Advancing EMS & Paramedicine

[thegreypilgrim]

I think we're all aware of the "hammering" of paramedics that goes on around this site - about how we're all uneducated, incompetent, and not to be trusted with "real" medicine, etc. Now, I admit to being among those who've done this. I acknowledge full well that the educational standards for EMS are seriously lacking and must be improved to college degree-appropriate level if we're going to be recognized as medical professionals from our colleagues. However, I think it must be said that these other medical people (physicians & RN's) do bear at least some level of responsibility for the overall sorry state of EMS education. After all, they're the ones in charge of developing and carrying out the educational process of prehospital personnel. Somewhere along the line they agreed that it's adequate.

Further along these lines, it seems (at least in my experience) that a large center of resistance to expanding the role of paramedics through education and, thus, scope of practice have been nursing associations. Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.

So, it seems like those of us who would like to see EMS professionalized, and paramedics advanced as medical professionals are fighting a multi-front war. We have fire services and private sector agencies that want to maintain the status quo of having paramedics mass produced every 6 months or so to keep the supply/demand curve in their favor by keeping costs down. While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on. It's hard to see where this will leave us, and incredibly frustrating.

[VentMedic]

After being in EMS for over 30 years, I can tell you it is not nursing, RT, PT, OT, SLP, RRT or any of the others that are to blame for this mess. Many of these professions are a lot younger than EMS which is now middle-aged but the others have achieved so much more in professional and legislative recognition by not whining about "nurses picking on them". They also took over many of the duties that had been done by nurses for decades and once they showed their education and professional status, they became health care team members FOR THE PATIENT and not hated enemies. EMS providers need to get over this "what everyone else should be doing for them" and take some responsibility for their own future.

Originally Posted by thegreypilgrim

I think we're all aware of the "hammering" of paramedics that goes on around this site - about how we're all uneducated, incompetent, and not to be trusted with "real" medicine, etc. Now, I admit to being among those who've done this. I acknowledge full well that the educational standards for EMS are seriously lacking and must be improved to college degree-appropriate level if we're going to be recognized as medical professionals from our colleagues. However, I think it must be said that these other medical people (physicians & RN's) do bear at least some level of responsibility for the overall sorry state of EMS education. After all, they're the ones in charge of developing and carrying out the educational process of prehospital personnel. Somewhere along the line they agreed that it's adequate.

One of the reasons nurses still have some control in the educational programs and in the state legislative offices is that there are not many EMS providers who have advanced their education enough to assume the roles. The same for the role of educators. Few have advanced to where college programs are common and thus you have certified teaching certified classes in the tech schools where the instructors are not required to have higher education of even a 2 year degree.

RNs and doctors did not force anyone to go to a medic mill instead of to a college. Every other health care profession saw what needed to be done and started advancing their education long before anyone MADE them get a degree. Unfortunately in EMS "if it ain't required I ain't gonna do it". It is amazing that in 2009 when some find out I have a 2 year degree in EMS from 1979 they are shocked and ask "did someone make you get that degree?" "Why on earth would you get a degree if no one made you get it?" or "That was stupid to waste your time getting a degree when you could have gotten a cert and still joined the FD for good pay and a pension." These are comments made to me by EMS providers and are repeated over and over today on many of the EMS forums.

Originally Posted by thegreypilgrim

Further along these lines, it seems (at least in my experience) that a large center of resistance to expanding the role of paramedics through education and, thus, scope of practice have been nursing associations. Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.

Did you happen to check your public health rules and regulations for your state? This is not a "not gonna let them do it" decision by nurses. The rules have been made by higher authorities than them. Also EMS agencies did help determine what they did and did not want to do when some of these rules were being designed. Florida has very liberal statutes for Paramedics and public health but many agencies have chosen not to expand into that area because "it's boring" as it involves more than just sticking a needle into someone's arm. This one "skill" mentality has been what has keep EMS out of expanding into other avenues.

Originally Posted by thegreypilgrim

So, it seems like those of us who would like to see EMS professionalized, and paramedics advanced as medical professionals are fighting a multi-front war. We have fire services and private sector agencies that want to maintain the status quo of having paramedics mass produced every 6 months or so to keep the supply/demand curve in their favor by keeping costs down. While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on. It's hard to see where this will leave us, and incredibly frustrating.

