1. #1
    Dustinney
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    Default is paramedic unavoidable

    Hey yall I gotta question we were talking round the table last shift about paramedic becoming a mandated cert for even black hat wearing firefighters what do yall think cause what we do as a EMT-I is honestly all I want to do I don't have a interest in everything paramedics can do ambulances get there bout the same time we do ill let them have the ALS work but what do yall think is having the paramedic cert going to be unavoidable?

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    I think it varies by location. We have some departments around here that require Paramedic. Some (like mine), require EMT. And some only require first responder.
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    Like GT said, it varies by area. Of the 525 members at work, slightly less than 200 of them are ALS providers.

    We have the luxury of having very aggressive, open protocols, and our EMT-I's and EMT-P's practice the exact same procedures, with the exception of RSI (must be a two paramedics on board to perform RSI). We also rarely (if ever) have to call for orders from the hospital.

    Right off hand, I can only think of one department in my area that requires their members to be ALS, and even then, they're only required to be EMT-I.
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    That's kinda what I thought I live in the out skirts of atlanta Ga and pretty much all the surrounding departments you gotta have EMT-I before your probation is over but I've heard some departments are making anyone in the rank of Lt and higher to be a paramedic but I didn't know if its true

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    Across the country that is true. Many departments are making people of a certain rank or higher be medics. I'm not sure around your area.
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    In NJ you can only practice as a medic if hospital based (don't think there are any exceptions..?_
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    It is going to be a national standard in a decade or so.
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    Quote Originally Posted by TNFF319 View Post
    It is going to be a national standard in a decade or so.
    In what way? I don't see how that could be.
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    Quote Originally Posted by ChiefKN View Post
    In what way? I don't see how that could be.
    I believe people will no longer be satisfied with BLS response and transport. It may not become a national standard, but I believe fewer EMTs will be on the street. EMTs are just continuing their education and rolling right on to medic. The ability to do more for the pt and PAY are huge reasons. EMS is way under paid. A medic doesn't make enough so an EMT moves up to survive. Volunteers will continue to be first responders and EMTs, but larger cities will make the transition. My view is also jaded. The Memphis area is very ALS. If a fire department responds to a medical, chances are a medic is on scene. Even the volunteer departments are begining to have a medic show up. I am still shocked by paid departments that do not do any medical. EMS in TN is also advanced.
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    Quote Originally Posted by TNFF319 View Post
    I believe people will no longer be satisfied with BLS response and transport. It may not become a national standard, but I believe fewer EMTs will be on the street. EMTs are just continuing their education and rolling right on to medic. The ability to do more for the pt and PAY are huge reasons. EMS is way under paid. A medic doesn't make enough so an EMT moves up to survive. Volunteers will continue to be first responders and EMTs, but larger cities will make the transition. My view is also jaded. The Memphis area is very ALS. If a fire department responds to a medical, chances are a medic is on scene. Even the volunteer departments are begining to have a medic show up. I am still shocked by paid departments that do not do any medical. EMS in TN is also advanced.
    Gotcha, I thought you had some info that I wasn't aware of.

    The northeast, NJ specifically, is very different then other areas. ALS is a hospital based function. If a FD runs the EMS, it's BLS.

    I think it could change in the future, but from what I've seen EMS changes at a pace that would make Firefighters lose patience.
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    Quote Originally Posted by ChiefKN View Post
    Gotcha, I thought you had some info that I wasn't aware of.
    No the national standard I was refering to is public demand. I think the public will contiune to demand more for less. They want a fireman to show up and solve any problem under the sun and they want it fast and cheap.
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    Both career departments in my area are very paramedic heavy. While it's not a formal requirement for a new member to become one in one of the departments, it is a very strong expectation and almost a defacto requirement for promotion.

    In the other department, becoming a paramedic for new personnel is now a requirement, In fact, they send all new membes to paramedic class shortly after the academy, and you must pass to retain your position. I don't believe it's required for older members, but I do believe it is now a requirement for promotion to captain and beyond.

