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    Default EMS Educational Standards

    Question: Are you for or against raising the educational standards of the EMT-P to the EMS-AAS, a two year degree? The degree would be required to recieive the EMT-P cert. Tech school programs would no longer qualify one to be certified as a P. Please include the reasons for your opinion.
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    What would the rationale be for raising the standard to a degree required level?
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    Quote Originally Posted by DeputyMarshal View Post
    What would the rationale be for raising the standard to a degree required level?
    The inconsistency of the various paramedic programs regarding their curriculum and standards. Many programs don't require even a basic college level A&P and pharmacology prior to application. They run a condensed, watered down, in house A&P and pharm for EMS. A paramedic is a medical professional, and needs to understand how the human body works before they Many programs focus on preparing their students to pass the NREMT (or state) exam, not so much for creating strong paramedics. There are programs as short as three months, such as the one that Houston uses for their FF's. This creates a very low barrier for job entry, and also oversaturates the market with medics. Places like FL and OH can demand that every FF be a medic in order to get hired due to the overabundance of medics. If it's easy to get certified as a P, you get individuals who get the P-card just to get a fire job, take an apathetic atitude towards pt care, never strive to improve their clinical knowledge, and drop their cert at the first opportunity.

    If a paramedic were treating your mother or another close family member, would you want someone who wanted to be a medic bad enough that they had to do two years of college to get the position, or the three to six month wonder who rather be anywhere but on the box treating your family member?

    Requiring an EMS degree as a minimum standard would give the medic at least the basics of a medical education; it would reduce the supply of medics allowing the existing ones, the ones who did at least two years of school, to earn higher compensation; it would result in providers that actually have an interest in medicine, or at the least, be proficient in it.

    Edit: Also, with the public looking at our salaries, pensions, etc, it may become evident that we're essentially unskilled labor. By that, I mean that we can get on the job with as little as a GED, and no felonies. We start FF's here at 48k plus night diff, paid holidays, a pension, DROP, etc. Other county positions that pay that well (w/o a DROP and a lower pension multiplier) typically require four year degrees and maybe prior experience. Our medics are making around 70k right out of the academy with the bonuses that come with the position. It would be wise to require applicants to have a job related degree to be able to apply, or at least give hiring preference. If applicants had to have a fire science degree in their possession, that could knock weeks off the academy, saving the dept money. You weed out those that are looking for easy access to a job with a great schedule and benefits. Your people will also have demonstrated the ability to study and retain information by having that degree.
    Last edited by edpmedic; 03-03-2011 at 08:18 PM.
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    There are states that already do require the associates for the paramedic and that still doesn't always solve the problem. A degree has been required in Kansas for a while now and there are programs here that turn out people that have their MICT, but they wouldn't do well on the streets. While there are other programs that produce a competent individual, who fresh out of their program is better prepared for the streets than someone who has been on them for a few years already. The two common denominators for the really good programs in this area are:
    1. Instructors who are there to teach the students and not someone focused on their programs total number of individuals certified.

    2. The programs usually have the ability to weed the individuals that are there just for the pay raise that they'll receive after they complete the program. The most common way is that the instructor assigns the student a daily grade for their personality.

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    I for one would never consider becoming a paramedic a pay raise, But I guess many would which is a shame. I am half way through medic school now and I have to say it is very hard. The program is 14 months and that is after 9 months to become an EMT-I.

    I am just getting into cardiology now.... I think my head is going to explode, So much to learn. Which leads to my next statement, I think a longer program would allow for more complete understanding of the meat and potatoes of being a medic. Not just getting ready for the NREMT exam.


    I think the thing that scares me the most about being a paramedic is when done I will be in charge of the ambulance. How hard was it for you guys to make the transition?
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    Quote Originally Posted by L-Webb View Post
    I think the thing that scares me the most about being a paramedic is when done I will be in charge of the ambulance. How hard was it for you guys to make the transition?
    I was in charge of the ambulance after a one semester ALS course. Becoming a paramedic doesn't necessarily make you a better manager. It does make you more knowledgeable about patient care, which is, of course, a good thing. Hopefully you'll become a good manager as well.

    There are those who complain that EMS providers aren't given any cred, regardless of their level of certification. Moves such as requiring a degree can help deal with that as paramedic moves toward being a profession (like nurses) as opposed to a certification. When paramedics reach that level, you may see more field practice - diagnoses and treatment without transport to a hospital. A little of that occurs now, but not like it does in some places.

