Someday all the EMT-Bs and Is will just have to stop making excuses for not getting their Paramedic patch...Period. Then there would not be such a shortage as described above. What is the problem? Too much education? Too much responsibility? The program to be a Paramedic is only a few hundred hours. It is not a 4 year degree. What is with all the whining just to do a BGL? That patient still deserves the benefit of a Paramedic assessment and whatever knowledge/skills that Paramedic has to offer. The ideal situation is still a two Paramedic truck and then there is a possibility of that service advancing to hypothermia and RSI protocols rather than catering to a mixed crew and the lowest denominator dragging them down.
Does your BLS protocal incl. glucose monitor finger-stick?
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Shishkabob
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Not debating that one bit Vent (hence why I'm in medic school)
But if someones going to argue to take something away, they need a valid reason, and not just fall back on "Basics don't have A&P"
But if someones going to argue to take something away, they need a valid reason, and not just fall back on "Basics don't have A&P"
Afflixion
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Strong words. I will concede to your point, there is no reason for the whole EMT alphabet. If they just scrapped the Intermediate and Basic altogether you will lose those who don't care enough to further advance themselves and their careers and you will have none of this ridiculous banter about "what skills should BLS be able to perform." I will freely admit that I went to a medic mill and that I am not the most educated medic around and though I kick myself every time I think about it, I did take the next step and am currently working on fixing the education problem.
JPINFV
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How about if we're trying to add something, the argument goes past, "Well, the technical skill is so easy a caveman can do it."
JPINFV
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Really? Who, exactly, am I assisting when there isn't a medic on my unit? If the medic is there, then yes, but a medic isn't always present.
EMT-Basics are trained primarily for first-aid and have very little "training" or education about and for medical emergencies which actually makes them a poor choice for even doing dialysis or NH transfers.
Afflixion
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JPINFV
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Actually, I've taken a different view. EMT-Bs are poor for NH/dialysis because we have very little education in chronic disease, basic patient care, and body mechanics.
I'm not whining, my reason is that by the time I would finish medic school, I will hopefully be in medical school. I just don't understand the problem with basic's having a BGL test as a tool to assess whether to give the oral glucose they already are certified to give. I have worked for a company that uses them and it has come in handy a few times for basics.
Quite frankly there should be 2 levels EMT and Paramedic. EMT should cover all the skills of EMT-I and be able to prep a patient for a medic and treat simple diabetic emergencies. That way a medic will still be able to have experience in EMS before they are allowed to be educated how to give drugs; then licensed to provide care. EMS will not be able to move forward as its own profession until those involved are licensed and forced to act upon their license, not their protocols under the license of someone else.
So there you have my opinion, but nothing changes the fact that I think the arguments so far against basics having them are not very good ones.
Quite frankly there should be 2 levels EMT and Paramedic. EMT should cover all the skills of EMT-I and be able to prep a patient for a medic and treat simple diabetic emergencies. That way a medic will still be able to have experience in EMS before they are allowed to be educated how to give drugs; then licensed to provide care. EMS will not be able to move forward as its own profession until those involved are licensed and forced to act upon their license, not their protocols under the license of someone else.
So there you have my opinion, but nothing changes the fact that I think the arguments so far against basics having them are not very good ones.
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Shishkabob
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Again, arguing a tool over an intervention is rather strange. Tools make no change in condition by themselves. Interventions do.
If a medic were to push Adenosine without first looking at an EKG, he'd be called dangerous. Why is it some of you want basics to administer glucose without first checking a BGC?
See where the silliness comes in?
Afflixion
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Why 2 levels? You state so they are educated prior to administering drugs but what about nurses? They do have "two levels" per say with the LVN and RN (which is in the process of being phased out but most RNs were never LVNs prior and seem to do just fine. having two levels in EMS will not accomplish much and will still be sacrificing patient care.
Why? Because a typical paramedic doesn't have a good enough education to treat patients without help effectively when they come out of medic school. Pre-hospital medicine is different than hospital medicine. Just look at nurses for instance. Part of pre-hospital medicine often involves rescue and the logistics of moving patients that nurses don't have to worry about. When a nurse begins working in a hospital, s/he is part of a team. There are many other nurses around the new nurse to show her the ropes. The best part is ultimately, the doctor makes the call. See with nurses they are not the one directing care, they are part of a team lead by a doctor. This is why it is so competative for a nurse to shift to pre-hospital medicine such as med-flight. There are other classes they must take and it is preferred that they are also paramedics.
Lets look a doctors who are in charge of patient care. Not only do they have a base education during undergrad, but they have medical school, and at least one residency before they are licensed to provide care on their own. Now their scope is much higher, but you see the how they have a progression where they work under an experienced provider before doing so on their own.
Now paramedics are by no means doctors, but they must make calls in the field on their own; without a team around them. In order to do so, I believe they need to see it done, then do it in school, then they should be eligible to be licensed. While paramedics are part of the overall health care team, in the field they often are the ones making the calls.
The other reason I have for the two tiered system is that if EMTs were phased out, we would be even more understaffed than we already are. Boston may be okay with staffing, but the rural areas would be devastated. Especially since licensing paramedics would require more education such as preferably a B.S. in Para-Medicine, but a A.S. minimum in a college setting.
Lets look a doctors who are in charge of patient care. Not only do they have a base education during undergrad, but they have medical school, and at least one residency before they are licensed to provide care on their own. Now their scope is much higher, but you see the how they have a progression where they work under an experienced provider before doing so on their own.
