in other threads by senior members here, is difficult. Critical thinking and reasoning are going by the wayside.

Now I must go and ponder the question on the PPV thread. If that is truly a test question, then there is work to be done.

[Just Plain Ruff]

Ventmedic, the game's afoot.

[chbare]

Nurses in a few specialty areas are allowed to perform invasive procedures. Flight Nursing would be an example. I am allowed to place chest tubes and place central lines. However, I think this does make an interesting point. A point that Dustdevil emphasized with his "9" year comment.

I have had to spend several years obtaining education, experience, and credentials to have the ability to function with the autonomy of a medic and have the ability to provide similar interventions as a paramedic. The more I work in my current field, the more I wonder if my qualifications are actually adequate.

Then, I look at my state. We have EMT's with less than 300 hours of training providing interventions and making autonomous decisions that are on par with what I do. How people advocate such an approach?

If I understand the argument, it goes like this; This is the way my state does things and I cannot do anything to change that, so I just accept it?

I also understand many people pull the "rural" card. People who live in rural communities should have access to high level EMS care as well as people in urban communities. Look at nursing, you go to a hospital and you expect a nurse to deliver your care. Even in tiny rural hospitals you have nurses. Yes, I know all about the push to replace nurses with providers with less education. The difference being, Nursing as a profession has chosen to aggressively fight this practice. Do we see this occur in EMS?

I see only three types of people provide care as independently as some of these providers. Physicians, PA's, and Nurses with master's degrees. Food for thought?

Take care,

chbare.

[stcommodore]

exactly, the trauma service at Hershey Medical vs. Hospital of the University of Penn are both looked at the same regardless of location so why are we looking at EMS different?

[Just Plain Ruff]

I've been lurking and reading and I'm not sure why we are arguing this point?

In my 2 cents a person who takes a 120 hour course is just getting the basics. There is no way that you can convice me that someone with 120 hours of classwork has the knowledge nor the experience to perform any skills that a medic can do.

Administering the patient's own meds seems to be the rage these days so I'll give that to the EMT's but they should have additional training on these medications and the risks and benefits of giving them. They should not be giving any type of medications without emt to physician contact. It should be on the physicians shoulder to allow this administration and the EMT should not be autonomous on this issue whatsoever.

Bottom line-an EMT should not be able to make the decision to assist in giving a patient's own medications without medical control contact.

On to the subject of skills. Advanced level skills should not be undertaken by emt's period. If the emt cannot give medications thru an IV then they should not be starting an iv.

You can teach anyone to perform the skills but it takes someone with more education to be able to really understand why and when a intervention should take place.

It takes an RN at least two years to get their education. It takes an LPN a shorter time to get their credentials yet they are unable to do many things an RN can do. This should be no different in EMS. If you don't have the education time then you should not be doing certain skills.

Until EMS becomes a degreed/education based field and not just a field that teaches you to do a skill then we are going to continue to be looked down on similar to the way cinderella was treated by her step mother.