thegreypilgrim
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So, what should the educational standard for paramedics be?
Let's put it to a vote
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I'd like to know what the statistics are between the U.S. and other developed nations regarding pt outcomes in EMS, in systems that don't use nurses or doctors on 911 ambulances. I'd like to know how much of a difference a mandatory two or four year degree has on pt morbidity and mortality.
I voted for the Assosciate's. I'm not convinced that anything more than that will change the care our patients get to any great degree. If you're talking about specializing in different areas, then that's a different story, but then working towards a specialty means that you're passing the minimum standard anyway.
I voted for the Assosciate's. I'm not convinced that anything more than that will change the care our patients get to any great degree. If you're talking about specializing in different areas, then that's a different story, but then working towards a specialty means that you're passing the minimum standard anyway.
JPINFV
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I put Bachelor's, but I'd like to add a caveat. The programs would be a single unified program, so foundational courses like general chemistry, anatomy, biology, etc would be a part of the program, not a prerequisite.
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thegreypilgrim
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Interesting, so what would the prerequisites be? Or are we talking about a hypothetical scenario in which American undergrad degrees do not require prerequisites?
medic417
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I'd be curious if a doctor on board made any difference. I really think the majority of patients that die in the ambulance with a Paramedic on board would die with a doctor on board. Just the nature of the limited work space and equipment available.
JPINFV
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This would be the hypothetical scenario where undergrad degrees don't need a prereq. by integrating the pre-reqs into a unified program, the programs have some control over the quality of those courses.
usafmedic45
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'
Most of them don't already, especially outside of health care.
Shishkabob
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Saw a study that compared BLS to ALS to Doctor level trauma care in the field... doctor level trauma care had a massively larger mortality rate compared to Paramedic. Could have sworn that study is somewhere on this forum...
This has always been my view, especially when some of our... down under friends... tout how "superior" their systems are compared to the US.
For what we currently do, an associates.
Before we can talk about any of this we need to fundamentally redesign the scope of practice model.
A person with 120 hours of education who can only give oxygen and glucose is not appropriate. Even the new "Advanced EMT" can do about half of what our volunteers can do and maybe 1/3rd of what our entry level Paramedic Ambulance Officers can.
These levels are not appropriate for the 21st century and are at odds with what is happening in the rest of the world.
We put our volunteer Technicians through a course that lasts almost a year part-time. While they are studying the student is able to use the Technician scope of practice when working with another Technician or above.
Scope of practice: Automated defibrillation, 3 lead ECG interpretation, (basic rhythms), entonox, methoxyflurane, LMA, GTN, aspirin, salbutamol, glucagon/glucose, ondansetron, paracetamol. Adrenaline is not included in the delegated scope of practice but can be administered to an anaphylactic patient in consultation with an Intensive Care Paramedic.
Now we have a 3 year Bachelors Degree for Paramedic and a Post Graduate Certificate for Intensive Care Paramedic. Brown does not advocate such a system for the US given the differences in higher education e.g. our degrees have no "pre requisites" or "general education" and take only thee years because they are a totally specialised qualification in field of study.
Our Paramedics have the scope of practice of a Technician plus manual defibrillation, cardioversion, 12 lead ECG interpretation, adrenaline, morphine, naloxone. There is talk of midazolam for seizures and ceftriaxone too.
Intensive Care Paramedics with the Post Graduate Diploma can intubate, some have RSI and thrombolysis, administer atropine, ketamine, frusemide (probably being withdrawn anyway), midazolam and ketamine.
Brown thinks there should be an Associates Degree for ILS and a Bachelors Degree for ALS.
A person with 120 hours of education who can only give oxygen and glucose is not appropriate. Even the new "Advanced EMT" can do about half of what our volunteers can do and maybe 1/3rd of what our entry level Paramedic Ambulance Officers can.
These levels are not appropriate for the 21st century and are at odds with what is happening in the rest of the world.
We put our volunteer Technicians through a course that lasts almost a year part-time. While they are studying the student is able to use the Technician scope of practice when working with another Technician or above.
Scope of practice: Automated defibrillation, 3 lead ECG interpretation, (basic rhythms), entonox, methoxyflurane, LMA, GTN, aspirin, salbutamol, glucagon/glucose, ondansetron, paracetamol. Adrenaline is not included in the delegated scope of practice but can be administered to an anaphylactic patient in consultation with an Intensive Care Paramedic.
Now we have a 3 year Bachelors Degree for Paramedic and a Post Graduate Certificate for Intensive Care Paramedic. Brown does not advocate such a system for the US given the differences in higher education e.g. our degrees have no "pre requisites" or "general education" and take only thee years because they are a totally specialised qualification in field of study.
Our Paramedics have the scope of practice of a Technician plus manual defibrillation, cardioversion, 12 lead ECG interpretation, adrenaline, morphine, naloxone. There is talk of midazolam for seizures and ceftriaxone too.
Intensive Care Paramedics with the Post Graduate Diploma can intubate, some have RSI and thrombolysis, administer atropine, ketamine, frusemide (probably being withdrawn anyway), midazolam and ketamine.
Brown thinks there should be an Associates Degree for ILS and a Bachelors Degree for ALS.
I think the benefit of the degrees required in various countries isn't the life saving/quality preserving stuff.
That is usually very protocol driven and relatively time sensitive.
I see the benefit as being able to direct the patient to the most appropriate resource other than the high cost ED.
it is the ability to treat and release without the patient having to go through 10 layers of people who all draw a paycheque and $10,000 worth of diagnostics.
