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    Quote Originally Posted by edpmedic View Post
    No. I was referring to what appeared to be your belief that EMS (as in 911 system medical response resources) should be teaching patients, who have called 911, how to manage their medical condition rather than them being instructed by those who actually diagnosed them and prescribed medications for it.

    Just wondering if you felt that these same medical response resources should pull out their portable couch on a psych call and provide psychiatric counseling on the scene rather than having the patient be treated by their own psychiatrist or other psychiatric professionals?

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    Quote Originally Posted by FireMedic049 View 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.





    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?
    It's not about having every medic educated to be able to fill an expanded practice role. It's about being educated to a certain point as a minimum, and then being able to specialize with some additional education if you choose to do so. That's what nurses do. 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. 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.

    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. 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. You're only making money really on respiratory cases, the 2-5% of arrests you may save, and diabetic complications. Maybe another 10-15% need lifting, such as a bed confined elderly pt, or someone with an orthopedic injury. Basics know how to lift people. The rest dont really need "emergency" medical services. 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.

    The community outreach, working in MD offices, etc. aren't traditional EMS. 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. 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. 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. 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. 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.

    http://icma.org/en/Article/11568/Nur...in_Richmond_VA

    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.

    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. 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.
    Last edited by edpmedic; 03-23-2011 at 11:16 AM. Reason: grammar
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    Quote Originally Posted by FireMedic049 View Post
    No. I was referring to what appeared to be your belief that EMS (as in 911 system medical response resources) should be teaching patients, who have called 911, how to manage their medical condition rather than them being instructed by those who actually diagnosed them and prescribed medications for it.

    Just wondering if you felt that these same medical response resources should pull out their portable couch on a psych call and provide psychiatric counseling on the scene rather than having the patient be treated by their own psychiatrist or other psychiatric professionals?
    No, but I don't feel that every psych pt needs to go to an ED, where they'll be billed (or the taxpayer will be billed) for an eval by the attending, the psychiatrist possibly, then another bill for BLS txp to a psych facility. That's plenty of waste, and part of the reason why our medical insurance premiums rise so much every year. I don't feel that all psych pts need to go to the ED any more than I feel the majority of our pts need to go to the ED. Getting the pt where they need to go is in their best interests, and indirectly saves us money as well.
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    Quote Originally Posted by edpmedic View Post
    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.

    http://icma.org/en/Article/11568/Nur...in_Richmond_VA
    My ex-wife is one of the select RAA triage nurses that does this program...it's quite interesting to see how the EMD integrates with the triage nurse. Ya know what? It's perfectly acceptable to sometimes tell a caller they need to take a $5 bus trip to the ER, not a $500 taxi...uh, ambulance.

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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.
    I'm in CT. FYI, "RN" isn't a degree. Registered Nurses (RNs) can be either graduates of hospital based nursing programs (diploma nurses) or degree holders from college based nursing programs (degree nurses, usually BSN).

    In addition, there's no career advancwment opportunity for anything less than a BSN.
    They've been telling nursing students that for 20 years. It still hasn't proven to be the case. There are some (non-patient care) career paths in nursing that require a bachelor's level degree but, in general, direct patient care isn't one of them. Most importantly, a BSN isn't required to be an RN so that pretty well invalidates your argument in faovr of requiring an associates level degree for an EMT-P.

    I don't see the quality of medic programs improving on a grand scale.
    And you probably won't. Making a degree a requirement just means that you'll see the same mediocre programs cost more and take longer.

    with EMS given as a degree, you're assured at least a minimum standard of quality with the program
    Sorry, but that's just not a guarantee. If you want higher standards for EMT-Ps, you need to address your EMT-P licensure system.

    The instructors would also need to be formally educated to be allowed to teach.
    Are you telling me that your insturctors aren't properly trained already? There's your problem.

    You lack the inability to understand and implement best practices and evidence based research.
    With all due respect, an EMT-P doesn't need that. A mechanic doesn't need to be able to understand thermodynamics or metalurgy to fix an engine; he just needs to know how to use the specific tools in his toolbox. By the same token, an EMT-P doesn't need more than a passing knowledge of pharmacology to administer a small constellation of drugs based on specific protocols.

