EMS Educational Standards

[FireMedic049]

No I'm just the only one with this thinking. I'm just only one willing to tell you cause I'm not here to kiss your rear end. & just because a few of your buddies agree with you does not mean you are correct.

You might want to rework this one because most of it doesn't make much sense or help your position.

True some of your medications that you are allowed to give, are used by physicians as a long term treatment....But when it is used in the EMS field it is only meant as a short term stabilization tool.

Please name a few and we can discuss them.

You are only allowed to use those drug under a physicians guidance. Either thru standing orders, verbal orders.


Your protocols aren't just something you medics talk about in a cute lil meeting. They written by a physician(s). They allow you to do your job. Nothing is left to your discretion. You must (or at least should) follow within ur defined scope of practice.

You clearly know very little about what you are talking about with regards to the paramedic level. Treatment protocols are written by physicians, this is true. However, you are absolutely wrong that "nothing is left to (my) discretion" when treating a patient.

I'm a little familiar with your County's paramedic service and their reputation and I'm pretty confident in saying that they are also allowed to exercise their discretion in treating patients.

I don't understand why you are getting worked up...they are my opinions. I am not alone. Thus beauty of the debate!

Trust me, I'm not "worked up". I understand they are your opinions, however I feel that most of these opinions are born out of not knowing what you are trying to talk about.

That's a biased statement because I feel safe in saying these people you had contact with have the same opinions that you do. Talk to someone with a different view from yourself. & you might find you were right or wrong.

I'm more than willing to talk to people with different views, however in my 18+ year career, providing EMS in 2 states and a fair number of EMS organizations and EMS systems, you are the only person that I have encountered that thinks paramedics really want to be doctors and try to act that way when providing EMS care.

I will back up a moment...& apologize I stooped down to a level of name calling I should not have done...& which I apologize as I don't know you. I've placed you into a broad spectrum of a (hopefully) small group of co-workers I just can't stand. No fair to you.

Thanks, but I'm not sure when the name calling occurred.

But I stand by my opinion until it can be proven otherwise. Maybe one day when I step up into the roll of paramedic I might have a change of mind...But from my perspective it's just kind of silly to make something so hard out of something that is so dang simple. I like to live by the KISS method. IMHO

I'm sure your perspective will change if that occurs. I agree that this job really isn't all that complicated and that we aren't doctors, but many of the statements you have made seem to devalue and show a lack of comprehension of what the job actually is beyond the BLS level.

[ffscm72]

You might want to rework this one because most of it doesn't make much sense or help your position.

Man I hate it when the keyboard batteries dies...lol no was supposed to be not...lol Just as bad as auto correct on the "smart" phones...lol

Please name a few and we can discuss them.

We can start with the ones you discussed earlier...
Morphine- pain relief (short term)
Plavix- blood thinner (usually given to pt w/ CVA)
Nitro- dialator (short acting med for cardiac pt)

I'm open to hear more what you all do w/ these.

You clearly know very little about what you are talking about with regards to the paramedic level. Treatment protocols are written by physicians, this is true. However, you are absolutely wrong that "nothing is left to (my) discretion" when treating a patient.

I'm a little familiar with your County's paramedic service and their reputation and I'm pretty confident in saying that they are also allowed to exercise their discretion in treating patients.

Yes you can do what is within your standing orders. But can you just add meds to your list w/o approval from a physician...heck no. Heck in some cases you can't administer the meds you have now w/o approval from a physician.

I'm more than willing to talk to people with different views, however in my 18+ year career, providing EMS in 2 states and a fair number of EMS organizations and EMS systems, you are the only person that I have encountered that thinks paramedics really want to be doctors and try to act that way when providing EMS care.

then why do you fight my opinions so hard. You are defending a whole system....I speaking of a few members not only in the ALS system but in BLS system as well. I've been doing this for 12+ years, I've been in 2 states as well & like you a fair number orgs & systems. I like a lot of what I see. I just think its heading in the wrong direction sometimes, mostly because I see BLS & ALS wanting more & more without being proficient at what they got & know now.