Can you show me anything in the Paramedic curriculum that prepares you to work in a critical care unit?

It is amazing at how other professions have over come being stepped on by becoming the peers of other professionals rather than alienating themselves as enemies with the "us against them" crap attitude. Get over it. Every allied health professsion has had to meet the challenges expected by nursing and set by their own state and national accrediting/certifying agencies. The other agencies also knew there was not substitute or shortcuts to education. They pushed for their degrees and encouraged as many in the profession to become educated so that when licensing standards were raised, very few were left out with only a diploma or tech cert.

Maybe you should review the history of nursing to see exactly how far they have come and the changes they have gone through since the 1970s. EMS had every opportunity to become stronger than nursing in the 70s but too many in the profession, providers and agencies, fell for the quick cert mentality. If you notice, many of us that did start in the 1970s in EMS have a 2 year degree from a college in Paramedicine. That was the way it was intended to be. Nursing still hadn't acheived its goal at that time. Nurses and the other allied health professions have streamlined their professions to just a couple of levels. They don't keep adding a cert level for each "skill" until there are over 50 different certs. Nursing also doesn't force everyone to be a nurse as FDs want every FF to be a Paramedic. They do encourage their lower levels such as the CNA and the LPN to become RNs and do not allow the lowest level (CNA) to dictate what direction RNs should take their professional status.

Do the RNs tell agencies not to monitor the QA/QI of Paramedic performance for certain skills? Do they tell EMS medical directors not to be involved with their Paramedics? Do RNs tell your agencies not to provide you with continuing education? Are RNs responsible for all the publicity Paramedics are getting for not recognizing misplaced tubes? Do you actually blame nurses each time you miss a tube? The one advanced skill that was given to Paramedics in the 1960s by physicians (not nurses) and somehow some have managed to muck it up?

It is also amazing that at one time the Paramedic could do central lines (including subclavian), intracardiac epi, chest tubes and pericardiocentesis and not once did any RN give me grief about what I did as a Paramedic. Evidence based medicine took those things out of EMS and NOT nurses.

However, don't expect anyone to allow you or support you to do something you have NEVER been trained and educated for.

Here's some good reading for you and it wasn't written by a nurse.
2,000 Hours to train a Paramedic?

http://www.fd-doc.com/2000Hours.htm

You might also review some of the EMS history in the states that increased their "hours of training" by a whopping 100 hours. It was the EMS providers that thought it was scandalous to require that many more hours. Maybe you should go to a few of your state meetings and see who is against the changes. Usually educated people like RNs and MDs support education and rarely if ever tell people to do less or stay at a low level. Unfortunately, the numbers in EMS with only a cert out number those with education and that includes the RNs and MDs who have tried to help. The whole issue that RNs and MDs have with EMS providers is that they DO NOT have the education to expand their roles. If RNs do not want LPNs with 2x the education and training of Paramedics in the ICUs and EDs, what makes you think they should make the exception for someone with 624 hours of PREHOSPITAL taining? The hospitals didn't want RTs in the ICUs to manage the ventilators until we had some proof of education. How about Radiology Technologists? Why do some in EMS believe they are the exception and that they are being picked on "just because"?


There are many, many articles for you to look up as this is a topic that has been in EMS journals for decades and there is nothing mentioned about the mean nurses picking on the poor Paramedics. Problems were identified in the early 80s and the EMS agencies that responded to the problem areas went on to be successful. Those who whined about education and blamed everyone else are those that still feel that way today and still have gone nowhere.

Just do a search on EMS training on any medical search engine and start reading. Enlighten yourself about what EMS has been and where it tried to go.

So no, EMS did this mess all by itself. Until EMS providers stop blaming everything on others and take some responsibility for their own education, there is nothing nursing, RT or MDs can do to help you. Hell some in EMS see absolutely no need for any college level A&P and are perfectly happy have a 10th grade reader for a Paramedic text and an 8th grade book for EMT-B.

[VentMedic]

Here were some of the better discussions on the topic way back when Rid was here.