    There are advanced practice paramedics these days, just as there are advanced practice nurses.
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    Where I am from most all medic programs are 1 year to a year and a half there are no condensed programs. Most program are competitive to get into and they have an application process. In Missouri you have to do at least 600 Clinical/Ride along Hours and 300 patient contacts so there is no way to do that in 3 months it is pretty much a full time job after class, clinicals, and studying. To touch on what the other guy said no matter if your class is 3 month or 2 years you are not gonna catch all the people that are good at taking test but not a good hands on medic. However most teacher are pretty good at weeding out the s*** bags and graduating sound medics although some do slip through. For this reason though my area is not saturated with medic candidates so you go against a lot less people when testing for a fire/medic job or medic job. I also believe Missouri is going to the degree thing and the programs can only be offered at an institute of higher education and that goes into effect Jan 2012 and all program have to meet a certain criteria otherwise they will not be able to offer a medic program.

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    Personally, I'm mixed on the subject.

    I'm definitely in favor of seeing the Paramedic level be more on par with that of nursing in terms of licensure, compensation and the ability to move state to state without having to "retrain" or "retest" in order to practice. Plus, as more and more is being added to the scope of practice, more upfront education/training will be necessary to adequately cover the material.

    I agree that the training should be such that not every Tom, Dick & Jane can end up on the streets providing care as a Paramedic.

    However, I'm not convinced that a degree program will specifically result in a better end product. In my immediate area there are 2 options for where you can get Paramedic training. The Community College (basically a "Part-time" schooling for the better part of a year) and via a subsidiary of the local major college's medical school and hospital (basically a "Full-time" schooling). This option can be either a Paramedic only training or done as part of a degree program.

    The EMS agency I've worked at the past 9 years is one of a few in the County that does the field precepting for the second option. We typically got a handful of student each semester. We also precepted the other program's students, but not as frequently. Based on my experiences, I'm not convinced that the degree program actually created "better" Paramedics.

    The majority of students we saw tended to have little to no experience as EMTs prior to starting Paramedic training. Several of them had no interest in actually being Paramedics. They wanted to be Doctors and saw the training as a stepping stone towards that end goal. Some never even tested for the actual certification which apparently wasn't required to get the college credit for the course.

    The problem I see (at least in my area) is not one that I think a degree requirement will specifically fix because I've seen numerous good and bad providers come out of both training avenues.

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    Quote Originally Posted by L-Webb View Post
    I for one would never consider becoming a paramedic a pay raise, But I guess many would which is a shame. I am half way through medic school now and I have to say it is very hard. The program is 14 months and that is after 9 months to become an EMT-I.

    I am just getting into cardiology now.... I think my head is going to explode, So much to learn. Which leads to my next statement, I think a longer program would allow for more complete understanding of the meat and potatoes of being a medic. Not just getting ready for the NREMT exam.


    I think the thing that scares me the most about being a paramedic is when done I will be in charge of the ambulance. How hard was it for you guys to make the transition?
    How is it a shame to become a paramedic for a pay raise? I thought about what I would like to do that pays well, and being a paramedic was what fit the bill. If the pay was lousy, I would have had to go into another career, as my family prefers to be clothed and fed.

    As far as being in charge of the bus, good systems will have an FTO program in place, rather than just throwing you to the wolves. In my old system, NYC, there are always two medics. The senior medic drives, and the junior medic rides as attendant, and writes the reports. The senior medic watches over the junior medic and gives guidance. If the pt's condition is serious, you'll both be in the back anyways.
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    Quote Originally Posted by tree68 View Post
    I was in charge of the ambulance after a one semester ALS course. Becoming a paramedic doesn't necessarily make you a better manager. It does make you more knowledgeable about patient care, which is, of course, a good thing. Hopefully you'll become a good manager as well.

    There are those who complain that EMS providers aren't given any cred, regardless of their level of certification. Moves such as requiring a degree can help deal with that as paramedic moves toward being a profession (like nurses) as opposed to a certification. When paramedics reach that level, you may see more field practice - diagnoses and treatment without transport to a hospital. A little of that occurs now, but not like it does in some places.