I'm sure your perspective will change if that occurs. I agree that this job really isn't all that complicated and that we aren't doctors, but many of the statements you have made seem to devalue and show a lack of comprehension of what the job actually is beyond the BLS level.

So why complicate the simple? How much do I need to comprehend when our job is the same? Stabilize, transport, & tell the doc what you got. It's not brain surgery. I would love to go & go the next level. I just simply can't afford it.

[bossteen]

For an overweight small town firefighter you seem to be full of opinions.

[ffscm72]

For an overweight small town firefighter you seem to be full of opinions.

& can still do the job better than you i'm sure. Unless you have something add, that is of relevance besides cheep insults, just stay out of it.

[FireMedic049]

Man I hate it when the keyboard batteries dies...lol no was supposed to be not...lol Just as bad as auto correct on the "smart" phones...lol

ha ha

We can start with the ones you discussed earlier...
Morphine- pain relief (short term)
Plavix- blood thinner (usually given to pt w/ CVA)
Nitro- dialator (short acting med for cardiac pt)

I'm open to hear more what you all do w/ these.

You mentioned drugs used for long term treatment that EMS uses for short term stabilization. Morphine is predominately for short term pain relief and in CP & CHF for its vasodilation. Morphine really isn't used as a long term treatment. I wasn't the one who brought up Plavix and really can't comment much on it as it's not a pre-hospital medication in my state. Like morphine, nitro is a short term medication in both settings.

Yes you can do what is within your standing orders. But can you just add meds to your list w/o approval from a physician...heck no. Heck in some cases you can't administer the meds you have now w/o approval from a physician.

No, we can't just add to the list without approval, however I'm not talking about doing that. I'm discussing whether or not a patient is administered any of the medications or receives any of the procedures we are allowed to perform. We (at least here) have some discretion regarding what treatments the patient will receive and that was the point that you seemed to miss. The protocols are more like guidelines and not necessarily rigid directions for treatment to be followed blindly.

then why do you fight my opinions so hard. You are defending a whole system....I speaking of a few members not only in the ALS system but in BLS system as well. I've been doing this for 12+ years, I've been in 2 states as well & like you a fair number orgs & systems. I like a lot of what I see. I just think its heading in the wrong direction sometimes, mostly because I see BLS & ALS wanting more & more without being proficient at what they got & know now.

Because, in my opinion, your statements have not been limited to a "few members" providing ALS or BLS. You've mentioned them specifically, however you've also made comments that, as I've said, seem to devalue the overall system in order to try and make points about that minority.

So why complicate the simple? How much do I need to comprehend when our job is the same? Stabilize, transport, & tell the doc what you got. It's not brain surgery. I would love to go & go the next level. I just simply can't afford it.

You are right, it doesn't need to be complicated and it's not brain surgery, however you have a lot to comprehend if you think that EMS at the BLS level is the same job as EMS at the ALS level. If you grossly oversimplify things to the point that we all treat, transport and hand over to the hospital, then sure it's the same job, but that would be a huge misrepresentation of EMS as a whole and specifically the care available at the ALS level.

[bossteen]

You haven't added anything of relevance. You are a small town EMT with very limited experience and education, otherwise you would understand the importance of increasing educational requirements. The days of scoop and screw are over, have been for a while, the problem is we have providers who are woefully under educated for the increasing job requirements. RSI, 12 lds, Ultrasound, disaster medicine, confined space medicine, dive medicine etc... all have a place pre hospitally. Just like the increasing push for education for fire officers there is an increasing push for education for those pushing drugs that can and are lethal in the wrong hands. I don't know the paramedic that hurt your feelings, but seriously dude, you sound like the LA of the EMS board. Re read some of you posts, you are a small fish in a small pond, there is a whole lot of EMS and firefighting out there that you have no clue about. At 20 I would give you a pass, but 30? Chattanooga will be well advised to pass on a candidate such as yourself.

