Paramedic Practitioner? Masters degree and future of EMS

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ExpatMedic0

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My grandma would actually like to hear more about the thread topic ;-) Any other thoughts on paramedic practitioners, master's degrees, and the future of EMS? I did not start the thread, but its an interesting topic I like hearing thoughts and opinions on.
 

DPM

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To maybe steer things back in the correct direction:

The UK, Canada, Australia and New Zealand are the countries with probably the most comparable EMS systems. They all have certificates / associates levels of training, with advancement to bachelors and maters level for advanced level, critical care and Paramedic practitioners.

Are we doing it better, or are they? Is the education unnecessary? What do people think are the upsides and downsides of higher education standards for EMS?

Personally, I am for higher education. Paramedic training in the U.S. could be slightly extended (by adding more A&P, chemistry etc) to make it an associates program. With higher education standards across the board we could realistically petition for better pay and allowances. Likewise, with higher standards we can then have serious discussions with our medical directors and managers, to finally expand and improve our protocols.

My $0.02 anyway.
 

Tigger

Dodges Pucks
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C'mon dude... mods should have deleted that original inflammatory nonsequitor that everyone knew would turn into this multipage distraction from the original thread topic... well now look at the thread. Hey, now the troll is back with some more great "Grandma always said" crap.
We will not moderate the forum in that manner. That post hardly qualified as inflammatory and unfortunately there are many, many people who do in fact view the whole by their impression of a single part. While I hope we can all educate these people, I also expect that members here take the high road and don't let it devolve into what has happened above.
 

SandpitMedic

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My grandma would actually like to hear more about the thread topic ;-) Any other thoughts on paramedic practitioners, master's degrees, and the future of EMS? I did not start the thread, but its an interesting topic I like hearing thoughts and opinions on.
Always the voice of reason. Good ol' Expat.
 

ExpatMedic0

MS, NRP
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To maybe steer things back in the correct direction:

The UK, Canada, Australia and New Zealand are the countries with probably the most comparable EMS systems. They all have certificates / associates levels of training, with advancement to bachelors and maters level for advanced level, critical care and Paramedic practitioners.

Are we doing it better, or are they? Is the education unnecessary? What do people think are the upsides and downsides of higher education standards for EMS?

Personally, I am for higher education. Paramedic training in the U.S. could be slightly extended (by adding more A&P, chemistry etc) to make it an associates program. With higher education standards across the board we could realistically petition for better pay and allowances. Likewise, with higher standards we can then have serious discussions with our medical directors and managers, to finally expand and improve our protocols.

My $0.02 anyway.
This is true, and its also worth noting the U.S. higher education system differs dramatically from many commonwealth countries and the EU. For one, the U.S. uses an associate's degree, and a 4 year bachelor degree. Many other countries which offer paramedic degrees(mentioned above) do not offer either of these, but instead offer a 3 year bachelor degree. Another interesting thing, I have met and worked with paramedics from other countries who claim to have a "masters degree" or "postgraduate certificate", but never completed university at a bachelor's degree level.. so although it maybe a master's degree or post grad certificate to them, it's likely an associate's degree at best in the U.S. since we tend to use the step ladder tiered education system for the most part. Secondly the cost of higher education (especially at the University level) is much, much, higher in the U.S. I think its also worth noting that our healthcare system (including reimbursement system), is wildly different than many of the above mentioned countries. So these are all things to consider when comparing the U.S. to other countries. With that that said I still think we can learn a lot from many of those countries, specifically Australia who is really pioneering a lot of advanced EMS roles and education.
 

triemal04

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Oh to dream...what the hell. The first steps would be easy...:D

First and foremost, before any progress or future improvements can be made, EMS must be fixed and standardized across the country. Only when that is done is it both feasible and prudent to move forward. Putting a long-range plan in place would also work, but again, the base problems need to be fixed before moving on.

EMS needs to be better represented at the federal level, and in a way that leads to heavy enforcement of rules/standards. To be honest this would suck, but if the entire country is ever going to get on the same page it has to happen. Essentially, a department of EMS needs to be created with a lot of clout.

There needs to be one enforceable standard for education throughout the country. States can still certify people internally (no different than most medical professions) but the educational requirements need to be formalized, preferably with a 2 or 3 year degree.

There needs to be an enforceable standard for when EMT's and Paramedic's are used and who is actually a part of EMS; routine non-emergency transfers, dialysis runs, discharges and such do not require EMT's and Paramedics in attendance, should not be able to bill as if they are, and should not be allowed to legally call themselves ambulances or a part of the EMS system.

The ability to gain reimbursement from Medicare (and Medicaid since it get's federal funding) should be removed if states are non-compliant with either educational standards, or who is allowed to bill and represent themselves as an EMT/Paramedic.

Insurance companies need to have the option to refuse any and all payments for the same reasons.

Once the basics were taken care of then other interesting topics like funding, public needs vs private profits could be dealt with.

Of course, doing any one of those things would be an utter nightmare that was so filled with political backstabbing, public hysteria (fed by various interest groups) misinformation, people looking out for themselves, people pushing agendas and the standard stupidity and ignorance (that is part of both politics, the federal gov't and EMS) that nothing would get done, or done well.