Now paramedics are by no means doctors, but they must make calls in the field on their own; without a team around them. In order to do so, I believe they need to see it done, then do it in school, then they should be eligible to be licensed. While paramedics are part of the overall health care team, in the field they often are the ones making the calls.
The other reason I have for the two tiered system is that if EMTs were phased out, we would be even more understaffed than we already are. Boston may be okay with staffing, but the rural areas would be devastated. Especially since licensing paramedics would require more education such as preferably a B.S. in Para-Medicine, but a A.S. minimum in a college setting.
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Careful. RNs know their 2 or 4 years of education is just the beginning. Some EMT(P)s believe their training is the end all to all education and there is little more they need to know. Meanwhile, nurses gain initial experience while deciding on a specialty. They can have as much or as little responsibility as they want but they are adequately prepared through education and experience. RNs also have little problem making the shift to prehospital because they take the responsibilty seriously. When we fly to another country to pick up a sick child, there is not a doctor telling us what to do. Nurses may also have been lead on Code and Rapid Response teams which also may not have a doctor readily available. Actually, one reason why a Rapid Response team was created in some hospitals was the lack of an available doctor. Paramedics on the other hand have a very difficult time if they join a Flight team that does IFT because they have no ICU experience to draw from. Many also do not have a solid education experience to build from.
A Flight RN can usually challenge the Paramedic exam but still keep the RN seat. A Paramedic who wants to be a Flight RN must complete the education required which is at least a 2 year degree, 4 preferred, and then obtain 3 - 5 years of ICU experience before they can apply as a Flight RN even if they are working for that company as a Paramedic. Essentially the 5 years of experience better prepares the RN for Flight than the 3 years of EMS for the Paramedic in many places. Learning the ropes for the field is not that difficult if you are already accustomed to working at least two high acuity patients every shift for several years or managing 10 -15 floor or ED patients when the RN floats.
A med flight does NOT put new RNs on board and rarely puts new Paramedics on. However, some HEMS run with the same protocols as the ground without any extra skills or responsibilty.
They also have a doctor who is just a phone call away. They also have protocols or in some cases recipes that pretty much spell everything out. In many areas a Paramedic can not fart without calling for permission. Also, some have a very limited scope with few meds. CA is an example which is why an MICN does the CCTs there and their flight teams are usually RN/RN.
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daedalus
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Thats my stance as well.
That's why I corrected my wording to competitive as soon as I read my own words.
Inevitably the doc is in charge of every patient, but I'm talking about if a patient is in cardiac or respiratory arrest. Who is making the call about the next move in an ambulance? The paramedic is, even if he is only following protocols. But then again I think we need to move towards licensing them.
That's pretty much what I was trying to say about nursing Vent. When a nurse enters the hospital and decides they want to go into pre-hospital medicine they have to educate themselves to get there.
I was by no means trying to insult nurses. My point was that pre-hospital and hospital medicine are different. On an ambulance, the paramedic is in charge. In flight if a doc isn't riding, a nurse is in charge. This is different than being in a hospital where the doc is making the call on every patient.
Inevitably the doc is in charge of every patient, but I'm talking about if a patient is in cardiac or respiratory arrest. Who is making the call about the next move in an ambulance? The paramedic is, even if he is only following protocols. But then again I think we need to move towards licensing them.
That's pretty much what I was trying to say about nursing Vent. When a nurse enters the hospital and decides they want to go into pre-hospital medicine they have to educate themselves to get there.
I was by no means trying to insult nurses. My point was that pre-hospital and hospital medicine are different. On an ambulance, the paramedic is in charge. In flight if a doc isn't riding, a nurse is in charge. This is different than being in a hospital where the doc is making the call on every patient.
No a doctor is not always present 24 hours a day. RNs are expected to follow protocols and titrate drips their entire shift and may not even see a doctor.
As for the Paramedic, sometimes the education by "hours", which in some states is very minimum, coupled with poor mentorship on the job scares the hell out of me when you think about what they are allowed to do. Many come out of school lacking the preparation and some have not even intubated a live patient. Yet, they get the patch and after a brief orientation of their protocol book, they are allowed to do patient care on their own. It doesn't mean they are proficient. RNs at least respect the words competency and proficient before accepting a patient that is out of their comfort zone. Some Paramedics come out of school without knowing what they don't know.
This article gets circulated occasionally and while I do not agree with it for the future of the Paramedic, much of what it states is how many ALS agencies and their Medical Directors think. If you go over to the Fire forums, and this is not a bash by any means on FFs, you can read some of their comments on being a Paramedic. Most think it is just another cert or hurdle to get hired or advanced and it is no big deal. And, even with that attitude many still perform as a Paramedic very well because they do the skills as written.
http://www.fd-doc.com/2000Hours.htm
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daedalus
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Getting back to the topic with the BLS and EMT discussion, do you see any similarities?
Some are arguing just for a simple skill and recipe rather than knowing why because they just do it and there is no need to go beyond that one point.
I agree with you Vent. I worked with a few medics who scared the hell out of me, and I'm a basic. The problem is that until EMS providers are paid more, EMS will not attract higher quality career providers, and until we attract more and better career providers the standards will not be able to improve without losing too many people to sustain the current system. We really grew out of fire departments and are still burdened by it. (That doesn't mean all firefighters are bad medics, but EMS needs to be its own profession if we are to advance)
The article is an interesting read, but that's not where the profession needs to go. The ED is burdened enough as it is and currently basics call for ALS for most patients that really do need to go to the hospital.
The article is an interesting read, but that's not where the profession needs to go. The ED is burdened enough as it is and currently basics call for ALS for most patients that really do need to go to the hospital.
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medic417
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I second that. The author should be decertified immediately.