[FFMedic31]

We can start with the ones you discussed earlier...
Morphine- pain relief (short term)
Plavix- blood thinner (usually given to pt w/ CVA)
Nitro- dialator (short acting med for cardiac pt)

I'm open to hear more what you all do w/ these.

Plavix is used in the MI patient to begin the clot-busting process. Not only is it used in the emergency setting, but many patients continue taking Plavix for at least a year after the MI, if not the rest of their lives.

Using it in a CVA patient would be dangerous pre-hospital, as differentiating between an ischemic and hemorrhagic stroke pre-hospital seems to be beyond many providers. Exactly where do you know Plavix is given pre-hospital for CVA protocols??

FireMedic049 covered the other two meds.

[ffscm72]

You are right, it doesn't need to be complicated and it's not brain surgery, however you have a lot to comprehend if you think that EMS at the BLS level is the same job as EMS at the ALS level. If you grossly oversimplify things to the point that we all treat, transport and hand over to the hospital, then sure it's the same job, but that would be a huge misrepresentation of EMS as a whole and specifically the care available at the ALS level.

then enlighten me. what more do you do (or would like to do)? I'm just not seeing it I guess.
I'm not saying the EMS isn't important. A lot of patients wouldn't have chance he** without it. My point is some (maybe not you or some others) don't seem to know there role in the greater scheme & they bring it out in the field where it doesn't belong. There has to be a limit somewhere.

You haven't added anything of relevance. You are a small town EMT with very limited experience and education, otherwise you would understand the importance of increasing educational requirements.

The size a town or city doesn't matter. The game is the same. Am I limited no...different yes.

I can't argue though about the increasing educational requirements...I just question if it necessarily belongs in a college.

Plavix is used in the MI patient to begin the clot-busting process. Not only is it used in the emergency setting, but many patients continue taking Plavix for at least a year after the MI, if not the rest of their lives
Exactly where do you know Plavix is given pre-hospital for CVA protocols??

No where as far as I'm aware. I thought I saw it mentioned earlier in these threads & found it odd.
Now I do know (in some states) they are using as a preventive (if i remember correctly though it must meet some certain criteria or something of that nature). Friend of mine in NJ whom is resident physician for a neurosurgery unit was discussing this during a conversation. He found it odd as well.

[FFMedic31]

No where as far as I'm aware. I thought I saw it mentioned earlier in these threads & found it odd.
Now I do know (in some states) they are using as a preventive (if i remember correctly though it must meet some certain criteria or something of that nature). Friend of mine in NJ whom is resident physician for a neurosurgery unit was discussing this during a conversation. He found it odd as well.

You think you read it somewhere on these message boards and tried to use it as your own knowledge to try to make yourself appear better educated. Talk about your all-time backfires. All it did was bring your credibility (as an EMT-Basic) even lower in this discussion about Paramedics. If you want to have some credibility, get your Paramedic license. There's student grants and loans everywhere. Get your Fire Department to pay for it, looks like you guys have some pretty good funding. Until then, please leave this discussion to the educated members who have put their time into ALS EMS and please get back to your band-aid station and blood pressure checks. You trying to tell me what my job consists of is like a backstep firefighter trying to tell an Arson Investigator the same thing. I might have a slight idea of what his job is, but I am nowhere near their level in education and experience to speak so out of line.

[ffscm72]

I spend an average of 45-50 minutes with my patients. Yes, I perform interventions to best stablize my patient; Oxygen for hypoxia, IV with fluids for hypotension, intubation for respiratory failure/arrest. I assess and diagnose my patient by looking at skin presentation, vital signs, mental status, and EKG. And I begin the definitive treatment for them as well based on that diagnosis; I give Aspirin, Nitroglycerin, Morphine, and most notably Plavix. After transmitting my 12-lead EKG to the ER and giving them my radio report, I will transport my patient straight to the cardiac cath lab and completely bypass the ER. The ER physician never sees the patient.

I knew i read it some where.

Look I don't know everything you all are doing. But I know it is the same.
the plavix comment was a misunderstanding on my part. I digress & apologize.