Basically politics and pie in the sky dreaming as usual.
 

Tigger

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Oh to dream...what the hell. The first steps would be easy...:D

First and foremost, before any progress or future improvements can be made, EMS must be fixed and standardized across the country. Only when that is done is it both feasible and prudent to move forward. Putting a long-range plan in place would also work, but again, the base problems need to be fixed before moving on.

EMS needs to be better represented at the federal level, and in a way that leads to heavy enforcement of rules/standards. To be honest this would suck, but if the entire country is ever going to get on the same page it has to happen. Essentially, a department of EMS needs to be created with a lot of clout.

There needs to be one enforceable standard for education throughout the country. States can still certify people internally (no different than most medical professions) but the educational requirements need to be formalized, preferably with a 2 or 3 year degree.

There needs to be an enforceable standard for when EMT's and Paramedic's are used and who is actually a part of EMS; routine non-emergency transfers, dialysis runs, discharges and such do not require EMT's and Paramedics in attendance, should not be able to bill as if they are, and should not be allowed to legally call themselves ambulances or a part of the EMS system.

The ability to gain reimbursement from Medicare (and Medicaid since it get's federal funding) should be removed if states are non-compliant with either educational standards, or who is allowed to bill and represent themselves as an EMT/Paramedic.

Insurance companies need to have the option to refuse any and all payments for the same reasons.

Once the basics were taken care of then other interesting topics like funding, public needs vs private profits could be dealt with.

Of course, doing any one of those things would be an utter nightmare that was so filled with political backstabbing, public hysteria (fed by various interest groups) misinformation, people looking out for themselves, people pushing agendas and the standard stupidity and ignorance (that is part of both politics, the federal gov't and EMS) that nothing would get done, or done well.

Basically politics and pie in the sky dreaming as usual.
Of note, many of the things you list (which I agree with) might find solutions if we could just pass the EMS Field Bill. Moving EMS under the auspices of Health and Human Services would make a significant difference.

The rest of healthcare is soon (or is) being forced to prove their worth. If what they are doing isn't working, CMS will not reimburse. EMS is not far behind, but we lack the federal leadership to become efficient and this worries me.
 

EpiEMS

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The rest of healthcare is soon (or is) being forced to prove their worth. If what they are doing isn't working, CMS will not reimburse. EMS is not far behind, but we lack the federal leadership to become efficient and this worries me.
Poses a good question (perhaps for another thread): What does EMS do that is worthwhile, and what does EMS do that isn't?

And how does that link up with the need/desire/idea of midlevel providers in EMS/prehospital settings?
 

Medic 46

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Here in Pennsylvania the the pay scale runs anywhere from $10 to $20 an hour for a paramedic. Whether you have an AAS or not you make the same pay. Even as a nationally registered paramedic in PA I can't practice the same skills as a medic from California or Washington state. I can't RSI, I can't give blood, if I have a beta blocker overdose pt dying in front of me I have to 1. Pray I have reception 2. Beg a doctor to let me give glucagon because there is no protocol for it.
Point is I think before we start talking about education and accreditation we first need to actually standardize care in all states. Sure it's cool if with a degree a medic in Seatlle can RSI and I learn how to do it here. PA tells me that's a waste of knowledge and I will loose my license if I do.
 

DPM

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I hope that by standardising the educational requirements (more than the very basic standards laid out by title 22 etc) we can agree on a national standard.
 

triemal04

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Point is I think before we start talking about education and accreditation we first need to actually standardize care in all states. Sure it's cool if with a degree a medic in Seatlle can RSI and I learn how to do it here. PA tells me that's a waste of knowledge and I will loose my license if I do.
As the vast majority of paramedics should not be intubating and definitely should not be using paralytics he is right to say that.

CARE does not, and should not be standardized across states, counties, cities or departments. Different areas will have different needs. EDUCATION and the process of becoming a paramedic needs to be standardized nationally.
 

MackTheKnife

BSN, RN-BC, NREMT, EMT-P, TCRN, CEN
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Here in Pennsylvania the the pay scale runs anywhere from $10 to $20 an hour for a paramedic. Whether you have an AAS or not you make the same pay. Even as a nationally registered paramedic in PA I can't practice the same skills as a medic from California or Washington state. I can't RSI, I can't give blood, if I have a beta blocker overdose pt dying in front of me I have to 1. Pray I have reception 2. Beg a doctor to let me give glucagon because there is no protocol for it.
Point is I think before we start talking about education and accreditation we first need to actually standardize care in all states. Sure it's cool if with a degree a medic in Seatlle can RSI and I learn how to do it here. PA tells me that's a waste of knowledge and I will loose my license if I do.
I don't know if it is possible for nationwide standardization. Everyone has their "ricebowl" they protect whether it be the state EMS agency or the controlling medical group (if that still exists) as relates to delegated practice.
I'm finding out in nursing school that each state has a different Scope of Practice and skill sets vary accordingly. I have never understood how LEO's get paid a lot more than EMS personnel, but they do.
 