Progression of EMS

http://www.emtlife.com/showthread.ph...rogression+EMS

Basics before Advanced
http://www.emtlife.com/showthread.php?t=4830

Decent JEMS article:
EMS Needs a National Brand Identity

http://www.jems.com/news_and_article..._Identity.html

As a profession, EMS has a lot of work to do to create a respected image or "brand identity" on a state and national level. Perhaps the most poignant comment to illustrate this point came from an elected official in the Florida Senate when several of us were lobbying for an innovative change to the statutes that would dramatically improve patient care. One senator said, "We cannot vote to pave a road for you EMS people when you all want to take different roads." Painful. But you know, she was right. The measure failed.

We've been so busy pursuing the public vs. private agenda that we've lost credibility on a national front. We've invested so many resources battling each other that we've almost lost the war.

[jgmedic]

Vent, you make some great points here. Until we as a profession can show that we are willing to take on that extra education and show that we are medical professionals we can't expect people to just give us that respect we crave. It's not all about big, bad fire and nursing and all that. It's about us being ok with the status quo. People continue to flock to medic mills, because(esp. in SoCal), it's seen as a fast ticket to FD, and why not, when that's where the benefits and pay are. If students all of a sudden stopped being willing to pay the money for a quick P-card and demanded a better educational standard, these places would not exist.

[Summit]

Originally Posted by VentMedic

Here's some good reading for you and it wasn't written by a nurse.
2,000 Hours to train a Paramedic?

http://www.fd-doc.com/2000Hours.htm

That's a bunch of crap.

[VentMedic]

Originally Posted by Summit

That's a bunch of crap.

I agree but if you read some of the posts written by EMTs and Paramedics on the forums who are trying to differentiate or justify street smarts over college level courses, it all comes out the same "don't need no book learnin' stuff" to get the job done.

[thegreypilgrim]

VentMedic, I strongly suggest you take a long deep breath, go back and re-read my OP. You're on auto-pilot mode here.

I really don't know where to begin here, except to say that I'm not whining about "nurses picking on EMS". I don't know where you got that from. I realize that we (that is, prehospital providers) are largely the problem. We are very naive to think that 6 months in a medic mill qualifies us to practice advanced medicine independently whereas others in allied health hold 2-4 year degrees to do what they do. Since you apparently missed my being clear about this in the OP, let me be even clearer now: If there is going to be change it has to come from us first.

Now, my point was that I think there is a growing population of EMS providers who actually are tired of being looked down on and want to change their circumstances. I did not go to a medic mill - I went to a college paramedic program that could confer an AS degree. I'm currently working on a BS degree in EMS at a university as well. I would like to see other people start doing this as well. I believe I also made it clear in my OP that FD's and private companies represent the largest barrier to EMS advancement - a point you entirely passed over in that rant of a response.

For the record, I don't believe paramedics should be allowed to do XYZ procedure despite not having degrees "just because". I don't know how you could have formed that impression, but as it is I most certainly don't. I don't think that as things currently stand paramedics have the right to enter into critical care medicine. I never said that - I merely stated that we should expand our education first. Nor did I ever state that RN's & MD's should "force us" into getting degrees...another suggestion from way out of left field. No, we should push for this ourselves.

As for this:

Did you happen to check your public health rules and regulations for your state? This is not a "not gonna let them do it" decision by nurses. The rules have been made by higher authorities than them. Also EMS agencies did help determine what they did and did not want to do when some of these rules were being designed.

As a matter of fact I have. By all means, however, feel free to lecture me about what's happening in my own state while you're not even from here. Of course, the decision to not have paramedics help out with this was not "made" by nurses. I doubt any individual RN in the area actually gives a about who's giving H1N1 vaccines. I'm simply saying, that this suggestion came from public health & EMS and probably met a whole lot of resistance from FD's & ambulance services in the area because "it's boring" like you said. But the nursing association about had a seizure and raised a hellstorm about the idea as well - the combined efforts are what resulted in it not happening. The point was, it was an example of what is the general atmosphere in my state. People - both in EMS and in healthcare - just seem apathetic about the system, and would rather things just stay as they are. This was the inspiration for this thread - I'm simply reporting what I'm experiencing in my region. Sure, there's probably less resistance from RN's, MD's, etc. than FD's & private ambulance but nevertheless there is some resistance from those areas as well. Remember I said this is a multi-front battle? You're responding as though I'm bashing nurses and trying to say it's all their fault, which is a horrendous misrepresentation of what I said.

Having read a fair amount of your posts here, I have a good deal of respect for you as a medical professional and as a person; but, your reply to me here was entirely inappropriate, and turned my OP into a straw man. Please, for future reference, don't twist my words or take something you read in a post and in a reactionary fashion just run away with it. It's just unwarranted.