You think you read it somewhere on these message boards and tried to use it as your own knowledge to try to make yourself appear better educated. Talk about your all-time backfires.

I read it from you. U didn't explain what you used it for. DE medics do not have it in there protocols to use.

[FFMedic31]

Nowhere did I say it is used for CVA. Nice try. If you had any idea of what we were talking about, you'd understand what a 12-lead EKG is used for, and typically what is done in a CARDIAC cath lab.

[FFMedic31]

I knew i read it some where.

Look I don't know everything you all are doing. But I know it is the same.
the plavix comment was a misunderstanding on my part. I digress & apologize.



I read it from you. U didn't explain what you used it for. DE medics do not have it in there protocols to use.

How can you say you don't know everything we do, then follow it in the next sentence by saying it is the same as what you do? I mean, really dude? You don't have a leg to stand on at this point.

[ffscm72]

How can you say you don't know everything we do, then follow it in the next sentence by saying it is the same as what you do? I mean, really dude? You don't have a leg to stand on at this point.

Really? like you don't have an opinion on say..the government. You don't now everything they but you have an opinion anyway.

No...I don't know all the drugs you use & all the tools. But you do the same thing as BLS (at a higher level, no question there). Assess, treat (with more drugs at your disposal obviously), & transport. That's it. Job done, on to the next 911 call.

Now...just a moment ago I went up to my firehouse that employs some Paramedics from the county who works with us @ a BLS level. Now I just got into this same conversation with this person & we came to the same conclusion. EMS is EMS no matter the level. I can see I'm not putting my opinion across on here as articulate as did him. So obviously there is a communication problem. Sometimes I hate forums..lol

I did learn something that I was never aware while speaking w/ him, which leads me to this question to you....He said that some paramedics are licensed to operate on their own behalf (i hope I understood that correctly). Would this be true for your county, state, or whatever level you operate under? 2nd question How does that work? Who do you answer to? Do you have a separate board of physicians or Paramedic you answer to?
If that's the case then I can see why this has become an argument rather than a discussion.

I'll have to bow out to the comment of small fish cause I've just never heard of such a thing. I've been to several states & asked about how they operate &, with minor or major differences of course, I can't say i've ever heard of that.

[FireMedic049]

then enlighten me. what more do you do (or would like to do)? I'm just not seeing it I guess.
I'm not saying the EMS isn't important. A lot of patients wouldn't have chance he** without it.

I know you aren't saying that EMS isn't important. What you appear to be saying is that the provision of EMS is exactly the same on all levels. That's downright laughable. As I stated before, if you oversimplify it, then yes, we all assess & treat pt to the best of our ability, transport and hand off to the hospital. However, that view overlooks so much important detail.

My point is some (maybe not you or some others) don't seem to know there role in the greater scheme & they bring it out in the field where it doesn't belong. There has to be a limit somewhere.

If that's your point, then make that point by discussing actions related to that issue! If that's your point, then you are dragging a whole lot of unnecessary stuff into the discussion and making yourself look bad.

The size a town or city doesn't matter. The game is the same. Am I limited no...different yes.

Again, if you oversimplify it, then yes, the "game is the same" because the patient themselves and their complaint can be universal, however there are differences between the provision of small town EMS and large urban EMS.

I disagree with your assertion that you aren't "limited". As an EMT-Basic, in EMS terms, you are the definition of "limited".

[JohnVBFD]

My question, as I'm working on EMT-I.

Who in their right mind would argue AGAINST raising an educational standard?

[FireMedic049]

Really? like you don't have an opinion on say..the government. You don't now everything they but you have an opinion anyway.

Yes, Really. You're entitled to your opinion and you can keep on spewing them as long as you want to, however we are equally entitled to tell you that your opinion is an uninformed one.

No...I don't know all the drugs you use & all the tools. But you do the same thing as BLS (at a higher level, no question there). Assess, treat (with more drugs at your disposal obviously), & transport. That's it. Job done, on to the next 911 call.

Now...just a moment ago I went up to my firehouse that employs some Paramedics from the county who works with us @ a BLS level. Now I just got into this same conversation with this person & we came to the same conclusion. EMS is EMS no matter the level.