    The fire districts are hit and miss. Many of them prefer you get your paramedic, and it gives a very strong advantage if you bring paramedic to the table if you are looking to get hired. This is especially true in the parish to my west, where most of the fire districts handle thier own EMS transport.

    In our parish, that's not the case as EMS transport is handled by a parish run third service, A couple of the departments with paid staff, including ours, is heavily into ALS first response delivery, and a couple of them are not. Our Deputy Chief is a paramedic and 1 of the 2 shift personnel on each shift is a paramedic as well.

    The neighboring parishes to our east are almost all BLS, and while there are some fire department based paramedics, it's the exception and not the rule. In fact, the primarily career small city department to our east still doesn't run any EMS.

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    I am a volunteer at a small department and only about half of our guys are even first responders I don't think our chief is EMT B (not sure though) and we will usually be at a house a good 5-10 minutes before any ambulance. To me it would be a good idea to get EMT P just in case and the more training the better chances you have later.

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    It all depends on where you are. If you work for a dept that provides fire and ALS services with no separation of the two then most likely you will need a blue patch to get hired. As far as making you go to medic school once your on the job, well unless you signed a contract saying you would then good luck making that stick. Our dept, like almost all around here, only hires medics because all our units are ALS. Why hire an EMT and pay for them to go through medic school and risk the chance that they won't pass when you can hire someone who's already certified. It make perfect financial sense and quite a few of the locals have pushed for this too.

    As for getting people who are already on the job to become certified, legally I don't see anything the dept can do. They can either offer incentives to go to school or disincentives for not going to school. The latter was used by our County 8 or so years ago. The County wanted ALS engines but did not have enough medics nor did they have the money to hire any firemedics to add to the engines. So they decided to make the firefighter spot on the engines a firemedic spot and if the firefighter didn't get a medic patch before the date the engine was to go ALS then they got bumped out of their spot and put on the rescue as the driver. Some guys retired and others went to the in house medic school.
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    Quote Originally Posted by Firemedic 61 View Post
    It all depends on where you are. If you work for a dept that provides fire and ALS services with no separation of the two then most likely you will need a blue patch to get hired. As far as making you go to medic school once your on the job, well unless you signed a contract saying you would then good luck making that stick. Our dept, like almost all around here, only hires medics because all our units are ALS. Why hire an EMT and pay for them to go through medic school and risk the chance that they won't pass when you can hire someone who's already certified. It make perfect financial sense and quite a few of the locals have pushed for this too.

    As for getting people who are already on the job to become certified, legally I don't see anything the dept can do. They can either offer incentives to go to school or disincentives for not going to school. The latter was used by our County 8 or so years ago. The County wanted ALS engines but did not have enough medics nor did they have the money to hire any firemedics to add to the engines. So they decided to make the firefighter spot on the engines a firemedic spot and if the firefighter didn't get a medic patch before the date the engine was to go ALS then they got bumped out of their spot and put on the rescue as the driver. Some guys retired and others went to the in house medic school.
    Hopefully your dept. gave atleast a year before the engines went ALS. That would SUCK if you had even less time than that to complete a whole medic course. :x

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    In Ohio, most cities are requiring you to have the cert to even sit for the test. Minus the Youngstown area of Ohio. All the subs around Cleveland, Columbus, and Cincy require 240/medic to sit for the test or give extra credit for it.

