OP
OP
RocketMedic
Californian, Lost in Texas
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Clipper, you clearly have no idea what I am talking about.
Going Beyond The Minimum: Paramedic or Ambulance Driver?
- Thread starter RocketMedic
- Start date
No. But on this forum you will have those who take your word and do stupid things while defying some very carefully written protocols from their medical directors.
Fancy ICUs? Seriously? The things I mentioned have been around for at least 2 decades. HFOV is from the 1980s. Flolan has been around for about 15 years. Nitric Oxide became popular around 1990. Most ICUs have some type of big ventilators. I don't know of any ICU which relies on a transport ventilator. There are transport teams who can take mobile ECMO for both adults and kids. None of this stuff is new or fantasy or even "fancy".
Education, Education.
I read your post which was more about criticizing someone for not doing what you were doing which may not have been correct.
I see you miss my point about education before going with all the "fancy" stuff to use Chase's word.
VFlutter
Flight Nurse
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Again, it was a joke. We occasionally use Flolan and Nitrox but our CCPs are not really found of HFOV.
OP
OP
RocketMedic
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Clipper, although I respect your knowledge of vents and all, we have them for a reason. They work fairly well. What you fail to comprehend is that we should be learning more about them, when to use them and where they are weak, not throwing them with the KED and mast pants as a "never-use" type of intervention. The mentality of "I don't understand it, it must be bad" is stifling needed changes.
You do realize that these things actually do work well and save lives when properly applied?
By your logic, we should literally just drive the ambulance.
You do realize that these things actually do work well and save lives when properly applied?
By your logic, we should literally just drive the ambulance.
What he said. Im done in this thread.
Where are you at that you are using Nitrox? Don't their CCP protocols have pain management by other means? It also depends on if the pt is tubed as to whether Flolan is drug of choice for transport. Both nitric and Flolan are not that good for exposure. I will take non tube nitric pts if 20 ppm or less.
Our teams have RNs and RTs who can provide other ventilator support like the.Bronchotron or the Servo I.
To Rocket and sffd.
Wouldn't it still be better to ensure all Paramedics have advanced their base education before adding more complex skills? I think everyone should at least have 2 college level a/p and a pathophys class. All other health care professions require education before skills. If you only have skills without the education you are still considered a tech. EMS still is caught up in the "most skills wins" game. Some just don't get it that if you have the education behind you it is so much easier to gain skills.
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I feel like much of this confusion stems from not realizing that Chase is an RN in an ICU...
VFlutter
Flight Nurse
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ER/ICU. CCP = Critical Care Physician (who are all pulmonologists). I forget that CCP refers to critical care paramedics as well. And I meant iNO not Nitrox, that is probably causing confusion.
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Pavehawk
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Nitrox is not used for pain management, I think you may be thinking of nitronox which is the trade name for the 50/50 mix of N2O (Nitrous oxide) and O2.
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You're thinking of nitronox. Different animal. Nitrox is a mixed gas, usually with a higher oxygen percentage than air, in the breathing gas. Is anyone using (or knows of a facility) Heliox?
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Floridamedic / Ventmedic / Clipper1:
I know you have a lot of knowledge and transport experience. You are, after all, an experienced paramedic, RRT, CCT transporter, and paramedic instructor.
After all that, you'd think one would not be so insecure as to have to constantly deride others?
You'd also think that if you really cared about education - which you constantly crow about - you'd find a way to provide it in a less condescending and negative way.
No wonder you keep getting kicked off of forums.
OP
OP
RocketMedic
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Bravo, Halothane. Thank you.
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Where are the posts of the others? You forgot Vene. Have others mentioned education before?
Why is it that some in EMS continue to argue for more skills and not education to do the skills.
Kicked off? You ha e not kicked me off. But I suppose when the theme of a forum is more skills less education someone pro education would be unpopular. I think those I have met thru the education programs know I am not the enemy if you want to learn.
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No. No one has ever mentioned education on this forum before. Ever.
You keeping trying to justify your rudeness and condescension by pointing out how "wrong" and "poorly educated" we are. But being more knowledgeable than others does not compel or give you the right to be rude. As an educator, you should know that better than anyone.