You're kind of making our point with the first part of this, you don't know the ALS side of the job! At the BLS level, you assess the patient then, for the most part, the only treatment you will actually provide at that level is the administration of oxygen, CPR/AED, maybe assist a patient with taking their own medications, immobilization & bandaging. After that, transport to the hospital with a re-assessment. Pretty much the same stuff whether the pt was BLS or ALS.

At the ALS level, the patient will be assessed the same way, however there will likely be some additional questions that the EMT may not be trained or know to ask. If the pt is ALS, then additional assessment will be made using our diagnostic tools like EKG/12-leads and Glucometer. The patient will then likely get an IV and anything else BLS would provide. Then if appropriate, the patient would get medication. If the patient is not breathing, then they will get an advance airway. If their heart isn't beating right, then they might get paced or cardioverted to fix the disrhythmia. If their lung has collapsed, then they will get a needle inserted into their chest to fix that. Just to name a few. Yup, sounds like the same job.

I did learn something that I was never aware while speaking w/ him, which leads me to this question to you....He said that some paramedics are licensed to operate on their own behalf (i hope I understood that correctly). Would this be true for your county, state, or whatever level you operate under? 2nd question How does that work? Who do you answer to? Do you have a separate board of physicians or Paramedic you answer to?
If that's the case then I can see why this has become an argument rather than a discussion.

In PA, paramedics are not licensed, they are certified and operate under the direction of a Medical Director (for the service itself) and if needed, with the direction of a Medical Command Physician for a patient. For the most part, it's a permanent certification, however we must do 18 hours of con-ed per year and do a skills demonstration thing in order to maintain our medical authorization in order to provide ALS care.

[FireMedic049]

My question, as I'm working on EMT-I.

Who in their right mind would argue AGAINST raising an educational standard?

Oftentimes, those who would not be able to meet the new standard.

[Iceman26]

Yes, Really. You're entitled to your opinion and you can keep on spewing them as long as you want to, however we are equally entitled to tell you that your opinion is an uninformed one.

You're kind of making our point with the first part of this, you don't know the ALS side of the job! At the BLS level, you assess the patient then, for the most part, the only treatment you will actually provide at that level is the administration of oxygen, CPR/AED, maybe assist a patient with taking their own medications, immobilization & bandaging. After that, transport to the hospital with a re-assessment. Pretty much the same stuff whether the pt was BLS or ALS.

At the ALS level, the patient will be assessed the same way, however there will likely be some additional questions that the EMT may not be trained or know to ask. If the pt is ALS, then additional assessment will be made using our diagnostic tools like EKG/12-leads and Glucometer. The patient will then likely get an IV and anything else BLS would provide. Then if appropriate, the patient would get medication. If the patient is not breathing, then they will get an advance airway. If their heart isn't beating right, then they might get paced or cardioverted to fix the disrhythmia. If their lung has collapsed, then they will get a needle inserted into their chest to fix that. Just to name a few. Yup, sounds like the same job.




In PA, paramedics are not licensed, they are certified and operate under the direction of a Medical Director (for the service itself) and if needed, with the direction of a Medical Command Physician for a patient. For the most part, it's a permanent certification, however we must do 18 hours of con-ed per year and do a skills demonstration thing in order to maintain our medical authorization in order to provide ALS care.

Let's not leave out surgical crics.

[FireMedic049]

Let's not leave out surgical crics.

Right, I was just trying not to make the job out to be more than it is. After all, we aren't doctors.

[ffscm72]

My question, as I'm working on EMT-I.

Who in their right mind would argue AGAINST raising an educational standard?

Broadening & raising a standard are two different things.

You want to further your education...by all means...DO IT.

You want to raise educational standards because you think it will create better medics/intermediates/basics...I fly the BS flag. To me it's just another reason for some EMT's to say, "Hey, I got a degree. Give me more money!"
I've seen some of the best medics come from a certificate class, & the worst come from a college. Experience can be your best teacher.