    Most non-college paramedic programs only teach you the bare minimum of A&P and pharm that you need to simply pass the test.
    Becasue that's the national baseline of information/skills that an EMT-P is expected to master. If you happen to be in a program that goes further, great! But that's not the standard nor should you expect it to be.

    If someone was treating one of your family member...
    That's a straw man. I'd want a team of doctors specializing in a variety of disciplines but that's just not realistic.

    someone with the educational background to follow the latest studies and research, and be able to apply that to them?
    That would be the doctor at the other end of the radio. I don't want somebody with an asssociates degree presuming to be an expert in the "latest studies and research."

    I don't plan on moving up the food chain. I like medicine, but I like fire more.
    Then it sounds like you've chosen your field. Time to start that degree program in fire science.
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    Quote Originally Posted by MikeWard View Post
    RNs have rich opportunities.
    Yup. And it makes little difference if they're diploma or degree nurses.
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    Quote Originally Posted by edpmedic View Post
    It's not about having every medic educated to be able to fill an expanded practice role. It's about being educated to a certain point as a minimum, and then being able to specialize with some additional education if you choose to do so. That's what nurses do.
    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.

    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.
    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.

    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.
    OK, we get that you want a higher standard.

    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.
    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.

    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.

    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.
    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.

    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.
    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.

    The community outreach, working in MD offices, etc. aren't traditional EMS.
    Right, and they aren't actually considered to be "Emergency Medical Services" in the first place either.

    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.
    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.

    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.
    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.

    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.
    Yes it could be, but that doesn't necessarily mean that all paramedics nationwide need to be trained for 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.
    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.

    [/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.

    http://icma.org/en/Article/11568/Nur...in_Richmond_VA

    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.

    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.
    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.

    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!

    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.
    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?

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    Quote Originally Posted by edpmedic View Post
    No, but I don't feel that every psych pt needs to go to an ED, where they'll be billed (or the taxpayer will be billed) for an eval by the attending, the psychiatrist possibly, then another bill for BLS txp to a psych facility. That's plenty of waste, and part of the reason why our medical insurance premiums rise so much every year. I don't feel that all psych pts need to go to the ED any more than I feel the majority of our pts need to go to the ED. Getting the pt where they need to go is in their best interests, and indirectly saves us money as well.
    I agree, but again, this isn't something that using degree paramedics as the entry level will solve.

    In my area, EMS typically gets involved in most psych related incidents because the overall mental health services network lacks the ability to effectively respond to these situations. It takes too long to get a mental health worker to a scene to handle it that way. PD and/or EMS can't sit around waiting for them to get somebody there, so we (or the PD) usually take them to the hospital because there's no viable alternative currently. In some cases, they need medical clearance before being accepted for in-patient treatment, so they go to the ER.

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    Well I have been keeping up on this thread and I am just not seeing the need to make an AA degree mandatory for a Paramedic.
    1. The examples that were given as being the realm of P's with degrees because of better understanding of A&P, are run every day somewhere in the states with the right decisions being made by non-degree 'P's.
    2. I would agree that there are mills out there, program accreditation requirements should be more stringent.
    3. testing should be made more difficult, really a 70% to pass is ridiculous.
    4. Some of the issues that are being brought up should be left to other sectors of healthcare not EMS. If a person wants to be in public health let them go get a degree, PA, Nurse, or nurse practitioner, or even doc.
    5. I spoke with my friend in Australia, and it doesn't sound like prehospital patient care results in any better patient outcomes in a country with much higher educational standards, in other words there is only so much we as prehospital providers can do.
    6. All that said, if the idea is to create higher salaries by adding an arbitrary barrier to entry, I believe it would work.

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    Quote Originally Posted by tree68 View Post
    There are advanced practice paramedics these days, just as there are advanced practice nurses.
    Nurse Practitioners and PAs are physician extenders which can require up to a Masters degree and a DEA number. They are afforded privileges no Paramedic in the US even comes close to nor does any education program for Paramedics even at the Bachelors level. Why even think about reinventing the wheel when you already have PAs and NPs? They already exist if you want to do that type of work. Prehospital medicine is a specialty which needs to be mastered at the basic BLS and ALS levels before trying to become "advanced".