You are far from the only clinician on this forum who has training well beyond paramedic school, yet you are the only one who is consistently condescending and rude to those whose knowledge doesn't match your own. This forum is frequented by several physicians, medical students, PA students, ICU RN's, RRT's, flight RN's, an AA, at least one CRNA student, and probably several other advanced clinicians that I am not aware of. Every one of them is pretty disappointed (if not disgusted) with what passes for "education" in EMS. But somehow, they all manage to do what you don't: interact with those who have less training and education then them, without treating those people like crap.
Education is actually a frequently discussed topic on here, if you hadn't noticed. The paramedics and EMT's here know well that their education sucks compared to that of other clinicians, and do not need to be beat over the head with that fact. Many of them are smart, motivated folks who do what is in their power to fix things, by asking questions and discussing things on here, seeking educational opportunities for themselves, and advocating for increased educational standards. What the hell more do you want?
You keep claiming that there is a big problem here with the "Mongo want be able do more stuff to his patients, but Mongo no waste time on book learnin" mindset, but you are really just making crap up as justification for your rudeness, because that stuff is actually almost non-existent on this forum. The people here, for the most part, really want to learn.
You keep spouting about education, but you don't educate. You have lots of opportunities on here to explain and teach in a helpful and constructive way, but instead you just make a sport of constantly, rudely pointing out how inferior other's understanding of things are. I get pretty tired of seeing it, but I will challenge you every time I do.
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OP
OP
RocketMedic
Californian, Lost in Texas
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There is no such thing as a professional EMT. There are only paramedics and ambulance drivers. This is a controversial and inflammatory statement, but please, bear with me. This is not a slight against those who hold EMT certification, nor is it dismissing your service. Today, approximately seventy percent of American EMS workers are EMT's of some permutation, and your efforts are absolutely vital to our current operations. With that being said, we have a serious problem in our industry, and it starts with our facination with titles and our notions of what they should be. I offer this observation of truth from the perspective of a self-identified new paramedic. Many will hate me for it, many will accuse me of being an elitist and a 'paragod', there will be much protest. But ask your doctors, your corporate leadership, your lawyers, your enlightened non-ambulance-driving leadership. Ask Kelly Grayson, Skip Kirkwood or the JEMS regulars. They will likely agree with the sentiment.
Ambulance drivers are pretty easy to recognize- they are those of us who ignore advances and "evidence-based" medicine in favor of anecdote, who do things "because that's the way they're done" or out of a desire to use skills for their own sake instead of patient outcomes. They're the people who withhold pain medication when it is indicated, who claim "we don't diagnose", who educate us with war stories and mantras. They are the people who bucket along with vocational educations and refuse to accept that we can offer and provide more. These people are the ones who shirk responsibility for their own careers by blaming our employers for low pay, long hours and poor treatment. They place responsibility for substandard care on their limited educations and scopes of practice and the protocols written for the lowest common denominator, yet are the first to claim credit for positive outcomes. Worst of all, they are the ones who accept that we cannot do something. Look on our social media sites- there are thousands of ambulance drivers there, arguing that they cannot provide good care, telling people to "suck up" abusive employment scenarios, or defending the virtues of noble ignorance. Most ambulance drivers are going to be insulted by this.
Being a paramedic is not a certification level or an authorized skill list or even an education, it is a mindset. There are plenty of people I would readily call "paramedics" who wear white patches, and plenty of gold-patched ambulance drivers. What differentiates the two? The answer to that is multifaceted and is one of the reasons we are largely volunteers or paid far less than we would like. A paramedic is many things- they are responsible for patient care, they are responsible for the proper application of protocols, they are responsible for the operation of their ambulance. They are responsible, quite literally, for human life. With an eye toward that, those paramedics also realize that they are not educated to the mastery of all things, and continuously work to improve their practice, their knowledge base and (if they are great) their profession, on both a personal and a group level. This could mean college classes, professional expansion into other allied fields, or mentoring new providers. I am hesitant to extend this to "training", because that is a requirement that everyone should complete- I would say that participation in training only really matters if the students want to learn from it. Paramedics are those who seek "better" and actually work for it. On a personal level, I will advance an anecdote: I once spoke with a human-resources officer from a major EMS corporation on a flight. She told me that she evaluated candidates based on a number of factors, to include time as an EMT. When I expected to hear her speaking positively of 'street experience', she was actually very opposed to it. "If someone has been an EMT for a decade, I don't leap to experience. I think that they're lazy. I think that they're a professional ambulance driver uncomfortable with responsibility. I don't trust them with money, with medicine, and have to think hard about any job beyond driving an ambulance." As a new paramedic, this deeply influenced me- a hiring manager, a person of responsibility, trusted someone like me at 21 with a crisp new cert and little experience over an experienced EMT.
