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[Veneficus]

These are unrealistic expectations. You literary want PA's (Physician Assistant) staffing ambulances. This will never happen as you losing focus what the intent of a "Paramedic" was.

Well I must say, this is the first time I have ever been accused of wanting a PA for anything.

But it is not unrealistic, it is the future of EMS whether I say or want it or not. In the last couple of years, there have been significant increases to the basic science component of the paramedic curriculum. That follows a trend that was started in the prior update.

In many college based programs, a full year of A&P is a requirement, some will substitute college level biology or biochemistry.

Additional Bachelors of EMS programs have also come into existence, and the envisioned national scope of practice refers to a critical care paramedic level, the curriculum of which has not yet been established.

From: Emergency Care in the Streets 6th ed., Nancy Caroline et. al. (2008) (p. xIv)

I have seen this, I have no respect for that book, I consider it the worst EMS text in the industry, and I respectfully disagree with many of the positions of its author.

Also, in the 1970s providers at any level would not be able to imagine the advances made in medicine in the last now 16 years. There have been credited more and greater discoveries in medicine than in the entire prior history of Medicine dating back to BC.

To buy into war stories of the past as an actual direction of the future of EMS is a bit flawed.

Considering the most progressive EMS agencies in the US and many modern and developing nations overseas have embraced the realities of the evolution of disease processes and the patients who suffer from them, they have put to great effect the EMS provider in a public health and prevention role.

If one has such dedication and willingness to devote time to college and pay tuition out of his pocket (EMS agencies rarely cover tuition) and actually attain such standards, what will keep said person in his current EMS position?

In the city I sit in at this moment, in order to touch a patient or step foot on an ambulance, you need a 4 year degree. There are both masters and PhD programs in EMS, and many of the supervisory and national leaders hold such degrees.

The reason why so many motivated providers in the US leave EMS is because no matter what their education or ambition, they are still equated and cannot escape the fate of the masses of minimally trained providers.

I suspect from not only my personal position, but that of many of my friends and collegues in US EMS, if they did have a career that demanded and made use of professional development, they would still be EMS providers.

Some falsely assume that they will get a pay raise prior advanced education, but that idea is simply the opposite of how every other healthcare profession progressed and it will never work that way.

Truth be told those who attain such standards usually move on to MD, DO, PA RN fields.

That is true, and they stay involved and return to EMS in great numbers, which raises the mean level of EMS providers.

Fact is these are qualifications to work as a Paramedic for 99% of EMS agencies out there

High School Diploma or GED
State Drivers License
Paramedic Certification
AHA Cards
# Years on the job

This is also true, but it is unlikely to make you competative for the most desirable agencies.

It is also why the national average for EMS pay is so poor and there are few career professionals.

But times will change, as sure as the sun rises.

 

[Ecgg]

To buy into war stories of the past as an actual direction of the future of EMS is a bit flawed.


The reason why so many motivated providers in the US leave EMS is because no matter what their education or ambition, they are still equated and cannot escape the fate of the masses of minimally trained providers.

I suspect from not only my personal position, but that of many of my friends and collegues in US EMS, if they did have a career that demanded and made use of professional development, they would still be EMS providers.

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 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. 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?


Put the pleasantries aside let's speak bluntly:

Alphabet soup courses are here to stay:
1) Pad the resume
2) Con ed, and some are better than others and you may learn a thing or two.
3) Enhance scope of care

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.

We can all sit and bicker about how to invent a better mousetrap others actually become Doctors, PA's or Nurses.

 

[EpiEMS]

This is also true, but it is unlikely to make you competative for the most desirable agencies.

It is also why the national average for EMS pay is so poor and there are few career professionals.

But times will change, as sure as the sun rises.

This is the key. If there were opportunities for a bachelor's trained medic who could start at $45k+ (with upward mobility and opportunity to obtain graduate training in EMS to help improve the system, etc.), I guarantee you'd have more and more highly qualified people going into the field instead of becoming PAs, NPs, MDs, DOs, or, heck, like me, going into a non-medical field (and continuing EMS as a PT job or as a volley).

 

[ExpatMedic0]

This is the key. If there were opportunities for a bachelor's trained medic who could start at $45k+ (with upward mobility and opportunity to obtain graduate training in EMS to help improve the system, etc.), I guarantee you'd have more and more highly qualified people going into the field instead of becoming PAs, NPs, MDs, DOs, or, heck, like me, going into a non-medical field (and continuing EMS as a PT job or as a volley).

Most new medics I know do start around that... ;-)

 

[EpiEMS]

Most new medics I know do start around that... ;-)

D'oh!

Time for me to get my medic...I guess

 

[Wheel]

These are unrealistic expectations. You literary want PA's (Physician Assistant) staffing ambulances. This will never happen as you losing focus what the intent of a "Paramedic" was.

From: Emergency Care in the Streets 6th ed., Nancy Caroline et. al. (2008) (p. xIv)

If one has such dedication and willingness to devote time to college and pay tuition out of his pocket (EMS agencies rarely cover tuition) and actually attain such standards, what will keep said person in his current EMS position?

