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  1. #26
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    Quote Originally Posted by BoxAlarm187 View Post
    I assumed that what he was getting at, as I known he's had issues with the IAFF in the past. However, I've yet to hear any IAFF-based rhetoric about EMS education standards. Perhaps in collective bargaining states this has been brought up? I don't know, but I've personally never heard of the IAFF seeking to lower educational standards.



    I can see where you're drawing a parallel, but as a line officer who has been intimately involved in training and education in a progressive department I can confidently say that I don't know ANY of our employees that have sought an EMS AAS degree for the purposes of promotion. Perhaps there's someone out there that has, but it would certainly be the exception, not the norm.

    The previous discussion about pay incentives is interesting. I work with some excellent medics that I would want treating my family if they were ever sick. However, some of them have clearly stated that if they lost their 15% pay incentive tomorrow, they'd give up their ALS certification. The blurred line between "doing it for the money" and "doing it because you want to" blurs a little more....
    I mentioned the EMS AAS because some of our newly hired FF/medics already have this degree. Others are taking it because it's the quickest degree to get for promotional purposes, as you get a free year just for having the P-card.

    As far as pay incentives, consider that the paramedic cert is not merely an add-on specialty such as TROT, Hazmat, and such. Our Hazmat school is two weeks long, or 80 hours. You can promote to Technician off of that. For Apparatus Tech, you only need to know how to pump, drive, know your way around the engine, and pass the exam. EMS can and is a career in it's own right in many places. Compensating the same as a TROT cert (training around the year, but it equals around six FT weeks if you add it up, IIRC), or as an A-Tech or HM-Tech is not adequate for the amount of education, training, hundreds of hours of (uncompensated) ride alongs and hospital rotations, not to mention the continuing education requirements, and let's not forget that the paramedic also uses their education and training on a regular basis, numerous times a day in a busy system. Take the example of the engine medic. They're supposed to be on the bus half the time, and on the engine half the time, until they can promote out of the position. On the engine, they're still an ALS provider. On the ambulance, they may need to do rehab in the fire building on an high rise, or perhaps get dressed to pull a line or function as RIT in the event of delayed units. A decent salary for a fairly new medic is around 50k/yr in NOVA or NYC. I'm getting an additional 25k or so a year on top of the FF job. That's half of a single role medic's salary, and I'm on an engine half the time. That seems like fair compensation to me.
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    EDP,

    It sounds like your experience with your department is much like mine is with my department, having nothing to do with your current chief/our past chief. Unfortunately, we don't have a Tech or Tech II position, nor do our TROT, water rescue, or HM team members get a stipend - that's reserved solely for the ALS providers.

    I have an ALS provider on my shift who did 16 years of full-time EMS for a very progressive third party service with a very high call volume. He loved being a street doc (and still does) but was getting burned out on it. Like you, he entered the fire service, where he's only subjected to the ambulance between 30% and 50% of the time. It allows him to keep his excellent skill set while learning the intricacies of being a firefighter also.

    I also see NO need for a fully ALS system. About 200 of our 525 members are ALS providers, which gives us an ALS provider on every ambulance (with a BLS driver/attendant depending on the call; we don't run any BLS ambulances either), plus we generally have an ALS provider on every engine as well. This was worked exceptionally well for us, without over-saturating the system with medics.

    There are likely some places in which the fire-based EMS system isn't all it's made out to be. There are other places that it's working - quite well, at that. The same can be said for private or municipal EMS systems. The barrier here isn't whether it's fire-based or not, it's about how the system is structured to demand high performance from the members.
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    To answer your original question: No, P's should not be required to have a two year degree. A degree would not substantially make a difference in the long term outcome of the vast majority of pre-hospital care patients. You are correct though, a mandated two year degree will create a barrier to entry and indeed eventually raise P's salaries, that is true, but would it really affect patient care in a positive way? probably not.

    The fact is that the vast majority of pre-hospital care is done with standing orders and company/department SOPs: If A then do B and check for outcome.