    Quote Originally Posted by edpmedic View Post
    Yes, Wake Co. EMS in NC comes to mind.
    Wake County just gives a few Paramedics the privilege of riding around in a fly car to intubate and make decisions on which hospital to take the patient to. That way they do not have to worry about keeping all their Paramedics competent in all the skills Paramedics in other parts of the country do everyday. They may also do a few welfare checks which some FDs have already been doing for years. If you look at their protocols there is nothing any different in there that any decent FD/EMS couldn't do. RSI is not even that difficult to learn and be trusted with.

    Quote Originally Posted by edpmedic View Post
    Determining if a person threatening suicide and that they need to go to a psych facility is not counseling.

    EMS regardless of which service does it needs to get its act together and stay competent in the few skills and medications they do now. Being a Paramedic is not difficult and none of our FFs have had a problem passing the program or taking the NREMT. We are able to do what is necessary to get the patient to the hospital or declare them dead in the field instead of transporting a body. EMS and Paramedics don't need to be getting a big head at this time thinking they are the same as NPs or PAs. If you want to work in a hospital, become a nurse. Concentrate on prehospital medicine and get that right. Quit trying to be like another profession. I think that is just a cop out for not wanting to do the job as it is or attempt to make it better.

    I don't think a degree is required if you have a decent medical director who gives you good protocols to follow and trusts you enough to certify you to function as a Paramedic. If the medical directors felt more education and a degree was necessary, they would have pushed for it a few decades ago.

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    Quote Originally Posted by FFmedic60 View Post
    I don't think a degree is required if you have a decent medical director who gives you good protocols to follow and trusts you enough to certify you to function as a Paramedic. If the medical directors felt more education and a degree was necessary, they would have pushed for it a few decades ago.
    This..

    Here everything hinges on your medical director.

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    in Delaware they have raised the standards for EMT-P's to must have AA. I personally think it's stupid being you are nothing more than an EMT with way more drugs. Your job is to wheel & heal. You are not a rolling Dr. Do your job, treat the symptom as it presents itself & get the patient to definitive treatment facility. That's all you are meant to do. Not diagnose the problem. Just treat the symptom & transport to a Doctor w/ 9 years of medical school & a life time of training. Also so medics should not be allowed to be medic w/o having at least 5 years of BLS under their belt....I'm a lil' anti-medic. TO many of ya think you're gods (not all). But the more of you that go thru college to be a medic tend to be WAY to cocky for your own good. Give me a medic that took the non-college course & has a life time of experience over any of these NKOTB!
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    Quote Originally Posted by edpmedic View Post
    I agree. These agencies and companies thrive on the plentiful supply of medics. They hire new medics with little experience for the bare minimum (because they're happy just to get the work experience until they get a better job) work them to the bone, and then replace them with other new medics for the same low salary. It's even better if it's for a municipal employer. You get a lot of 1-3 year people who leave before they're vested for defined benefit. You can tell which places just want bodies to staff their rigs - they typically have just a one day orientation, maybe three ride alongs, and then you're thrown to the wolves. It costs them very little to hire and train, as opposed to companies and depts that run academies, or at least have FTO programs that may last months.
    This pretty much sums up my experience as a brand new medic in Phoenix. With the exception of Phoenix and a couple surrounding cities/reservations, all EMS is provided by two companies for the entire Phoenix metro area. If you're new, unless you've been an EMT-B with one of the companies for a few years already, you get put on General Transport rides. At the particular company I worked for, I was hired right at my interview which consisted only of a few basic questions (none being any kind of scenarios or medical questions), no background check, nothing. We had three days of orientation which consisted of just going over HIPAA stuff, charting, and going over the SOP's. Then we had to do three 12 hour shifts of precepting and then we were thrown out there to the street. Not to mention, they and the other EMS company run crews with one EMT and one medic, so right off the bat I was in charge of everything completely on my own. Even being a GT ride, the majority of my calls were all emergency transports so I hit the ground running and had to learn a lot on the fly fast. The turnover rate is really high. You don't get treated very well, management couldn't really care less about you for the most part because there are always new medics (and EMT's) looking for work they can replace you with and people already with the company willing to work OT to cover shifts that don't have permanent crews assigned to them.

