I will not try to convince you that the future of EMS is not barely skilled labor, but I would like to just advance your knowledge a bit?
The intent of that exert was to illustrate that a role of a paramedic was never intended to be Rhodes scholar as some of you so disparately advocate them to be. This was not the intent in the first place.
You are very correct, it was not meant to be. But it was also never purposefully limited either.
The understanding of disease of the day was that most life threatening illnesses happened suddenly and that a handful of skills could make a difference.
Our understanding of disease has advanced, the lessons of that day are no longer applicable in the modern world.
As we have seen from the advancement of technology, minimally skilled labor is replaced by automation over time. In order to remain relevant, and even viable much less valuable, EMS is actively undergoing a transformation.
Anytime there is change, it scares people, but pretending that what was applicable in the 1970s is the goal of today or the purpose of tomorrow is really just burrying (collective)your head in the sand and pretending the world doesn't change.
There was atime when paramedics claimed they didn't need 12 lead capability. A time when they claimed they didn't need pulse oximetry, and a time they claimed they did not need capnography. All of these have become commonplace in EMS. There is an ongoing debate of certain medication and procedures, but this is overall healthy.
Intubation, which was once the hallmark ofa paramedic is being reduced in favor of supraglottic airways. Peds intubation is phasing out. I suspect at least 1 cardiac medication will be lost in the 2015 AHA update, with potentially the downgrading of more.
EMS is actually demonstrating to push hospitals into adopting hypothermia treatments and increase efficency of both cardiac and stroke care.
King County, love them or hate them for various reasons, but they have posted excellent numbers in cardiac arrest saves and they require of their medics 3x more schooling than any other place I know in the US. Try to apply there with the minimum qualifications.
With respect I ask, "where have you been living?"
You can post "national standards" changes but the fact of the matter the medical directors in all these progressive medical centers for the most part are content with the paramedic model for street response..
I do not think you understand how medical direction works or its role. It has been demonstrated in multiple locations that individual medical directors cannot enforce education standards or dictate level of care. It is also extremely easy to replace a medical director, which further limits their effective power.
Some states, in order to curb medical directors who had conservative protocols below modern standards of care have adopted statewide protocols in order to dictate the desired standard to them. This has had the unwanted side effect of limiting progression or rolling it back in some areas, but raising the mean is said to justify the loss of both extremes.
There is also a very real legal threat facing any provider in any US healthcare agency from being the first to change.
It is also normal for the medical community to change slowly over time. I think it is a mistake to equate slow conservative change with a desire to remain stagnant.
Notice for your in extremis NICU transport with congenital anomalies it's very rare that the make up of transport team would only entail street paramedics, maybe because the medical directors are not content with said make up?..
Do you think that lack of advanced or specific education is a major or minor reason for that?
There are areas in the US that use only medics for airmed crews or critical care transport.
I have a fair amount of experience in NICU, but how many providers at any level do? A congenital abnormality in a child is either going to require corrective surgery or life long (depending on how long they can be expected to live anyway) medical treatment.
There is a saying in surgery that when you try to use medicine to treat a surgical illness, the only thing you accomplish is to delay the treatment the patient needs. Wouldn't you say that absent a surgeon on that NICU transport, the very goal is to buy time?
Alphabet soup courses are here to stay:
I agree, they are even ever expanding. If making money was my goal I would create and market those things like the coming of a messiah. Whether it was the greatest course ever developed or the most obvious money making scheme in history, there would be a parade of fools to pay for them.
If you sent me a resume that said you had an ACLS cert, do you think I would care? How many people in the know would care?
In my home state in order to keep your medic cert you need to have ACLS. Which means if you have it, all it shows me is that you met the minimum. If you don't have it, there are 1000 people who would rather have your spot that do the minimum.
Some agencies put you through their own course whether you have it or not as part of their standard orientation. Especially quality programs that add to the basic information. (in the appropriate way)
If you presented me with your PHTLS or ITLS card, I might even hold it against you, because I would suspect you think of trauma as a set of skills to perform and likely know nothing of the pathophysiology of it.
You can just write me off as an arrogant idiot, but before you do, consider I may have learned those values somewhere? From people who profess such view. People who hired and spent a considerable effort teacing me to be where I am today.
If they were hiring, what do you think their view would be?
2) Con ed, and some are better than others and you may learn a thing or two.
Like what?
As was rudely, but accurately pointed out, these courses do not impart any credentialing to perform care. You may not do anything you learned in them without the authority granted by medical direction.
If you show up in the ED with a trauma patient you administered estrogen, erythropoitin, doxycyclin, and atorvastatin to, without a standing order, you could find yourself in big trouble. Even with an order you could exceed your state allowable scope of medication administration.
The same for any other procedure or treatment you learn in these classes.
EMS Focus Bachelors Masters and PhD:
1) For the most part waste of time if your goal to increase your medical scope of care. Actually years on the job and getting those alphabet soup courses with something like FP-C / CCEMTP would enhance your scope greater than any EMS Focused Degree..
I don't think that is true.
With an EMS focused degree you are more competative for the jobs that would hire you.
Do you think a critical care flight agency wouldn't hire a medic with a bachelors in health science and no FP-C/CCEMTP compared to somebody with just those certs courses if they would accept the same pay?
4 years of self paid education compared to a couple day course?
I bet they would not only find that more valuable, they'd be willing to pay that person to go to those classes and pay them for being there.
Such an individual with those courses and degree and even modest experience is going to outcompete a few years experience and a cert at any agency worth working for.
Will they be hired by Slave Drivers minimum wage IFT ambulance service? Probably not, but who wants to be?
We can all sit and bicker about how to invent a better mousetrap others actually become Doctors, PA's or Nurses.
That they do...
But generally after we do, we sit around and try to figure out how to build that moustrap.