It also passes the costs of education on to the provider rather than the organization requiring larger amounts of training and con ed.
You definately get less people entering the field when they have a 4 year investment and in the US average 24K in costs. Compared to a few months and a couple $1000
That is usually very protocol driven and relatively time sensitive.
I see the benefit as being able to direct the patient to the most appropriate resource other than the high cost ED.
it is the ability to treat and release without the patient having to go through 10 layers of people who all draw a paycheque and $10,000 worth of diagnostics.
It also passes the costs of education on to the provider rather than the organization requiring larger amounts of training and con ed.
You definately get less people entering the field when they have a 4 year investment and in the US average 24K in costs. Compared to a few months and a couple $1000
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A highly educated, well skilled provider also saves money or so Brown thinks.
Example: Bob and Knob the EMTs who can only dish out oxygen must call for backup to do anything, that means you need more people, more vehicles, fuel, costs to run the vehicles, dispatch them, keep them stocked etc.
Browns last night shift we did fourteen jobs in fourteen hours and only called for Intensive Care once for ketamine. Every other job was one we could handle because we had the tools we needed at our disposal; 12 lead interpretation, adrenaline, ceftriaxone etc
Example: Bob and Knob the EMTs who can only dish out oxygen must call for backup to do anything, that means you need more people, more vehicles, fuel, costs to run the vehicles, dispatch them, keep them stocked etc.
Browns last night shift we did fourteen jobs in fourteen hours and only called for Intensive Care once for ketamine. Every other job was one we could handle because we had the tools we needed at our disposal; 12 lead interpretation, adrenaline, ceftriaxone etc
Aidey
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I like JPs suggestion.
As for prerequisites I'm confused as to what you mean. When I was looking into various 4 year programs a number of them had 2 years of general ED prerequisites with 2 years of specialized classes.
JPINFV
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Also, how much are pre-reqs really worth in terms of determining enrollment when the pre-reqs are often EMT experience (of questionable quality), a med terms course, and an A/P course?
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thegreypilgrim
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Well, by "prerequisites" I meant the 2 years of GE that precedes upper division coursework.
I am a fan of your suggestion.
I voted Associates at the minimum for what we do now.
There is something thing I have heard of occurring at 3 different, well known "private" services. This is the firing of some of those who have been around a while, and replacing them with new patches right out of school. Whether or not this is absolutely true, I cannot say, but the old saying about a duck applies. Why keep someone who's been around 9 or 10 years, when you can get someone fresh out of school and pay them a whole lot less? I mean hey, Business is Business, right?
As has been stated elsewhere, educating oneself is always a laudable goal. Having some of the core sciences that were required as Pre-reqs for my medic school have helped me greatly as a provider.
There is something thing I have heard of occurring at 3 different, well known "private" services. This is the firing of some of those who have been around a while, and replacing them with new patches right out of school. Whether or not this is absolutely true, I cannot say, but the old saying about a duck applies. Why keep someone who's been around 9 or 10 years, when you can get someone fresh out of school and pay them a whole lot less? I mean hey, Business is Business, right?
As has been stated elsewhere, educating oneself is always a laudable goal. Having some of the core sciences that were required as Pre-reqs for my medic school have helped me greatly as a provider.
Wolfpack87
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I understand what you mean, but I can't agree with this in the med-field. If all EMT-B,I,P and so-on have to have ongoing training, and constant re-certs every few years. Plus, field experience should outweigh education any day. As was mentioned on many other forums, what you learn in the classroom isn't what you get on the truck.
Am I not merciful?
No amount of continuing training makes up for a foundation in the theory of basic and clinical sciences.
It is from that foundation that comes the understanding as to why things are done or changed. It allows you to form educated opinions on whether or not a treatment or modality will work. How and when to properly apply it, and how and when to deviate.
Experience also does not make up for education, it is an adjunct to it. Without the knowledge of why, the only thing gotten from experience is an If:Then view of medicine. There is no way from that to know when a patient or treatment is an outlyer, off label, or common in the grand scheme of things. There is no way to determine the expected courses of disease processes or treatment modalities.
I have said it many times, but why not once more?
All valid theory applies to every patient you will ever see. But first you must not only be taught the theory, but you must be taught how to apply it. Sadly even in the best EMS education, the later part is often deficent, because many of the instructors don't know how to apply it.
The only people I have ever seen speak out against the value of education are the ones who do not have it, therefore do not understand the value of it, and then try to discredit it in order to make up for their own shortcomings.
You will never hear somebody who has no idea what they do not know claim to be ignorant. They know 100% of a very small world.
No amount of continuing training makes up for a foundation in the theory of basic and clinical sciences.
It is from that foundation that comes the understanding as to why things are done or changed. It allows you to form educated opinions on whether or not a treatment or modality will work. How and when to properly apply it, and how and when to deviate.
Experience also does not make up for education, it is an adjunct to it. Without the knowledge of why, the only thing gotten from experience is an If:Then view of medicine. There is no way from that to know when a patient or treatment is an outlyer, off label, or common in the grand scheme of things. There is no way to determine the expected courses of disease processes or treatment modalities.
I have said it many times, but why not once more?
All valid theory applies to every patient you will ever see. But first you must not only be taught the theory, but you must be taught how to apply it. Sadly even in the best EMS education, the later part is often deficent, because many of the instructors don't know how to apply it.
The only people I have ever seen speak out against the value of education are the ones who do not have it, therefore do not understand the value of it, and then try to discredit it in order to make up for their own shortcomings.
You will never hear somebody who has no idea what they do not know claim to be ignorant. They know 100% of a very small world.