[VentMedic]

Originally Posted by thegreypilgrim

Now, my point was that I think there is a growing population of EMS providers who actually are tired of being looked down on and want to change their circumstances. I did not go to a medic mill - I went to a college paramedic program that could confer an AS degree. I'm currently working on a BS degree in EMS at a university as well. I would like to see other people start doing this as well.

Unfortunately you are looked upon by the minimum education standard for your profession. That standard is still the "hours of training" cert present in all states but a couple.

Originally Posted by thegreypilgrim

I believe I also made it clear in my OP that FD's and private companies represent the largest barrier to EMS advancement - a point you entirely passed over in that rant of a response.

Did you bother to read my posts? The link I posted, "2000 Hours to Train a Paramedic?", was by a FD medical director.

I don't think that as things currently stand paramedics have the right to enter into critical care medicine. I never said that - I merely stated that we should expand our education first.

Then what did you mean by this comment?

While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on.

Or this?

Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.

I also don't know what state you are from to even pull up your public health statutes to see where EMS stands in them.

Nurses will defend the statutes and as I stated before, they do not allow other lesser trained individuals to do patient care without proper supervision so why should EMS be the exception? RT and other professions (Radiology, Ultrasound, Nuclear Med, Radiation Therapy, PT, SLP) were able to put restrictions on RNs from doing certain assessments and skills without the term "education" being properly defined. Thus, it is about who is the most qualified to do what is best for the patient.

[thegreypilgrim]

Originally Posted by VentMedic

Unfortunately you are looked upon by the minimum education standard for your profession. That standard is still the "hours of training" cert present in all states but a couple.

Don't I know it.

Did you bother to read my posts? The link I posted, "2000 Hours to Train a Paramedic?", was by a FD medical director.

Yeah, I read that swill. I don't understand your point, though, as I said FD's often stand in the way of increasing paramedic education standards...

Then what did you mean by this comment?
Quote:
While on the other hand we have nursing and other allied health associations resisting as well because they don't want their critical care toes stepped on.

Obviously, if paramedics education was augmented to the university level, then they could feasibly engage in critical care medicine. The vibe I get from nurses associations in my area leads me to believe that they would fight against increasing EMS education if they thought paramedics would be involved in CCT's. Hence the "stepping on their toes" metaphor.

Or this?

Quote:
Recently in my area it was suggested that paramedics be utilized to assist in the administration of the H1N1 vaccine. This idea was shot down by an irate nursing association.

I think this is pretty self-explanatory.

I also don't know what state you are from to even pull up your public health statutes to see where EMS stands in them.

California.

Nurses will defend the statutes and as I stated before, they do not allow other lesser trained individuals to do patient care without proper supervision so why should EMS be the exception? RT and other professions (Radiology, Ultrasound, Nuclear Med, Radiation Therapy, PT, SLP) were able to put restrictions on RNs from doing certain assessments and skills without the term "education" being properly defined. Thus, it is about who is the most qualified to do what is best for the patient.

Well, I don't know about where you're from, but around here paramedics can give medications via the IM and/or IN route...the fact that it's a vaccine we're talking about here doesn't make the process any more mysterious. I gave tons of vaccines in my clinical rotations - as far as I know nobody died from this. Then again, I am a paramedic so therefore must have screwed it up somehow right?

[Aidey]

thegreypilgrim - We had the same issue with vaccines in the state where I first started. While I was in paramedic school the county received a grant to put together a mass vaccination plan in the event of a pandemic or attack of some sort that required vaccinations to be administered.

While putting the plan together the suggestion was made to utilize Paramedics and the EMTs whose normal scope covered IM medications. The State RN association had what I can only describe as a hissy fit. They did not care that we were already trained in how to administer IM medications. They didn't care that the plan stated we would have to attend a class/briefing in the vaccine being given prior to being able to give it (I think that provision covered everyone in cases of vaccinations not normally given). I honestly never heard a reason besides "They aren't nurses".

The whole thing finally got resolved when the local medical directors got involved, and the state eventually decided to let Paramedics participate and that the RN association had no say in what happened because of how everything was organized in the state. The state ended up adding the EMTs who normally have IM medications this year with all the H1N1 issues.