    It would be interesting to see numbers-wise the change in overall px outcome by a degreed P versus non-degreed P. In other words: how many px have a different/better outcome because the P that attended them pre-hospital did something different than a non-degreed P would have done, which, in turn led to better care and outcome. I don't believe that number would be significant (except for that individual Px and his family of course).

    Really, what difference would it make if the medic had an additional year of classroom schooling with classes like EMS Management? Not that much.

    If patient care was the priority, I just don't see an arbitrary goal of an AA would really make the difference. I would suggest that instead of a degree just make the ride along time requirement in school, or, pre-program BLS experience more stringent.

    Your arguments for the pro using Candada and the Netherlands just because their healthcare systems are very different than ours, different funding and a lot less lawyers. I have a friend that is a P in Australia and she diagnoses PX and refuses transport in many cases, I can't imagine that happening for long here. I would like to see data that PX outcome is higher for similar maladies in those countries.

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    Quote Originally Posted by headoutdaplane View Post
    To answer your original question: No, P's should not be required to have a two year degree. A degree would not substantially make a difference in the long term outcome of the vast majority of pre-hospital care patients. You are correct though, a mandated two year degree will create a barrier to entry and indeed eventually raise P's salaries, that is true, but would it really affect patient care in a positive way? probably not.

    The fact is that the vast majority of pre-hospital care is done with standing orders and company/department SOPs: If A then do B and check for outcome.

    It would be interesting to see numbers-wise the change in overall px outcome by a degreed P versus non-degreed P. In other words: how many px have a different/better outcome because the P that attended them pre-hospital did something different than a non-degreed P would have done, which, in turn led to better care and outcome. I don't believe that number would be significant (except for that individual Px and his family of course).

    Really, what difference would it make if the medic had an additional year of classroom schooling with classes like EMS Management? Not that much.

    If patient care was the priority, I just don't see an arbitrary goal of an AA would really make the difference. I would suggest that instead of a degree just make the ride along time requirement in school, or, pre-program BLS experience more stringent.

    Your arguments for the pro using Candada and the Netherlands just because their healthcare systems are very different than ours, different funding and a lot less lawyers. I have a friend that is a P in Australia and she diagnoses PX and refuses transport in many cases, I can't imagine that happening for long here. I would like to see data that PX outcome is higher for similar maladies in those countries.
    "If A then do B and check for outcome," huh? Your what's commonly referred to as a cookbook medic. Not every pt fits into a neat little textbook presentation. For example, consider that many CHF pts developed that CHF secondary to their COPD (emphysema) over the years. Pulmonary HTN is a common contributing factor. They have dyspnea, and they're fairly tight, too tight to hear rales. Do you think they're having a COPD exacerbation? Are they developing APE? Is it both? What do you do first? How do you manage both conditions, and how do you go about that? That requires using at least two protocols. Take a good look at Wake Co, NC's EMS clinical guidelines. Their medics use guidelines, as in best judgment, rather than the simplistic "see A, do B."

    Do you understand the mechanism with which succinylcholine (one of the RSI meds) can cause hyperkalemia, and how that can lead to malignant hyperthermia? I'll bet the in house "pharmacology for EMS" that waters down a college pharm course into a week, and only covers the thirty meds or so didn't teach you that.

    Do you understand how to use the ETCO2 capnoline (nasal ETCO2 for non-intubated pts) for applications other than verifying tube placement? I'm guessing that the two week watered down "A&P" for EMS that the medic mill gives in lieu of requiring college A&P didn't give you the education to fully understand capnography and capnometry. Can you tell me how to diagnose a STEMI with a pt that has a LBBB or paced rhythm?

    To take NVCC's EMS AAS program as an example, you get human biology (A&P), general pharmacology, pathophysiology, advanced patho, a class dedicated to just 12 leads. EMS management is what you study when you progress past the AAS and go for an EMS Bachelors, BTW.