Truth be told those who attain such standards usually move on to MD, DO, PA RN fields.

Fact is these are qualifications to work as a Paramedic for 99% of EMS agencies out there

High School Diploma or GED
State Drivers License
Paramedic Certification
AHA Cards
# Years on the job

That may have been the purpose of the paramedic originally, but 95% of the calls we run are primary care based, or acute exacerbations of chronic conditions. Medicine has changed. Other fields are responding with more education and subsequently are receiving more money/reimbursement and ems is not.

I am a paramedic who loves being a paramedic. I don't think it is unreasonable for our profession to look to expand and educate ourselves like professions with similar scopes to ours. I think that it would be valuable to standardize this education and benefit those who want it with a degree, rather than a bunch of merit badge certs that measure knowledge and competency in no way shape or form. That way you equip providers with the ability to move into expanded practice areas like critical care transport or into management, research, and policy making.

We can't just say "we're not doctors" as an excuse not to push ourselves, get degrees, and get involved in research in order to benefit our patients as much as possible. I may be idealistic, but I think they deserve that.

 

[Veneficus]

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.

1) Pad the resume

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?

3) Enhance scope of care

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.

 

[Ecgg]

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?

Veneficus the reason you will never convince me is because I hold said degree in EMS with the alphabet soup to go along with it (probably more certs that I care to mention) what I lack is years on the job. To the employers that hire where I reside and probably majority of US, that EMS degree means absolutely nothing. It all boils down to years on the job as the determinant factor. Formal education in this field means absolutely nothing. Hence why this discussion is folly as it not at all applicable to real world.

This is the very reason I find myself currently pursuing a degree where formal education actually accounts for something.

 

[Veneficus]

Veneficus the reason you will never convince me is because I hold said degree in EMS with the alphabet soup to go along with it (probably more certs that I care to mention) what I lack is years on the job. To the employers that hire where I reside and probably majority of US, that EMS degree means absolutely nothing. It all boils down to years on the job as the determinant factor. Formal education in this field means absolutely nothing. Hence why this discussion is folly as it not at all applicable to real world.

This is the very reason I find myself currently pursuing a degree where formal education actually accounts for something.

Could you just PM me where you live?

edit: But I offer the problem may be your location and not the lack of opportunity.

 

[Veneficus]

Veneficus the reason you will never convince me is because I hold said degree in EMS with the alphabet soup to go along with it (probably more certs that I care to mention) what I lack is years on the job. To the employers that hire where I reside and probably majority of US, that EMS degree means absolutely nothing. It all boils down to years on the job as the determinant factor. Formal education in this field means absolutely nothing. Hence why this discussion is folly as it not at all applicable to real world.

This is the very reason I find myself currently pursuing a degree where formal education actually accounts for something.

Could any of the members reading this who work for a reputable agency get this person an interview?

 

[ExpatMedic0]

Could you just PM me where you live?

edit: But I offer the problem may be your location and not the lack of opportunity.

Ya I agree it could be the location and agency(s)

 

[Bullets]

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

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.


That they do...
But generally after we do, we sit around and try to figure out how to build that moustrap.

I think you underestimate how systems hire. Its pretty formulaic around here. If you want Job 1 you need this cert X and these clasess A, B, C
If you want Job 2 you need this cert Y and these classes D, E, F

You can apply, but know your application goes straight into the trash can

Part of these requirements is to help weed out the bad applicants, the theory being if applicants have taken the time to take some con-ed, which for us is ICS 100, 200, NIMS 700, 800, TLS and PEEPS then we will ony get applicants who have some desire to expand their education beyond the basic 120 hours of class time and actually pursue this as some reasonable fascimile of a career

"Degrees" are looked down upon, i have a simple Bachelors and have been told they cant hire me because i would have more education then their supervisors....

Continuing education is needed to update us when our protocols change, like when NJ added Aspirin to the BLS protocol or when they take SMR out of our protocols.

How would you propose continuing education occur in this field? EMS isnt the only career in which CEUs are required to work? Would a conference like The Gathering of Eagles not be a worthwhile class to attend? I understand it isnt bringing you to the education level of the presenter but it does impart knowledge and foster critical thinking amongst the field.

Or should you just get certified or licensed and never have to sit in classroom again?

 

[RocketMedic]

interview and job offer, with 7500 bonus and 2500 relo, wages starting at around 40k/year. EMSA Oklahoma. pm me so I can get you Ricks number, I could use the thousand-dollar recruiting bonus.

paid okc license, too.

did I mention that we are medically in charge?