It is not realistic to propose that we go to an all-paramedic model, nor will we. There will always be an entry-level into EMS, and it will functionally be an EMT or AEMT. With that being said, we should neither glorify that level or seperate it by title and job function. When our customers see us, they are not thinking "EMTs". They think of paramedics or ambulance drivers. Which one is something that we control with the services we offer. Those who offer basic services only are Ambulance Drivers. Those who treat their patients are Paramedics. Our customers have already made the differentiation. In the not-so-distant future, we are going to need to justify our financial existence. Those who think that our communities will continue to fund lavish lifestyles for fire departments, pay well for non-fire paramedics and pay for ambulances and their crews that offer what we do now are optimistic at best. In a future where we can realistically expect decreasing reimbursements, increasing costs and higher overall standards of care, there is very little place for those who want to do "what doctors do, but at 70mph" on a vocational education justified by anecdote and laying responsibility at someone else's door. We are going to become one of two things- literal medical transport or true professionals providing world-class medical care in the field with the ability to transport patients if needed. If we continue to revel as an industry in the noble ignorance of self-imposed limits, we are setting ourselves up to be a medical transport service with as much of the job security as our delivery drivers enjoy. Our scopes of practice will remain stagnant, our pay low and our workforce ignorant. If we want to avoid that fate, if we want to change our paradigm, we need to accept that increased educational standards, diversification of services offered and a more customer-oriented approach are going to be needed.
Don't believe me- look at nursing. Fifty years ago (one complete working generation), nurses stood at this same crossroads. Slowly, and with much wailing and gnashing of teeth, they made the collective decision to progress professionally. Wages climbed, acceptable scope of practice increased, and professional respect increased. Fifty years ago, a young man who wanted to be a nurse was a fool foregoing a profession. Today, it's a solid decision recognized as an entry to a profession in its own right. They too had their stay-behinds- the LPN, LVN, the CNAs, the nebulous "nurse's aide". Their lot in life has not changed- they lack the education to progress, and their stagnant practice makes them the menial hell-jobs of health care for all but a few who genuinely enjoy classic nursing. Their opportunities are limited.
We stand today in a world with more technology, knowledge and potential for service than at any time in history. We are on the edge of a demographic crisis that will see my generation caring for two large generations of very, very sick people for fairly long times. We can already see our political leaders and financiers preparing for inevitable changes in how we fundamentally operate. We can already see the hospitals, the ambulance corporations, the insurers pulling out of fiscal quagmires and the shocked reactions of communities finding out that change is coming. Hospitals that do not get paid for patients are going to demand that those patients go somewhere else or simply refuse to see them, or they will be drowned in debt and numbers. We are going to see more distributed care, more in-facility care, more nursing homes, more palliative care and more opportunities. We are not going to become doctors or offer full-service hospitals on wheels in my professional lifetime, but we are not going to remain as strictly "emergent medical transport" as we are, unless we accept limited employment and professional stagnation. I forsee a day when an old woman who falls and calls 911 does not only receive an assessment, but also treatment for an injury that does not require an ER, a hand off of her floor, and a referral to a doctor or other support structure who can help her adapt to her aging. Perhaps we could even come back to her home in a week to remove the sutures a paramedic placed. I foresee a day when a nursing home is not sending a patient out for 'weakness', but for a genuine health crisis that has not been corrected by their own treatments. I dream of a day when our professional social media is not overrun with fools who would withhold medication based on superstition, ignorance and fear. I dream of a day when our labor is not disposable, when our entry-level workers can support their families without welfare and food stamps, where we enjoy the protection of professionalism. I dream of a day when our average patient can be treated at home, our sick patients receive better care than a Stare of Life, and our extraordinary patients receive the same acute care that we provide today with transport to an appropriate facility, with labs, ECGs, and preparation for definitive care reliably completed. I foresee a day when a paramedic can respect a family's wishes and not forcibly resuscitate a patient with a terminal illness. All of these things will require changes. As an industry, we are not yet capable of assuming these roles, but that will change quickly when the first steps into that field become profitable.