    When over 90% of pts in EMS are non-acute, or non-time sensitive, I wouldn't expect the numbers to differ much from the degree medics to non degree medics. We're talking about maybe 5-10% of the pt population that would fare worse if they weren't given more than an O2 NRB and txp. Part of that 10% would be cardiac arrests, who typically stay dead regardless. That opens a whole other can of worms regarding the importance of ALS response and pt outcomes. Consider that a dept's current protocols reflect the medic's lack of education. That's why your friend in Australia, who is likely an Advanced Care Paramedic, which is above the Primary Care Paramedic, can treat and release. In NYC, you can't even give an albuterol in-line neb for an APE pt. Even if you could, that would be jumping protocols, and you would have to spend a few minutes on the phone with the doc-in-the-box giving a complete head to toe while your pt deteriorates.
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    All very good points, but again, I don't see the AA as fixing all the above mentioned examples. This would be a fairly easy question to answer if the studies are available, do countries that require university degrees for their paramedics have better pt outcome for similar injuries or maladies than the US? My gut level instinct says no, but I have no factual data to back it up.

    The standards to acquire the P could be increased to address your concerns, I just don't believe that the added expense and time of the other core classes e.g. humanities or social sciences, needed to get an AA are really necessary and/or would benefit px outcome. And again, if the AA req is put in place as a barrier to entry to increase wages, that is another subject, I am only speaking of pt longterm outcome.

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    Quote Originally Posted by edpmedic View Post
    "If A then do B and check for outcome," huh? Your what's commonly referred to as a cookbook medic. Not every pt fits into a neat little textbook presentation. For example, consider that many CHF pts developed that CHF secondary to their COPD (emphysema) over the years. Pulmonary HTN is a common contributing factor. They have dyspnea, and they're fairly tight, too tight to hear rales. Do you think they're having a COPD exacerbation? Are they developing APE? Is it both? What do you do first? How do you manage both conditions, and how do you go about that? That requires using at least two protocols. Take a good look at Wake Co, NC's EMS clinical guidelines. Their medics use guidelines, as in best judgment, rather than the simplistic "see A, do B."

    Do you understand the mechanism with which succinylcholine (one of the RSI meds) can cause hyperkalemia, and how that can lead to malignant hyperthermia? I'll bet the in house "pharmacology for EMS" that waters down a college pharm course into a week, and only covers the thirty meds or so didn't teach you that.

    Do you understand how to use the ETCO2 capnoline (nasal ETCO2 for non-intubated pts) for applications other than verifying tube placement? I'm guessing that the two week watered down "A&P" for EMS that the medic mill gives in lieu of requiring college A&P didn't give you the education to fully understand capnography and capnometry. Can you tell me how to diagnose a STEMI with a pt that has a LBBB or paced rhythm?

    To take NVCC's EMS AAS program as an example, you get human biology (A&P), general pharmacology, pathophysiology, advanced patho, a class dedicated to just 12 leads. EMS management is what you study when you progress past the AAS and go for an EMS Bachelors, BTW.

    When over 90% of pts in EMS are non-acute, or non-time sensitive, I wouldn't expect the numbers to differ much from the degree medics to non degree medics. We're talking about maybe 5-10% of the pt population that would fare worse if they weren't given more than an O2 NRB and txp. Part of that 10% would be cardiac arrests, who typically stay dead regardless. That opens a whole other can of worms regarding the importance of ALS response and pt outcomes. Consider that a dept's current protocols reflect the medic's lack of education. That's why your friend in Australia, who is likely an Advanced Care Paramedic, which is above the Primary Care Paramedic, can treat and release. In NYC, you can't even give an albuterol in-line neb for an APE pt. Even if you could, that would be jumping protocols, and you would have to spend a few minutes on the phone with the doc-in-the-box giving a complete head to toe while your pt deteriorates.
    To me it's not the degree per se, It's the time that is needed to learn the finer points you just touched.

    That was a good post. We are HEAVY into cardiology now, then we go to 12 lead, Then to ACLS. YAAAAAAY
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    I personally learned more functional A&P in my non degree paramedic classes than I learned in general A&P. We also didn't learn a single thing about capnography in my college A&P.