 

[ExpatMedic0]

"Degrees" are looked down upon, i have a simple Bachelors and have been told they cant hire me because i would have more education then their supervisors....

haha. Maybe its time to relocate and find a new agency ;-)

 

[Veneficus]

I think you underestimate how systems hire. Its pretty formulaic around here. If you want Job 1 you need this cert X and these clasess A, B, C
If you want Job 2 you need this cert Y and these classes D, E, F

You can apply, but know your application goes straight into the trash can

Part of these requirements is to help weed out the bad applicants, the theory being if applicants have taken the time to take some con-ed, which for us is ICS 100, 200, NIMS 700, 800, TLS and PEEPS then we will ony get applicants who have some desire to expand their education beyond the basic 120 hours of class time and actually pursue this as some reasonable fascimile of a career

"Degrees" are looked down upon, i have a simple Bachelors and have been told they cant hire me because i would have more education then their supervisors....

Many recruiting agencies and employers use software to look for keywords on applications, they pass up a lot of good employees doing that. But it is not a flaw in EMS specifically.

Degrees being looked down upon is part of the US cultural villification of education. It is also endemic in the "blue collar" workforce, where the fear of losing what is had because of not having an education is both real and feared.

Besides, it's NJ, you know the place is broken. Especially EMs and its first aid council.

Move the hell out of there.

Continuing education is needed to update us when our protocols change, like when NJ added Aspirin to the BLS protocol or when they take SMR out of our protocols.....

Continuing education will always be needed, I agree with that, but it is not a successful or reasonable strategy to make entry level education minimal and believe it can be made up for by "continuing" edcation, especailly when it is not continuing but a rehash of what was already covered.

The more front loaded your education the easier it is to mae transitions in practice. Do you know how I get guidline updates? In email, and I am expected to put them into practice as soon as I get the official email. There is no training day or period.

I also spend at least 15 minutes a day, everyday, and often more on keeping up with what is going on in my and related fields. Not becase I am special, but because that is what it takes to avoid falling behind.

You are talking about what? 48 hours in 2 years? of "refresher?" and expect it to have a positive impact on the mean level of provider?

Not realistic. It is why EMS is so far behind.

How would you propose continuing education occur in this field? EMS isnt the only career in which CEUs are required to work? Would a conference like The Gathering of Eagles not be a worthwhile class to attend? I understand it isnt bringing you to the education level of the presenter but it does impart knowledge and foster critical thinking amongst the field.

Generally I support going to conferences. But you do have to have a base level of knowledge to really get anything out of it. Otherwise, you just end up with basically out of context bullet point like ideas, some of which you might actually remember.

It really helps to go to conferences where you can participate. I have been to a few where all I did was get to lurk around. Waste of time.

Or should you just get certified or licensed and never have to sit in classroom again?

In healthcare, education is forever. It needs to be ongoing edcation, not refreshing education, that is a zero sum game. I also think if it was more formalized, then people should get some kind of lasting credit for it.

It also wouldn't hurt to mandate continuing education in basic knowledge that most in EMS don't have, like physiology.

 

[Summit]

I reread the whole thread. I guess I'll say I do see value in some of the alphabet soup courses as an introduction to people working that area or a minimum for those who are NOT working in that area.

What EMS generally does for CE is an anemic attempt to make up for the shortfalls of EMS education and as a system.

I think that most people on this forum are above average for EMS. I bet most people on this forum vastly exceed the minimal recert requirements. Most people on this forum who stick around aren't here to ask about stethascopes and sirens. I always recert NREMT with well over 200 hours, often in the 300s, of "NR eligable" con-ed hours, but most of my con-ed is not "eligable" because every day I work I think of at least enough questions to keep me occupied studying for more time than I have. I don't spend every moment doing that, but I do study a lot.

This forum can be a form of con-ed. There are some advanced discussion and good information in some of these threads and many posts that give me even more things to read up on.

I don't think there's any problem with people taking the letters classes to wet their tastebuds, gain exposure to topics outside their area, and to get hired. Beyond that, there is much more that we all ought to be professionals. We should all do our best to engender a culture amongst our peers in EMS that encourages real con-ed.

 

[Tigger]

Generally I support going to conferences. But you do have to have a base level of knowledge to really get anything out of it. Otherwise, you just end up with basically out of context bullet point like ideas, some of which you might actually remember.

It really helps to go to conferences where you can participate. I have been to a few where all I did was get to lurk around. Waste of time.

I just got back from EMS Today. Overall it most of the classes were excellent, and I was presently surprised to find that every class had more questions at the end (of more of an enrichment nature) than there was time for.

What was dismaying was a respiratory class with Bob Page where he asked questions in a "game show" format and you answered with a clicker. Some real no brainer questions would see only 60% (or less) of the audience getting it right. Eek. The baseline knowledge level of many of the EMT participants was just too low in many cases to understand even basic caponography.

 

[Veneficus]

I just got back from EMS Today. Overall it most of the classes were excellent, and I was presently surprised to find that every class had more questions at the end (of more of an enrichment nature) than there was time for.

What was dismaying was a respiratory class with Bob Page where he asked questions in a "game show" format and you answered with a clicker. Some real no brainer questions would see only 60% (or less) of the audience getting it right. Eek. The baseline knowledge level of many of the EMT participants was just too low in many cases to understand even basic caponography.

The prosecution rests.