What, then, should we call our EMTs? We have titles for a reason, to denote competencies, certifications, and to organize ourselves based on our jobs and responsibilities. Someone needs to be in charge at all times, today that's the paramedic. In most places, it's whoever is providing patient care or has the highest certification or seniority. "Ambulance driver" is a little insulting. EMT is useful, but limiting. "White patch mafia" or some of the Facebook memes are just plain inappropriate for a profession, as accurate as "asswipe" for CNAs. I offer that we should simply call our partners paramedics. That's what they are, just with smaller scopes of practice and less education. They are an integral part of the patient-care team we form and should be treated as such.
Those who wish to remain Ambulance Drivers can be just that, or perhaps Medical Transport Specialists. Frankly, I don't care what they do.
Ambulance drivers are pretty easy to recognize- they are those of us who ignore advances and "evidence-based" medicine in favor of anecdote, who do things "because that's the way they're done" or out of a desire to use skills for their own sake instead of patient outcomes. They're the people who withhold pain medication when it is indicated, who claim "we don't diagnose", who educate us with war stories and mantras. They are the people who bucket along with vocational educations and refuse to accept that we can offer and provide more. These people are the ones who shirk responsibility for their own careers by blaming our employers for low pay, long hours and poor treatment. They place responsibility for substandard care on their limited educations and scopes of practice and the protocols written for the lowest common denominator, yet are the first to claim credit for positive outcomes. Worst of all, they are the ones who accept that we cannot do something. Look on our social media sites- there are thousands of ambulance drivers there, arguing that they cannot provide good care, telling people to "suck up" abusive employment scenarios, or defending the virtues of noble ignorance. Most ambulance drivers are going to be insulted by this.
Being a paramedic is not a certification level or an authorized skill list or even an education, it is a mindset. There are plenty of people I would readily call "paramedics" who wear white patches, and plenty of gold-patched ambulance drivers. What differentiates the two? The answer to that is multifaceted and is one of the reasons we are largely volunteers or paid far less than we would like. A paramedic is many things- they are responsible for patient care, they are responsible for the proper application of protocols, they are responsible for the operation of their ambulance. They are responsible, quite literally, for human life. With an eye toward that, those paramedics also realize that they are not educated to the mastery of all things, and continuously work to improve their practice, their knowledge base and (if they are great) their profession, on both a personal and a group level. This could mean college classes, professional expansion into other allied fields, or mentoring new providers. I am hesitant to extend this to "training", because that is a requirement that everyone should complete- I would say that participation in training only really matters if the students want to learn from it. Paramedics are those who seek "better" and actually work for it. On a personal level, I will advance an anecdote: I once spoke with a human-resources officer from a major EMS corporation on a flight. She told me that she evaluated candidates based on a number of factors, to include time as an EMT. When I expected to hear her speaking positively of 'street experience', she was actually very opposed to it. "If someone has been an EMT for a decade, I don't leap to experience. I think that they're lazy. I think that they're a professional ambulance driver uncomfortable with responsibility. I don't trust them with money, with medicine, and have to think hard about any job beyond driving an ambulance." As a new paramedic, this deeply influenced me- a hiring manager, a person of responsibility, trusted someone like me at 21 with a crisp new cert and little experience over an experienced EMT.
It is not realistic to propose that we go to an all-paramedic model, nor will we. There will always be an entry-level into EMS, and it will functionally be an EMT or AEMT. With that being said, we should neither glorify that level or seperate it by title and job function. When our customers see us, they are not thinking "EMTs". They think of paramedics or ambulance drivers. Which one is something that we control with the services we offer. Those who offer basic services only are Ambulance Drivers. Those who treat their patients are Paramedics. Our customers have already made the differentiation. In the not-so-distant future, we are going to need to justify our financial existence. Those who think that our communities will continue to fund lavish lifestyles for fire departments, pay well for non-fire paramedics and pay for ambulances and their crews that offer what we do now are optimistic at best. In a future where we can realistically expect decreasing reimbursements, increasing costs and higher overall standards of care, there is very little place for those who want to do "what doctors do, but at 70mph" on a vocational education justified by anecdote and laying responsibility at someone else's door. We are going to become one of two things- literal medical transport or true professionals providing world-class medical care in the field with the ability to transport patients if needed. If we continue to revel as an industry in the noble ignorance of self-imposed limits, we are setting ourselves up to be a medical transport service with as much of the job security as our delivery drivers enjoy. Our scopes of practice will remain stagnant, our pay low and our workforce ignorant. If we want to avoid that fate, if we want to change our paradigm, we need to accept that increased educational standards, diversification of services offered and a more customer-oriented approach are going to be needed.