    I actually thrived in the situation, truth be told. I came from a paramedic program that required 250 clinical hours and 500 vehicular/ride-along hours and I was an EMT already with ER experience on top of it. The departments we did our ride time with were very aggressive in having us run all the calls after our first few shifts to really force us to have to think and get used to what it's like out there. They monitored you very closely and were always there as a safety net, but they were very aggressive and I learned a lot fast with regard to how to run a call and developing a routine, so being thrown out there by myself with just an EMT partner I felt pretty comfortable pretty quick but it was still a bit intimidating my first shift or two. However, that's me. I know a lot of people who should not be put in that kind of situation being brand new. That's a ton of responsibility to put on someone's shoulders who has never been alone before.

    At any rate, it's not a very demanding system there with regard to standards and hiring and your post really made me think about it. Whereas here in the Chicago area when I moved back, the tests I had to take and the background stuff and everything else I had to do gain my ALS privileges in the medical systems here were almost harder and stricter than getting my paramedic cert in the first place, and I came from a pretty solid paramedic program. It's just amazing how things change from state to state and region to region in the EMS world.

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    Quote Originally Posted by ffscm72 View Post
    in Delaware they have raised the standards for EMT-P's to must have AA. I personally think it's stupid being you are nothing more than an EMT with way more drugs. Your job is to wheel & heal. You are not a rolling Dr.
    I think this is somewhat overly simplistic, ignorant view of what a Paramedic is able to do in comparison to an EMT.

    Do your job, treat the symptom as it presents itself & get the patient to definitive treatment facility. That's all you are meant to do. Not diagnose the problem. Just treat the symptom & transport to a Doctor w/ 9 years of medical school & a life time of training.
    Ah yes, the old "paramedics don't diagnose" statement. Well, it's pretty much a fallacy. The truth is, Paramedics do diagnose. If we give D50 to a diabetic patient with low blood sugar, then we've clearly "diagnosed" their problem as "hypoglycemia". Activating a "STEMI alert" (if your system supports such) for a patient with ST elevation in multiple leads means that you have "diagnosed" that they are having an Acute MI. The scope of a diagnosis may be limited, but it's a diagnosis nonetheless.


    Also so medics should not be allowed to be medic w/o having at least 5 years of BLS under their belt...
    I partially agree with this. There should be a minimum amount of BLS experience required before attending Paramedic training, however I know that waiting 5 years is excessive for the most part and really excessive if a person is working full-time in a busier EMS system.


    .......I'm a lil' anti-medic. TO many of ya think you're gods (not all). But the more of you that go thru college to be a medic tend to be WAY to cocky for your own good. Give me a medic that took the non-college course & has a life time of experience over any of these NKOTB!
    Yes, there are some with over-inflated egos, but really not much different than most occupations in that regards. Being a "good" Paramedic requires a degree of cockiness.

    I'd be willing to bet that (based on my experiences) there's probably at least as many EMTs that think they are just there to drive the ambulance and move the patient as there truly are Paramedics that "think they are gods".

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    Quote Originally Posted by FireMedic049 View Post
    I think this is somewhat overly simplistic, ignorant view of what a Paramedic is able to do in comparison to an EMT.
    What does the your patch say that you get from national registry? EMT-Paramedic....like it should be...EMT before medic. Get the patient to where he/she needs to be

    Quote Originally Posted by FireMedic049 View Post
    Ah yes, the old "paramedics don't diagnose" statement. Well, it's pretty much a fallacy. The truth is, Paramedics do diagnose. If we give D50 to a diabetic patient with low blood sugar, then we've clearly "diagnosed" their problem as "hypoglycemia". Activating a "STEMI alert" (if your system supports such) for a patient with ST elevation in multiple leads means that you have "diagnosed" that they are having an Acute MI. The scope of a diagnosis may be limited, but it's a diagnosis nonetheless.
    I can see your point on this....I can't agree with it though. You may have diagnosed the symptom as it presents itself, but you have not diagnosed the problem as a whole. D-50 by itself is worthless. Without proper meal & further analysis from a physician you will continue to see that patient time & time again with the same signs & symptoms. Can the patient refuse once he is CAOx4?...of course (at least in Delaware he can). That does not mean he is cured. ST elvations...another symptom of a larger problem. Again, your treatments can only subdue the symptoms as they present themselves to you. You are a valued part of the medical setting. But you stop as soon as you drop off the patient to the RN or Dr.

