Ok, now I'm a bit puzzled since Paramedics are already "educated to a certain point as a minimum" and can take on expanded roles with additional education.
Originally Posted by edpmedic
Is there a large number of US trained paramedics trying to work in other countries? If not, I don't see this comparison as being all that relevant.
I'm taken aback by the lack of education that U.S. medics receive, and the lack of standardization in education for the field. Texas has a three month zero to hero program. There are others that run six or nine months. Many of these places are mainly concerned with getting their students to pass the NREMT, nothing more. U.S. medics would not be allowed to be employed as medics in other industrialized nations such as Canada, Australia, Germany, NZ, etc. dur to our lack of education. With a two week in house A&P and a week of pharm, I can't say I blame them.
OK, we get that you want a higher standard.
At best, some programs require basic college A&P, usually w/o lab, and pharm. I'd like to see more advanced A&P, like what nurses get, maybe microbiology and O-chem. You're performing invasive procedures and deciding when and where to inject medications into people. Three weeks combined of A&P and pharm is inaqequate. General pharmacology only scratched the surface.
I whole heartedly agree that we treat and transport far too many patients via ambulance in this country. Moving to degree paramedics is not going to have much of an impact on this problem. The main reason so many people go to the hospital via EMS and some get prophylactic IVs on the way is because of liability concerns.
The growing trend in medical insurance reimbursement is to only pay for treatments that are showing a clear benefit to the pt. At some point, we're going to have to justify why a taxi ride to the ED costs $300-500 or more. Maybe 5-10% of our pts are time sensitive, which means that their morbidity/mortality are directly affected by our rapid response and tx.
Our sue happy, coddling society is what is preventing us from telling some people that their "problem" is BS and they need to see their PCP rather than be seen in the ER. Command physicians are worried about the "what if" scenerios so protocols are focused that way and we end up putting IVs into people that 99.9999999% of the time could be transported without the IV and have no adverse outcome.
I routinely have patients where I work now that if I was where I started out, would be transported BLS (all response unit ALS system) with the Medic Unit being cancelled, but here they get IV, O2 and EKG only because that's what the expectation is here. Almost all ambulances here are ALS, so I guess they figure, why not do something since you're already there.
I disagree. Some of these patients could be handled at a lower level (assuming "IV" is comparable to "Intermediate"). However, from my experience as an EMT-I, treatment of cardiac related patients was Paramedic level. Also, if any of these particular patients were particularly bad, the additional treatment would be beyond the "I" scope of practice.
The bulk of this would be the STEMI pt, the CVA pt, the multitrauma pt. Each of these could be handled by an EMT-IV. It's easy to obtain and transmit a 12 as a basic.
Maybe your area is different, but where I'm at EMS billing is typically done as a base rate (dependent on care provided) plus an additional (nominal) charge for mileage.
In order to keep money in EMS, we're going to need to transfer from mileage based billing to reimbursement by skill hours. No one's going to approve that with EMT-P education being what it is at the present.
Right, and they aren't actually considered to be "Emergency Medical Services" in the first place either.
The community outreach, working in MD offices, etc. aren't traditional EMS.
I'm not sure what "IFT" refers to, but working in the ED is not working "in the field". If most EMT-P programs don't prepare their students to work in these areas, then maybe it's because that's not the focus of initial paramedic training? Until recently, paramedics worked predominantly providing emergent pre-hospital medical care. So, the education focused on that and additional training was provided in order to work in those other clinical settings.
But the EMT/medic don't only do 911 prehospital txp. The field includes IFT, CCT, flight, and working in the ED. Most EMT-P programs don't prepare the student to function in these environments.
Well I guess I'm not a "real paramedic" then since I'm only "trained" to operate in the clinical setting that I only work in.
A real paramedic should have the education to be able to do CCT, flight, etc. They should be able to do more than just skills in the ED.
Yes it could be, but that doesn't necessarily mean that all paramedics nationwide need to be trained for this.
Nurses don't just work in the ED or on the floor. They specialze in all different types of specialties. Paramedics can do the same. The community outreach services would be one way the FD could see additional revenue from paramedics.
If that's what you were saying, then that wasn't clear. It came off as though you were saying a 911 response ambulance crew should be doing this.
I wasn't saying to educate pts while on a call, but rather have a program where the FD sends interested medics around to pt's homes and help them manage their condition, and also to educate as to alternatives to the ED.
[/quote]It's another way for a medic with a broken down body to get off the road, and to get off of shift work if they want. Real treat and release, or to direct txp by alternate means, won't come with our education as it stands currently. Nurses are doing this over the phone in Richmond, triaging pts and informing them of alternatives to EMS response and txp to an ED.
Educated paramedics can do the same, whether it's while working at the 911 dispatch center, or on the road. It saves money. The board of supervisors and the bean counters like that. [/quote] What is "real treat and release"? As I already stated, I can do treat & release and alternate tx now.
I'm a little confused. You're stating that a EMT-CC or I is basically the same as an EMT-P and the training isn't that different to be a paramedic elsewhere in the world, but earlier you stated that US Paramedics couldn't work in other countries because our education was so poor.:confused:
As far as someone being able to do our job by just learning the skills, I'll reference NYS. Their EMT-CC, which I believe is the equivalent of an EMT-I elsewhere, can do all the skills a paramedic can, but needs to call OLMC for most of their meds and therapies. They're basically just information gatherers for the doctor. That's why anyone trained in a basic assessment and our psychomotor skills can do our job. The difference in education isn't all that great, when compared to what's necessary to practice as a paramedic elsewhere in the world.
Now, I can't speak to NYS training and certification, but from personal experience there is a huge difference in overall scope of practice, skills and education between NC EMT-I and PA EMT-P!
Is the problem one that can only be fixed by a degree program or is the real problem poor teachers and/or bureaucracy that allows substandard students to enter and/or graduate from the current programs and then not get weeded out at the medical command review level?
Some systems even have their paramedics call for everything. I believe L.A. is like that, but I could be wrong. NYC paramedics can't treat two simultaneous conditions at once. If they need to jump protocols, they need to call OLMC, then abandon the first protocol, and then go to the next one. I didn't realize how restricting that was until I left the system. Here, the protocols are more like guidelines. As long as you can justify your action, and are referencing a protocol (or several as the case may be), you're okay. For extraordinary care, you can still call OLMC. It seems to me the NYC REMSCO knows how inadequate our education is, and how the quality of medic can vary greatly from FDNY to the hospitals to the privates, and reflect that in their protocols and SOP's. If paramedics had a better education as a minimum standard, we wouldn't have this problem.