Don't believe me- look at nursing. Fifty years ago (one complete working generation), nurses stood at this same crossroads. Slowly, and with much wailing and gnashing of teeth, they made the collective decision to progress professionally. Wages climbed, acceptable scope of practice increased, and professional respect increased. Fifty years ago, a young man who wanted to be a nurse was a fool foregoing a profession. Today, it's a solid decision recognized as an entry to a profession in its own right. They too had their stay-behinds- the LPN, LVN, the CNAs, the nebulous "nurse's aide". Their lot in life has not changed- they lack the education to progress, and their stagnant practice makes them the menial hell-jobs of health care for all but a few who genuinely enjoy classic nursing. Their opportunities are limited.
We stand today in a world with more technology, knowledge and potential for service than at any time in history. We are on the edge of a demographic crisis that will see my generation caring for two large generations of very, very sick people for fairly long times. We can already see our political leaders and financiers preparing for inevitable changes in how we fundamentally operate. We can already see the hospitals, the ambulance corporations, the insurers pulling out of fiscal quagmires and the shocked reactions of communities finding out that change is coming. Hospitals that do not get paid for patients are going to demand that those patients go somewhere else or simply refuse to see them, or they will be drowned in debt and numbers. We are going to see more distributed care, more in-facility care, more nursing homes, more palliative care and more opportunities. We are not going to become doctors or offer full-service hospitals on wheels in my professional lifetime, but we are not going to remain as strictly "emergent medical transport" as we are, unless we accept limited employment and professional stagnation. I forsee a day when an old woman who falls and calls 911 does not only receive an assessment, but also treatment for an injury that does not require an ER, a hand off of her floor, and a referral to a doctor or other support structure who can help her adapt to her aging. Perhaps we could even come back to her home in a week to remove the sutures a paramedic placed. I foresee a day when a nursing home is not sending a patient out for 'weakness', but for a genuine health crisis that has not been corrected by their own treatments. I dream of a day when our professional social media is not overrun with fools who would withhold medication based on superstition, ignorance and fear. I dream of a day when our labor is not disposable, when our entry-level workers can support their families without welfare and food stamps, where we enjoy the protection of professionalism. I dream of a day when our average patient can be treated at home, our sick patients receive better care than a Stare of Life, and our extraordinary patients receive the same acute care that we provide today with transport to an appropriate facility, with labs, ECGs, and preparation for definitive care reliably completed. I foresee a day when a paramedic can respect a family's wishes and not forcibly resuscitate a patient with a terminal illness. All of these things will require changes. As an industry, we are not yet capable of assuming these roles, but that will change quickly when the first steps into that field become profitable.
What, then, should we call our EMTs? We have titles for a reason, to denote competencies, certifications, and to organize ourselves based on our jobs and responsibilities. Someone needs to be in charge at all times, today that's the paramedic. In most places, it's whoever is providing patient care or has the highest certification or seniority. "Ambulance driver" is a little insulting. EMT is useful, but limiting. "White patch mafia" or some of the Facebook memes are just plain inappropriate for a profession, as accurate as "asswipe" for CNAs. I offer that we should simply call our partners paramedics. That's what they are, just with smaller scopes of practice and less education. They are an integral part of the patient-care team we form and should be treated as such.
Those who wish to remain Ambulance Drivers can be just that, or perhaps Medical Transport Specialists. Frankly, I don't care what they do.
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VFlutter
Flight Nurse
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Bro, use the return button every now and then :blink: But awesome post otherwise.
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OP
OP
RocketMedic
Californian, Lost in Texas
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Edited it, the copy-paste from Polaris kinda sucks.
NomadicMedic
I know a guy who knows a guy.
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You took a beating from the protocol monkeys on PoF though...