    But the problem is that some medics don't just stop there...I'm waiting on the one medic that buys his own Rx pads...lol

    Quote Originally Posted by FireMedic049 View Post
    I partially agree with this. There should be a minimum amount of BLS experience required before attending Paramedic training, however I know that waiting 5 years is excessive for the most part and really excessive if a person is working full-time in a busier EMS system.
    I say five mostly as an a rounded off number...I wouldn't want to see someone jump from one right to the other. Busy or not. I think 5 years lets you appreciate what & where you have come from

    Quote Originally Posted by FireMedic049 View Post
    Yes, there are some with over-inflated egos, but really not much different than most occupations in that regards. Being a "good" Paramedic requires a degree of cockiness.
    cockiness is one thing...sinful pride is another....lol


    Quote Originally Posted by FireMedic049 View Post
    I'd be willing to bet that (based on my experiences) there's probably at least as many EMTs that think they are just there to drive the ambulance and move the patient as there truly are Paramedics that "think they are gods".
    I can't argue with that statement

    Please don't get me wrong, God bless a medic...but some of them kill me with their attitudes. especially the newbies. I know you have your own protocols to follow, but I'm starting to wonder if your higher ups have missed the point of pre-hospital care. Wheel & heal is the name of the game....Not on call house doctors..& that goes double for basics(cause they are just as bad)!
    Last edited by ffscm72; 07-17-2011 at 03:18 PM.
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    Quote Originally Posted by ffscm72 View Post
    What does the your patch say that you get from national registry? EMT-Paramedic....like it should be...EMT before medic. Get the patient to where he/she needs to be
    Yes, "BLS before ALS", however you really didn't rebut my point. Both aspects are important, however there is a significant difference in the training and scope of practice between EMT and Paramedic and to say that a Paramedic is "nothing more than an EMT with way more drugs" is rife with ignorance.


    I can see your point on this....I can't agree with it though. You may have diagnosed the symptom as it presents itself, but you have not diagnosed the problem as a whole. D-50 by itself is worthless. Without proper meal & further analysis from a physician you will continue to see that patient time & time again with the same signs & symptoms. Can the patient refuse once he is CAOx4?...of course (at least in Delaware he can). That does not mean he is cured. ST elvations...another symptom of a larger problem. Again, your treatments can only subdue the symptoms as they present themselves to you. You are a valued part of the medical setting. But you stop as soon as you drop off the patient to the RN or Dr.
    You may be able to see my point, but I don't think get it though. My point was centered on your treat the symptoms, not diagnose comments and I think you're reading too far into my comments.

    In order to properly treat the symptoms, one has to identify what those symptoms are along with utilizing the available diagnostic tools to add more context to those symptoms. I'm not talking about making an equivalent diagnosis to that of a physician. It's more of a "field diagnosis" thing. Continuing with the diabetic example, the field diagnosis is not about distinguishing between Type I or II diabetes or whatever, it's simply a matter of identifying (diagnosing) "hypoglycemia" as the problem in order to know what the proper course of treatment is.

    For example, one day I had a pt with a significant altered LOC along side of the road. Nobody around him knew him, no medic alert bracelet, no obvious injury so we had nothing to go on as to what the cause was. He was partially dressed for work at a restaurant (not located in that part of town), his ID listed his address as being in another town several miles away so he appeared to be "out of place". The incident location was very close to an area in which illegal drug activity is not unusual so pretty much all signs pointed towards a drug overdose. The problem ended up being "hypoglycemia" as he was a diabetic and lived in that area now, but his ID wasn't current. Without diagnosing that (not diabetes) as the cause, the proper course of treatment would not have been known.