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    thanks for the input but I have another question for yall i have friends who are going to a national regestry EMT-B class instead of EMT-I I know you can go to paramedic from EMT-B but is it do able how far behind and how hard do yall think it will be to go just totally jump over Intermediate and start learning medic skills thanks again for the input

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    Quote Originally Posted by Dustinney View Post
    Hey yall I gotta question we were talking round the table last shift about paramedic becoming a mandated cert for even black hat wearing firefighters what do yall think cause what we do as a EMT-I is honestly all I want to do I don't have a interest in everything paramedics can do ambulances get there bout the same time we do ill let them have the ALS work but what do yall think is having the paramedic cert going to be unavoidable?
    sounds like you must be in the west coast, where they (and certain Chiefs) promise that the future is EMS only! and almost no fires will be in this progressive future. I'm sorry.

    all hail to the paramedic ticket...I want to do the work of a female nurse.

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    Quote Originally Posted by . View Post
    I want to do the work of a female nurse.
    You could do a lot worse in life.
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

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    Quote Originally Posted by . View Post
    all hail to the paramedic ticket...I want to do the work of a female nurse.
    But not a male nurse?

    Paramedicine ain't all that bad when delivered in the right model.
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    I wish it was avoidable. I'm dreading another year of school not to mention it's like 300 clinical hours or something crazy

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    I do not see it as being something everyone will have to do. As a matter of fact, I see the private sector will be providing paramedic service in the future. Firefighter/paramedics are pricing themselves out of the market. Once a guy promotes he no longer works as a Paramedic. The cost to train a PM is close to 100K. That's just too much money!

    The privates do not pay as well. The standard to become a paramedic is the same for a private student as well as for a firefighter. Times are changing, and it's not all good for the fire department.
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    Quote Originally Posted by paulLepore View Post
    The cost to train a PM is close to 100K. That's just too much money!.

    WTF, $100k??????????? How does it cost that much to send someone through medic school?
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    WTF - really?
    Let me do the math for you:

    We pay a firefighter 75K (on the west coast).

    I have to pay his salary while he is in school for 6 months. I have to pay time and one half to fill his spot while he is in school. The cost of school is 10K and there is NO guarantee that he will make it. Here is the breakdown.

    Firefighter in school for 6 months - $37,500
    Overtime for firefighter in school - $56,500
    Tuition for Paramedic school - $10,000
    -----------
    Total $103,000
    These are "real" numbers for us on the West coast. I understand that these costs are higher than in most parts of the country.

    By the way Firemedic, I really like and agree with the saying on your signature line.
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    Quote Originally Posted by TNFF319 View Post
    It is going to be a national standard in a decade or so.
    1) Doubt it will ever become a national standard.

    2) Impact of patient-outcome research is diminishing the return-on-investment for an all-paramedic (or mostly paramedic) fire service.


    http://firegeezer.com/2009/11/22/the-neon-red-elephant-of-ems/


    3) The delivery of "paramedic" level skills will continue to move down the training chain. We are teaching soldiers self/buddy care that includes starting an IV.

    We have moved from restricting the use of AEDs to paramedics only (1984) to anyone with a couple of hours of training.

    Before this generation files for retirement we may see out-of-hospital ems systems with fewer paramedics seeing more patients and performing more skills.

    http://firegeezer.com/2009/03/14/adv...paramedics-20/

    Transport units will be EMT-enhanced, with the Advanced Practice Paramedic handling the 05% of the patients needing aggressive, PATIENT OUTCOME IMPROVING prehospital care.

    At some point, a policy maker will notice that 80% of the "emergency" runs for urban fire departments are ems 1st responder .... that do no require a $500K all-hazards pumper staffed with four highly trained, multiple role responders.

    The implication will ge beyond the Phoenix Ladder Tender or Memphis hyper-user diversion program. May disrupt all we know about municipal fire department deployment.

    >>>>>>>>>>>>>>>>>>>>>>>>

    For the short term, I would say metro Atlanta will probably require EMT-I and struggle to require 1st line supervisors and higher to obtain AND MAINTAIN a National Registry EMT-Paramedic credential.

    Other places, like Baltimore, wanted an all-paramedic firefighting force but the cost is prohibitive.
    Last edited by MikeWard; 02-08-2011 at 12:44 AM. Reason: expanded, addressed suburban atlanta question

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