As I've stated in other threads, I feel that more education isn't the silver bullet for EMS it keeps getting made out to be, atleast here in the U.S.A. A large bulk of the education I did receive was essentially useless to me. In the field, I can assess and diagnose a pt but can't do anything about it.
I think it could be argued that the same thing probably happens to a lesser extent in the ER. The physicians may be able to identify some esoteric pathology, but their actual course of action is to punt the patient to another service.
There's obvious limitations in the prehospital environment. But some of these are being pushed back. For good or bad, ultrasound is starting to appear in some environments. While a lot of the point-of-care technology is some combination of too expensive / too delicate / too inaccurate / too slow, it's also making it's way in there. As these things develop we'll probably have a greater role in identifying pathology, and initiating treatment.
One role that's been discussed a lot is screening for sepsis using prehospital lactate measurement, although this benefit might be restricted to systems transporting to either busy / congested ERs, or those with long transport times.
The word "diagnosis" is loaded with all sorts of badness that get physician's mightily upset, but if we accept that you or I may occasionally identify the root cause of someone else's medical problem through luck or sheer genius, I think this is valuable when it happens. I can't say that it's been that often for me.
In other instances, I have no way to apply knowledge beyond a theoretical point. Then on arrival to the hospital, after giving a C/C, the staff ignores EMS and that is if they listened to anything at all, so all this info gleened during assessment isn't good for anything other than filling out a report that will only be read by the service QA and billing.
Don't take this the wrong way, because it's not intended as a slam, but I feel like sometimes we need to be honest with ourselves about what we're doing.
I can't speak to anyone else's experiences or competency, but for me, I know that on a given day, even a fairly poor ER physician is going to be able to assess and examine a patient much better than me. They're going to have seen most presentations more often, they're going to have experience with real-life examples of most of the zebras that might be hanging around, and they're going to consider a much wider list of differentials, including things that I haven't even thought of.
I think what we can bring to the ER is a description of the circumstances in which the patient was found, information from bystanders and neighbour's about how the current situation developed, or what happened in the days prior. We can also be useful in describing how the patient's presentation has changed, especially if we fixed a problem, or have given analgesia. That's stuff that the physician isn't necessarily going to be able to get via physical exam or history taking.
I'm not saying that I haven't been in a situation where I've pointed out something that's been missed, but it's pretty rare.
If you're having issues where they're not looking at your 12-leads, and tossing them in the garbage, then they're just being stupid. But this really shouldn't be happening anymore -- because this represents the loss of valuable information that may affect the patient's treatment.
While I think a 6 week course ought to be criminal, I also think requiring a degree without fixing other things in a broken system puts an undo burden on EMS personnel, especially with the current cost of education.
I guess this is a major issue in the US. I paid the equivalent of about $3,000 US / year for two years for my paramedic, and about the same for my EMT. I also did some university, and paid between $4,000-$6,000 / year. I imagine in the states those numbers would be much higher.
If it cost $20,000 / year to take a four year Bachelor's degree, then, yeah, there's definitely an issue there. But, at the same time, we really can't call ourselves professionals and having it mean any more than the professional in "professional hair dresser", if we don't start demanding that our paramedics have a baccalaureate.