    Some patients we can diagnose and "cure" their immediate problem. Some patients we will be able to reach a basic diagnosis and attempt to manage until we can get to the hospital. Some patients we won't be able to diagnose the cause of their problem. Some of them will have symptoms we can treat, some won't.

    Maybe it's a semantics thing, but whatever you want to call what we do for some patients in order to treat them properly, it's still arguably a diagnosis.

    I say five mostly as an a rounded off number...I wouldn't want to see someone jump from one right to the other. Busy or not. I think 5 years lets you appreciate what & where you have come from
    I've seen and precepted students who have jumped right into Paramedic training following EMT class and as a rule, they weren't ready.

    5 years certainly will do as you stated, however that long really isn't necessary for a lot of providers to gain that insight if working on a routine basis.

    I know you have your own protocols to follow, but I'm starting to wonder if your higher ups have missed the point of pre-hospital care. Wheel & heal is the name of the game....Not on call house doctors..& that goes double for basics(cause they are just as bad)!
    What is it that has you wondering that?
    Last edited by FireMedic049; 07-17-2011 at 05:53 PM.

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    Quote Originally Posted by ffscm72 View Post
    in Delaware they have raised the standards for EMT-P's to must have AA. I personally think it's stupid being you are nothing more than an EMT with way more drugs. Your job is to wheel & heal. You are not a rolling Dr. Do your job, treat the symptom as it presents itself & get the patient to definitive treatment facility. That's all you are meant to do. Not diagnose the problem. Just treat the symptom & transport to a Doctor w/ 9 years of medical school & a life time of training. Also so medics should not be allowed to be medic w/o having at least 5 years of BLS under their belt....I'm a lil' anti-medic. TO many of ya think you're gods (not all). But the more of you that go thru college to be a medic tend to be WAY to cocky for your own good. Give me a medic that took the non-college course & has a life time of experience over any of these NKOTB!
    I'd have to agree with FireMedic049. To say paramedics do not diagnose patient's conditions is stupid. No, my diagnosis is not the final say when it comes to the patient's medical records, that would be their PCP. But what exactly do you call looking at the patient's symptoms as a whole to decide immediate treatment? If I have a patient who has a blood sugar of 20, I treat them with D50 or Glucagon. They are having a hypoglycemic incident, pretty cut and dry. Diagnosing a patient with a condition does not mean directing and providing long-term care for the condition. Or how about 3rd degree heart block? I am taught how to identify and treat this condition, not simply the signs/symptoms it causes. I'm not just treating the hypotension it causes, or the skin presentation. I am treating the root of the symptoms, the heart block itself. By identifying and diagnosing this condition, I am able to treat the condition as a whole instead of simply treating symptoms.

    No, we don't diagnose everything. There are plenty of calls I go on that I am not able to identify the root of what is going on with patients. In those instances, yes, I simply treat symptoms that I can address. But there are also plenty of medical conditions and events that I AM taught to recognize and treat the root of the incident rather than simply treating symptoms. To say that a paramedic is not able to do this, such as with a patient having an MI, demonstrates a lack of knowledge on your part on what exactly a paramedic is taught. How exactly do you think a doctor diagnoses an MI? He looks at the same 12-lead EKG we do, looks at the same signs and symptoms we do. The ER doc diagnoses the patient with the MI, but he doesn't go to the cath lab with the patient to break the clot, and he obviously doesn't give the patient follow-up afterwards. But he diagnosed the medical event in the first place. We are taught to do the same thing but with fewer conditions, the ones that will immediately present a danger to the patient's life.