    It comes down to the time to learn the information and the instructors taking the time to teach a good amount of A&P. (My instructor was an A&P instructor during the months when there was no medic program).

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    When you're talking about paying paramedics (or EMS folks in general), don't forget that Medicare/Medicaid and the insurance companies pay squat for EMS. If they started paying the true cost of the transport, maybe companies could afford to raise the pay of the medics. A significant number of our transport are Medicare/Medicaid, so we're stuck with what they pay...

    I'm with a small, independent not-for-profit ambulance. We staff one P 24/7 and rely chiefly on volunteers for drivers and basics. We still need a subsidy from the towns we serve to break even...
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    Quote Originally Posted by tree68 View Post
    When you're talking about paying paramedics (or EMS folks in general), don't forget that Medicare/Medicaid and the insurance companies pay squat for EMS. If they started paying the true cost of the transport, maybe companies could afford to raise the pay of the medics. A significant number of our transport are Medicare/Medicaid, so we're stuck with what they pay...

    I'm with a small, independent not-for-profit ambulance. We staff one P 24/7 and rely chiefly on volunteers for drivers and basics. We still need a subsidy from the towns we serve to break even...
    The nursing profession started out with diplomas. As a profession, they decided to move to degrees. They emphasized the benefit to their pts above everything else. They were able to justify increased compensation and insurance reimbursement for that reason, and the gains in benefits, salary, working conditions and such followed. CRT's are becoming obsolete in favor of RRT's (respiratory therapists). You need to have a BSN to work in certain health systems; an RN is no longer adequate. EMS is really the only medical profession that doesn't require a degree.

    As far as the cost of txp, when you think about it, 80 plus percent of out txp's could be done by a taxi or ambulette.
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    Quote Originally Posted by edpmedic View Post
    The nursing profession started out with diplomas. As a profession, they decided to move to degrees. They emphasized the benefit to their pts above everything else. They were able to justify increased compensation and insurance reimbursement for that reason, and the gains in benefits, salary, working conditions and such followed.
    And, oddly enough, the best nurses I know are diploma nurses. I don't know where you are but there's no difference in salaries and benefits between diploma and BSN nurses here. An RN is an RN.

    IMHO, there is no inherent benefit in requiring an Associates level degree to be a medic. If you want to improve the quailty and consistency of medics, you need to improve the quality and consistency of medic programs. You don't need to tie them to an academic degree to do that.

    EMT-Ps fill a specific niche in the health care system. If you're looking for something more, I'd suggest moving on to another profession higher up the food chain rather than trying to make a silk purse out of a sow's ear.
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    Quote Originally Posted by edpmedic View Post
    The nursing profession started out with diplomas. As a profession, they decided to move to degrees. They emphasized the benefit to their pts above everything else. They were able to justify increased compensation and insurance reimbursement for that reason, and the gains in benefits, salary, working conditions and such followed. CRT's are becoming obsolete in favor of RRT's (respiratory therapists). You need to have a BSN to work in certain health systems; an RN is no longer adequate. EMS is really the only medical profession that doesn't require a degree.
    This is true, but we're also the only part of the medical profession where many patients think they shouldn't have to pay for the services provided to them.

    As far as the cost of txp, when you think about it, 80 plus percent of out txp's could be done by a taxi or ambulette.
    This is true, but the decision for this not to happen is made by people with college degrees, not EMS itself.

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    Quote Originally Posted by DeputyMarshal View Post
    And, oddly enough, the best nurses I know are diploma nurses. I don't know where you are but there's no difference in salaries and benefits between diploma and BSN nurses here. An RN is an RN.


    IMHO, there is no inherent benefit in requiring an Associates level degree to be a medic. If you want to improve the quailty and consistency of medics, you need to improve the quality and consistency of medic programs. You don't need to tie them to an academic degree to do that.