DPM

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As the vast majority of paramedics should not be intubating and definitely should not be using paralytics he is right to say that.

CARE does not, and should not be standardized across states, counties, cities or departments. Different areas will have different needs. EDUCATION and the process of becoming a paramedic needs to be standardized nationally.
Why do you say this? Why do some states / areas have different needs? They don't have differently trained Doctors and Nurses.
 

EpiEMS

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Why do you say this? Why do some states / areas have different needs? They don't have differently trained Doctors and Nurses.
Not to speak for triemal04, but I think the value proposition of EMS differs greatly in different areas. Consider transport times and the propensity of a patient to go from potentially unstable to critical over a longer period. Don't forget, as well, that different areas have different resources - perhaps an area doesn't have much in the way of ALS services available, but an enterprising medical director thinks that his or her EMTs can quite easily, say, use CPAP, draw up epinephrine, or administer morphine by auto-injector.

Like states as laboratories of democracy, EMS needs to be somewhat customizable by region.
 

DPM

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Not to speak for triemal04, but I think the value proposition of EMS differs greatly in different areas. Consider transport times and the propensity of a patient to go from potentially unstable to critical over a longer period. Don't forget, as well, that different areas have different resources - perhaps an area doesn't have much in the way of ALS services available, but an enterprising medical director thinks that his or her EMTs can quite easily, say, use CPAP, draw up epinephrine, or administer morphine by auto-injector.

Like states as laboratories of democracy, EMS needs to be somewhat customizable by region.
All medics in all systems have the daily potential to see very sick patients. I don't think that having longer or shorter transport times should determine the level of provider that you get. I think defining what constitutes ALS at a national level, and setting appropriate educational requirements will help to improve EMS nationwide. We do a disservice to our patients when some systems are very much on the cutting edge, using evidence based practice and embracing the new science, while others are not. ETCO2 usage, pain relief, back boards to name a few of these contentious issues. When the research has been done and the consensus made, then we all need to be carrying out best practice.
 

Carlos Danger

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Poses a good question (perhaps for another thread): What does EMS do that is worthwhile, and what does EMS do that isn't?

And how does that link up with the need/desire/idea of midlevel providers in EMS/prehospital settings?
I think where they link up is in the disconnect between what EMS providers typically do/see in a normal shift, versus how they are currently trained and what the needs of most patients are.

One of the biggest failings of the EMS system is that it still requires virtually every patient to be transported to the ED.

Most American paramedics receive fairly in-depth training in a very narrow scope of practice. Typical training focuses solely on recognition and short-term management of acute, life-threatening emergencies, and completely eschews anything involving the assessment or management of chronic conditions or the provision of even very basic primary care. This results in a provider who is only able to provide useful care to very few people - only very sick or injured patients - everyone else needs to be taken to the ED to be assessed and cared for by someone else, even if all the patient needs is a few sutures or a course of antibiotics, and even if the patient would be better served with a referral to a clinic rather than a visit to the ED.

We would probably all agree that while we certainly do see very sick patients sometimes, most of us see far more patients who need help with a chronic condition or need treatment for a minor illness or injury that doesn't necessitate a visit to the ED. That's were a paramedic practitioner comes in: not only can they provide all the critical interventions that paramedics traditionally provide, but, just like a PA or NP in an urgent care setting, they can also avoid transport for many patients who would otherwise have no choice but to go to the ED.
 

Brandon O

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Most American paramedics receive fairly in-depth training in a very narrow scope of practice. Typical training focuses solely on recognition and short-term management of acute, life-threatening emergencies, and completely eschews anything involving the assessment or management of chronic conditions or the provision of even very basic primary care. This results in a provider who is only able to provide useful care to very few people - only very sick or injured patients - everyone else needs to be taken to the ED to be assessed and cared for by someone else, even if all the patient needs is a few sutures or a course of antibiotics, and even if the patient would be better served with a referral to a clinic rather than a visit to the ED.

We would probably all agree that while we certainly do see very sick patients sometimes, most of us see far more patients who need help with a chronic condition or need treatment for a minor illness or injury that doesn't necessitate a visit to the ED. That's were a paramedic practitioner comes in: not only can they provide all the critical interventions that paramedics traditionally provide, but, just like a PA or NP in an urgent care setting, they can also avoid transport for many patients who would otherwise have no choice but to go to the ED.
The other shoe, however, is that not only are EMS providers not well-versed in non-emergent conditions, they're also not good at distinguishing what's emergent versus not. And that triage is not really an easy skill to acquire. (See: 90% of emergency medicine.)
 

triemal04

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Why do you say this? Why do some states / areas have different needs? They don't have differently trained Doctors and Nurses.
But they do different things depending on the location and setting. It's easier to see with nurses than doctors though they have the issue too. For example, a nurse working in a family practice doc's office will be able to, and expected to do very different things than a nurse in an ER. A nurse in one ER may do different things than a nurse in another because that's what the hospital wants.

But they were all trained to do the same things initially, to the same standard, and in a way that, more or less, is consistent nationally. What they are made to do afterwards should not be dictated at the national level.
 

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