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    I think we missing the point....why have an A.A degree for a job that only requires you to stabilize the patient...You are given NO drugs to cure the underlying issue. MI, Diabetes, & whatever else. Your job is to stabilize...nothing more.
    E.M.T= Emergency Medical Technician. No matter your level...the job is always the same. & it isn't as deep as some of us have made it out to be. treat & street ya'll. nothing more...nothing less. I will always rely on you, the paramedic...you have the knowledge to do more for those who need you in there time of need. But can your knowledge be obtained w/o need of a college degree that not everyone can afford? Yes...I know it can. I've watched the best of the best do it & do it VERY well.
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    Quote Originally Posted by ffscm72 View Post
    But can your knowledge be obtained w/o need of a college degree that not everyone can afford? Yes...I know it can. I've watched the best of the best do it & do it VERY well.
    Yes, they are not arguing that there aren't great paramedics out there....but there are also jackasses who have gone through the easiest 7 month paramedic course they can POSSIBLY find, just to get that little "EMT-P" patch, so they can ride the big red truck. Not only would making paramedic an AA or BS course open up new doors and possibilities for the paramedic, but it would also weed out a good number of the guys who don't give a rats ***** about medicine and just want to be firefighters. And yes it would cost more, but if one does just a BIT of digging, there are TONS of scholarships and grants to be had.

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    Quote Originally Posted by ATFDFF View Post
    Yes, they are not arguing that there aren't great paramedics out there....but there are also jackasses who have gone through the easiest 7 month paramedic course they can POSSIBLY find, just to get that little "EMT-P" patch, so they can ride the big red truck. Not only would making paramedic an AA or BS course open up new doors and possibilities for the paramedic, but it would also weed out a good number of the guys who don't give a rats ***** about medicine and just want to be firefighters. And yes it would cost more, but if one does just a BIT of digging, there are TONS of scholarships and grants to be had.
    AA/BS degrees doesn't guarantee good medics nor assure that most people won't just get thru it to ride the big red truck.

    If you take out all the "junk" in college courses & maybe add a course in "common sense" then I'd be more into it. Unfortunately it's all about the dollar.
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    Quote Originally Posted by ffscm72 View Post
    AA/BS degrees doesn't guarantee good medics nor assure that most people won't just get thru it to ride the big red truck.

    If you take out all the "junk" in college courses & maybe add a course in "common sense" then I'd be more into it. Unfortunately it's all about the dollar.
    Clearly nothing will be able to completely eliminate people who are "just doing it." BUT there is a huge difference between someone committing to a (usually) part-time 7 month program where more than 50% of your time is in the field, as opposed to a 2 or 4 year program, learning TRUE A&P, more indepth studies of your drugs, etc.

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    Quote Originally Posted by ffscm72 View Post
    I think we missing the point....why have an A.A degree for a job that only requires you to stabilize the patient...You are given NO drugs to cure the underlying issue. MI, Diabetes, & whatever else. Your job is to stabilize...nothing more.

    It's certainly true that a degree is not essential to being able to competently provide Paramedic level care. It's equally true that a degree will not guarantee a "better" pre-hospital provider. There's valid points on both sides of the debate and moving towards a degree based certification/licensure for Paramedics could help move the profession to a more even standing in the medical field, thus resulting in better compensation and new opportunities.

    E.M.T= Emergency Medical Technician. No matter your level...the job is always the same. & it isn't as deep as some of us have made it out to be. treat & street ya'll. nothing more...nothing less. I will always rely on you, the paramedic...you have the knowledge to do more for those who need you in there time of need. But can your knowledge be obtained w/o need of a college degree that not everyone can afford? Yes...I know it can. I've watched the best of the best do it & do it VERY well.
    Yes, this job isn't necessarily as "deep" as some make it out to be, however it's also no where near as "shallow" as you make it out to be.

    Do you realize that "treat & street" is not an EMS term? It is an ER term referring to quickly addressing a patient's complaint (the "treat") and discharging them from the ER (the "street") rather than having them linger in the ER unnecessarily.

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    Quote Originally Posted by FireMedic049 View Post
    It's certainly true that a degree is not essential to being able to competently provide Paramedic level care. It's equally true that a degree will not guarantee a "better" pre-hospital provider. There's valid points on both sides of the debate and moving towards a degree based certification/licensure for Paramedics could help move the profession to a more even standing in the medical field, thus resulting in better compensation and new opportunities.
    Exactly my point....for the most part (there are certainly exceptions to this) EMTs/Medics tend to be looked down upon by the rest of the medical field. I'm certainly not saying we need the same standing as a physician or even a BSN RN, but if we start to show more schooling requirements/more requirements in general, it would make a pretty clear case for project medical directors to give us more rights and responsibilities. And, in turn, this improves our leverage to get more from our employers, etc.