    EMT-Ps fill a specific niche in the health care system. If you're looking for something more, I'd suggest moving on to another profession higher up the food chain rather than trying to make a silk purse out of a sow's ear.
    I don't know where you live, but since I was in HS back in the early 90's, and probably before that, you needed at least an RN degree to work as a nurse. Diplomas were no longer sufficient. That was NYC. Now, here in VA, you need a BSN to get into a hospital system in NOVA, unless you have a hook somewhere. In addition, there's no career advancwment opportunity for anything less than a BSN. It's also difficult to get work as a CRT; preference is given to the RRT. A PT degree went from four to six years some time ago.

    Employers and insurance companies have no reason to pay more than what's currently offered since anyone can become a six month wonder, sometimes even qucker. I don't see the quality of medic programs improving on a grand scale. These are typically for profit entities. They make their money by running as many classes in possible, in the least amount of time possible, and getting their students to pass the NR or state exam. To make the program more difficult, or to require college A&P and pharm at a minimum as a pre-requisite, would drive their business to quicker, easier schools. with EMS given as a degree, you're assured at least a minimum standard of quality with the program. The instructors would also need to be formally educated to be allowed to teach. The students will have passed basic English composition, be proficient in math as it applies to drug calculations (read any EMS forum and look at all the students that struggle with med math, which is simple algebra, ratios and fractions), and understand basic chemistry and how it applies to the human body, so that they can actually understand what our meds and therapies are doing to the pt on the callular level. Otherwise, you get "CPAP pushes lung water," (this is how some instructors explain CPAP), that atrovent opens the lungs in a different way than albuterol, or the inability to grasp that not all pts need high flow O2, you get the inability to grasp science behind permissive hypotension, when and why to use albuterol, bicarb, and how much fluid and when for a crush syndrome, or what to infer from a reading from an ETCO2 capnoline (nasal). You lack the inability to understand and implement best practices and evidence based research.

    Evidence based research is why we have permissive hypotension protocols, post arrest induced hypothermia, why lasix isn't routinely used for APE, why we don't pace asystole, why we can double up on ntg and repeat more than the arbitrary three times for APE, and how we can use CPAP for more than just CHF pts. Certain systems, such as mine, allow us to call OLMC for "extraordinary care," which is asking for orders within our scope that differ from protocol, but are in line with current evidence based research and best practices. I knew long ago that an APE needed more than three ntg five minutes apart, that you could give the same pt concurrent albuterol through an in-line neb in certain cases, how hyperventilation reduces CPP in the head trauma pt, hoe hyperventilation in a cardiac arrest impedes coronary perfusion. It's about keeping up with the most recent science, and being able to explain why you're requesting it to the doc, when simply following the "see A, do B" protocol isn't the best treatment course for the pt. I know of someone who got permission from OLMC to give high dose dopamine (30 mcg/kg/min IIRC) with ntg spray prn to mitigate a significant rise in BP for the cardiogenic shock. He basically rendered the same effect as dobutamine, which is given for it's inotropic effects. Who would have ever thought of that with the condensed pharm for EMS, with it's 30 or so 911 meds? Matter of fact, there's a whole interfacility side to EMS. The medic will need exposure to hospital meds as well. Most non-college paramedic programs only teach you the bare minimum of A&P and pharm that you need to simply pass the test. Three weeks of A&P and pharm combined just ain't cutting it. If someone was treating one of your family member, would you want someone who was groomed to pass a test, given just the bare essentials to do so, or someone with the educational background to follow the latest studies and research, and be able to apply that to them? Do you want to live where the EMS system is restricted to blanket protocols, with providers who don't fully understand why they're doing what they're doing, but just following the steps so they don't get jammed up by QA/QI?

    Unless they start employing FF/PA's, or FF/RRT's in the near future, I don't plan on moving up the food chain. I like medicine, but I like fire more.
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    Quote Originally Posted by FireMedic049 View Post
    This is true, but we're also the only part of the medical profession where many patients think they shouldn't have to pay for the services provided to them.

    This is true, but the decision for this not to happen is made by people with college degrees, not EMS itself.
    Not true. How many people use the ER as their PCP, and have no intention of paying? They're either using a medicaid entitlement, or are uninsured and know the hospital has no way to find them after being treated.

    In other countries, the people who would otherwise engage in 911 abuse are able to be triaged out onscene, and sent to the appropriate destination by other means. This may be urgent care, outpatient psych services, etc. Others need to be educated how to manage their disease, such as diabetics and CHF'ers, so they don't need to call 911 as often. This is what's possible in other countries where you need a four year degree to be a medic. Wake Co. EMS in NC does this with their Advance Care Paramedics.
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    Quote Originally Posted by mspangler View Post
    I personally learned more functional A&P in my non degree paramedic classes than I learned in general A&P. We also didn't learn a single thing about capnography in my college A&P.

    It comes down to the time to learn the information and the instructors taking the time to teach a good amount of A&P. (My instructor was an A&P instructor during the months when there was no medic program).
    A&P doesn't teach you capnography/capnometry; rather, it teaches you what to make of the numerical values and waveforms, and how to guide your pt care with that real time information. In-house A&P is hit or miss, and will never cover what a college level one does. You can also take more advanced A&P w/lab, O-chem or microbiology if you choose, and get way more than the functional A&P that you're talking about.
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    Quote Originally Posted by edpmedic View Post
    I don't know where you live, but since I was in HS back in the early 90's, and probably before that, you needed at least an RN degree to work as a nurse. Diplomas were no longer sufficient. That was NYC. Now, here in VA, you need a BSN to get into a hospital system in NOVA, unless you have a hook somewhere.
    Interesting. My ex-wife has her nursing degree, but does not have her BSN, nor does she intend on getting it, and has been given job offer one after another since she graduated 5 years ago - ICU, SICU, ER, etc. This down here in the Richmond area, and isn't unusual at all for this region.
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    Quote Originally Posted by BoxAlarm187 View Post
    Interesting. My ex-wife has her nursing degree, but does not have her BSN, nor does she intend on getting it, and has been given job offer one after another since she graduated 5 years ago - ICU, SICU, ER, etc. This down here in the Richmond area, and isn't unusual at all for this region.
    That was five years ago that she graduated. Like you say, it isn't unusual for the region. I might get lucky and get an RN job in the NOVA health system if I was working as an ER Tech or somehting first. Otherwise, it's exceedingly difficult to get hired as a basic RN in NOVA. Five + years ago, RN's were is short supply. You could write your own ticket. It was well known that the nursing profession was wide open. The nursing courses filled up with teeny boppers, and now there are plenty of RN's in the area. It's competitive to get into an RN program nowadays. You need to have a high GPA, and you're still put on a waiting list. The nursing profession has tried to make the BSN the minimum standard, but that hasn't worked out yet. What has been happening instead is the inreasing trend to grant specialty assignments and offer promotional opportunities to BSN's and higher. Exceptions are made, of course, for the experienced RN, or if you have a good hook.

    I was looking at Valley Health in Winchester. They want a BSN, or 3-5 years experience as an RN, and that's for a non-ladder position. Unless they're desperate, you're not getting on as a new grad. I expect more of the same nationally as the years go on. I hardly ever see LPN's/LVN's anymore, except for NH's.
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    Quote Originally Posted by BoxAlarm187 View Post
    Interesting. My ex-wife has her nursing degree, but does not have her BSN, nor does she intend on getting it, and has been given job offer one after another since she graduated 5 years ago - ICU, SICU, ER, etc. This down here in the Richmond area, and isn't unusual at all for this region.
    RNs have rich opportunities.

    INOVA has been "rightsizing" health care, replacing many RN assignments with lesser credentialed caregivers. The RN becomes the nursing care supervisor and patient care manager.

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    Mike, I know what you mean. One reason that my ex didn't persue her BSN was because she has no desire to be a nurse manager...but as time goes on, she continues to be pressed into management/decision making roles, despite her desire to only give one-on-one patient care.