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    It is as shallow as I make it. Our treatments are limited & so our or skills....& for proper reason. Why? cause we do not have the proper medical analysis tools required nor proper facilities. Why? cause we are only meant to stabilize & get them to that facility. To think you do more than that is only fooling yourself into believing you are part of the end solution. You stabilize...I stabilize. That's it...nothing more, nothing less. Know your role in the bigger scheme & you'll become better member of what you are meant to do. If you want more, go get it & move on. (e.g. LPN, RN, DR) what ever floats your boat. If you want better pay from an employer? go be a nurse or DR. This is EMS, it's run by the Department of Transportation...the same people that make the lil' yellow lines crooked as all get up & get paid WAY to much for it...lol

    & yes I'm aware of where the saying "treat & street" come from. But the same can hold true for EMS....Get them to the hospital in a timely manner instead of pretending to diagnose the pt. in the back of a bumpy ambulance & not having them linger in the back of an ambulance so some self inflated provider can pretend to be more than he/she is.

    *side note: please be aware (cause I haven't mention this & it VERY wrong to point the blame @ one group) that I don't just hold these opinions to just medics....EMT-Basic's are VERY MUCH as guilty of this. We all aspire to be more, but in the process forget to be the best @ what initially trained for.
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    Quote Originally Posted by ffscm72 View Post
    It is as shallow as I make it. Our treatments are limited & so our or skills....& for proper reason. Why? cause we do not have the proper medical analysis tools required nor proper facilities. Why? cause we are only meant to stabilize & get them to that facility.
    I kind of disagree with your analysis. Yes, our skill set and treatments do not reflect the entirety of what is available in the medical field. However, your consistent portrayal of what EMS and specifically Paramedics can do paints more of a picture of the old "load & go" days of early EMS rather than reflect the reality that the modern ALS ambulance can provide a significant amount of what would be a patient's initial ER care in their home or wherever they are at.

    Yes, our education and tools have limits, however we seem to be getting more stuff added on a somewhat regular basis.

    In the 15 years that I have been an ALS provider, EMS (at least where I've worked) has added the following off the top of my head to our scope of practice, skill set, or diagnostic equipment:
    * 12-lead EKGs with telemetry
    * Alternate airway adjuncts (Combi-tube, King-LT, etc.)
    * C-PAP
    * Adult IO access
    * Capnography
    * CO monitoring equipment
    * Lactate meters
    * Numerous medications, including additional narcotic options and nitrous oxide.
    * Numerous revisions and expansions of treatment protocols allowing paramedics to use their own discretion regarding treatment when in the past a Medical Command Physician would have needed to be contacted prior to treatment.


    Some systems have expanded even more allowing the use of things like pre-hospital thrombolytics, portable ultrasound & interactive assessment/diagnostics (video conferencing with MDs).

    Who knows what the future will hold, but our limitations will be influenced by multiple factors including the ability or inability to squeeze even more equipment into our tiny ER on wheels and the feasibility to do so and not simply because "we aren't doctors" or because "we are only meant to stabilize & get them to that (hospital)".


    To think you do more than that is only fooling yourself into believing you are part of the end solution. You stabilize...I stabilize. That's it...nothing more, nothing less. Know your role in the bigger scheme & you'll become better member of what you are meant to do.
    The vast majority of providers that I've known over my now 18+ year career do understand their role and do not think they are more than what they are in their role.

    & yes I'm aware of where the saying "treat & street" come from. But the same can hold true for EMS....Get them to the hospital in a timely manner instead of pretending to diagnose the pt. in the back of a bumpy ambulance & not having them linger in the back of an ambulance so some self inflated provider can pretend to be more than he/she is.
    Well, if you know what the origin of "treat & street" is, then using it in the fashion that you are (linking it to EMS) is only making you look more foolish in this discussion.
    Last edited by FireMedic049; 07-19-2011 at 02:05 PM.

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