    It's amazing the difference in both in-hospital and pre-hospital care once you get north of Spotsy.
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    Quote Originally Posted by BoxAlarm187 View Post
    It's amazing the difference in both in-hospital and pre-hospital care once you get north of Spotsy.
    Agreed!

    I also see it with ED physician coverage (at least in DC), more PAs and NPs and fewer MDs.

    Mike

  20. #45
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    Quote Originally Posted by edpmedic View Post
    Not true. How many people use the ER as their PCP, and have no intention of paying? They're either using a medicaid entitlement, or are uninsured and know the hospital has no way to find them after being treated.
    I think you missed my point. I'm not talking about knowing you will be billed and having no intention of paying or utilizing some sort of public assistance health insurance.

    I was referring to the belief that they shouldn't be billed in the first place for utilizing EMS.

    In other countries, the people who would otherwise engage in 911 abuse are able to be triaged out onscene, and sent to the appropriate destination by other means. This may be urgent care, outpatient psych services, etc. Others need to be educated how to manage their disease, such as diabetics and CHF'ers, so they don't need to call 911 as often. This is what's possible in other countries where you need a four year degree to be a medic. Wake Co. EMS in NC does this with their Advance Care Paramedics.
    It's possible now for people to be referred to alternate treatment facilities. The ability to do this doesn't necessarily curb 911 abuse.

    If a patient needs to be taught how to manage their disease, then that education should be provided by their PCP or clinic, NOT by EMS during a 911 response. Just like you can't teach a paramedic the "background" knowledge of most diseases in order to make the type of independent treatment decisions you are advocating for in less than an hour, you won't be able to teach somebody to manage their disease in the time frame that EMS is typically with a patient (less than an hour). Part of properly managing any medical condition is the inclusion of a physician. That's where education regarding chronic medical conditions should be done.

    Do you also advocate EMS providing on scene psychiatric counseling?

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    Quote Originally Posted by edpmedic View Post
    . In-house A&P is hit or miss, and will never cover what a college level one does.
    My in-house A&P covered more than my college level general A&P did with the exception of bones. The only thing we didn't have was the lab.(truthfully I learned very little clinically significant information in my lab, although it was cool to feel a lung) But my medic instructor is an A&P instructor at the school and this may be the exception to the rule.

    A&P doesn't teach you capnography/capnometry
    misunderstood your statement linking the two.

    I'm all about advancing Fire/EMS, especially at the ALS level but I don't think a degree requirements are the way to go. Accreditation to ensure the quality of education being provided is. A paramedic can only be as good as the information taught.

    Instead requiring a degree, have prerequisites of: EMT-B, General A&P, Adv A&P and microbiology before being to apply for paramedic. Even pharmacology if you want.

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    Quote Originally Posted by Fire-ALS View Post
    My in-house A&P covered more than my college level general A&P did with the exception of bones. The only thing we didn't have was the lab.(truthfully I learned very little clinically significant information in my lab, although it was cool to feel a lung) But my medic instructor is an A&P instructor at the school and this may be the exception to the rule.



    misunderstood your statement linking the two.

    I'm all about advancing Fire/EMS, especially at the ALS level but I don't think a degree requirements are the way to go. Accreditation to ensure the quality of education being provided is. A paramedic can only be as good as the information taught.

    Instead requiring a degree, have prerequisites of: EMT-B, General A&P, Adv A&P and microbiology before being to apply for paramedic. Even pharmacology if you want.
    The first problem is, we bill for txp, rather than skill hours. It's mileage plus the category ot txp, such as BLS, ALS1, ALS2, etc. In nursing, for example, there is a certain dollar amount attatched to equipment, and a certain amount of time attatched to the procedure. Those are called skill hours. Paramedics would have to be recognized nationally as "licensed providers." New revenue streams for the FD and also in non fire EMS will become available. BCBS and Medicare are already trying to further curb insurance reimburstments:

    http://www.boston.com/lifestyle/heal...h_care_reform/

    "Community Outreach" paramedics (or whatever you want to call them), that perform a function similar to visiting nurses, starting with targeted chronic 911 callers, will help to lower call volume, which also lowers unnecessary, expensive transports. How much did your insurance premium jump last year? Paramedics in other countries, who typically hols four year parameedic degrees, can treat and release, and also refer to the proper definitive care destination by alternative methods of txp if necessary. We already run 911 EMS at a financial loss. As the polulation grows, we're just going to put more medic units on the street, and also more engines since 70% or so of their call volume is ALS first response. EMS in the U.S. is just a catch-all for anything and everything medical. It can be more than that, as is evidenced elsewhere. Not transporting everyone to the hospital saves a lot of money in billing for the healthcare system in general.

    As far as protocols, anyone trained to do an assessment and psychomotor skills can do our job. Some systems do this now with the EMT-E (or A), where they can give some of the most important drugs, transmit an ECG, and just carry out whatever the OLMC doc says to do. Educated providers can instead use clinical guidelines and treat according to their scope of practice and clinical judgmant. You need a degree for this.

    EMS isn't only 911 ambulance txp. You have IFT, CCT, medics working in the ED and sometimes the ICU, etc. Do a four year degree, and you can specialize, just like nurses. Years one and two, gen ed. Year three, the paramedic curriculum for the puropses of NREMT testing. Year four, a specialty. This can be CCT and flight, an Emergency Care Paramedic who works in the ED, Critical Care for the ICU (not CCEMT-P), or Community Health, who can work in a doctor's office, do treat and release in the field, etc. You build these bridges, and higher salaries through negotiation will come.
    "The democracy will cease to exist when you take away from those willing to work and give to those who are not." Thomas Jefferson

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    Quote Originally Posted by FireMedic049 View Post
    If a patient needs to be taught how to manage their disease, then that education should be provided by their PCP or clinic, NOT by EMS during a 911 response. Just like you can't teach a paramedic the "background" knowledge of most diseases in order to make the type of independent treatment decisions you are advocating for in less than an hour, you won't be able to teach somebody to manage their disease in the time frame that EMS is typically with a patient (less than an hour). Part of properly managing any medical condition is the inclusion of a physician. That's where education regarding chronic medical conditions should be done.
    See above post.
    "The democracy will cease to exist when you take away from those willing to work and give to those who are not." Thomas Jefferson

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    Quote Originally Posted by FireMedic049 View Post
    Do you also advocate EMS providing on scene psychiatric counseling?
    You mean like this?

    http://www.co.sanmateo.ca.us/portal/...tcurrchannel=1
    "The democracy will cease to exist when you take away from those willing to work and give to those who are not." Thomas Jefferson

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    Quote Originally Posted by edpmedic View Post
    See above post.
    I think you're blurring the line a bit. A paramedic working in the ER, ICU, doctor office, clinic, etc is not EMS.

    While it's certainly possible and maybe even appropriate to provide some of the "community outreach" you describe via the local ambulance service, doing so doesn't make them "Emergency Medical Services" any more than providing wheelchair van services does.


    As far as protocols, anyone trained to do an assessment and psychomotor skills can do our job. I think that's an overly simplistic view of the job and doesn't acknowledge that there's a difference between "doing the job" and doing it well.

    Educated providers can instead use clinical guidelines and treat according to their scope of practice and clinical judgmant. You need a degree for this. I don't know about where you practice, but I can pretty much already do this now. I can also treat & release patients and refer patients to alternate resources. Sometimes it just needs run past a medical command physician first.

    You appear to be advocating for degree paramedic programs in order to create something along the lines of an "expanded practice paramedic" and provide "non-traditional" pre-hospital services. I have no problem with this concept however, I don't see a true need for every paramedic to be trained to this level.

    Not every doctor is a cardiologist, oncologist, surgeon, etc. So why does every paramedic need to be trained for an "expanded practice" role?

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