    There are advanced practice paramedics these days, just as there are advanced practice nurses.
    Yes, Wake Co. EMS in NC comes to mind.
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    Quote Originally Posted by FireMedic049 View Post
    Personally, I'm mixed on the subject.

    I'm definitely in favor of seeing the Paramedic level be more on par with that of nursing in terms of licensure, compensation and the ability to move state to state without having to "retrain" or "retest" in order to practice. Plus, as more and more is being added to the scope of practice, more upfront education/training will be necessary to adequately cover the material.

    I agree that the training should be such that not every Tom, Dick & Jane can end up on the streets providing care as a Paramedic.

    However, I'm not convinced that a degree program will specifically result in a better end product. In my immediate area there are 2 options for where you can get Paramedic training. The Community College (basically a "Part-time" schooling for the better part of a year) and via a subsidiary of the local major college's medical school and hospital (basically a "Full-time" schooling). This option can be either a Paramedic only training or done as part of a degree program.

    The EMS agency I've worked at the past 9 years is one of a few in the County that does the field precepting for the second option. We typically got a handful of student each semester. We also precepted the other program's students, but not as frequently. Based on my experiences, I'm not convinced that the degree program actually created "better" Paramedics.

    The majority of students we saw tended to have little to no experience as EMTs prior to starting Paramedic training. Several of them had no interest in actually being Paramedics. They wanted to be Doctors and saw the training as a stepping stone towards that end goal. Some never even tested for the actual certification which apparently wasn't required to get the college credit for the course.

    The problem I see (at least in my area) is not one that I think a degree requirement will specifically fix because I've seen numerous good and bad providers come out of both training avenues.
    True, just because it's a college offering the P program doesn't necessarily mean that it's going to be the best program. My program was through a hospital in Brooklyn. I felt it prepared me well. The thing is, there are way too many fly by night medic mills, that run from three to six months, although some are longer. They just seek to pump out as many graduates as they can, and just teach them how to pass the NR-P exam. They don't require any sciences, and generally give a very condensed A&P and pharmacology watered down to just the need to know basics to function as a cookbook medic in a 911 system.

    Making a degree program the minimum standard puts these medic mills out of business. The students are required to have basic English, math, psych, and basic sciences, such as A&P (typically w/lab), and general pharmacology, all taught as college courses. These sciences, along with the ability to do algebra (for drug calculations for starters) and proficiency in a college composition course (business writing typically qualifies as well, and also has direct career applications) are all guaranteed to be part of the paramedic's education. These abilities are the least that should be acceptable to be considered the basics of a medical education; organic chemistry and physics could be validated as well. These medic mills are largely the reason why many systems have strict protocols rather than medical guidelines that allow flexibility in clinical decision making. These medical directors know they're dealing with three and six month wonders. Education alone doesn't produce the best medic, but neither does a poor education base (in the sciences) and good experience, no matter how productive your skills stations and clinical sessions were. There will also be the elimination of cronyism in these programs, such as preceptors falsifying extra ride hours and/or performed skills and pt contacts, and the time spent during skills and classroom sessions will be largely devoid of useless war stories.

    Edit: It doesn't take all that much to become proficient as an EMT-B. It certainly doesn't take two or three years. It's not very difficult to perform spinal motion restriction, take a BP, pump and blow, apply a swing and swathe, etc. The better medic programs address the student's lack of experience as a basic. As far as students using the education as a stepping stone, well, I would too if I could only make 15 bucks an hour if I'm lucky in some places. But, if there were only degrees, the laws of supply and demand would raise salary and benefits, and it would eliminate many of the Ricky Rescues and whackers who just want to do it for the lights and sirens and adrenaline rush. Look on any EMS forum and there are many threads on what lights they should get for their POV, what they should carry on their belt, where they can get EMS vanity license plates, etc.
    Last edited by edpmedic; 03-07-2011 at 04:37 PM.
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    Quote Originally Posted by edpmedic View Post
    Edit: It doesn't take all that much to become proficient as an EMT-B. It certainly doesn't take two or three years. It's not very difficult to perform spinal motion restriction, take a BP, pump and blow, apply a swing and swathe, etc.
    Right it doesn't, but it's been our experience with the students that came to our service to precept, a lot were not proficient at all with their BLS skills.

    The better medic programs address the student's lack of experience as a basic.
    Unfortunately, not enough address it by requiring the students to actually demonstrate proficiency with BLS skills before being enrolled in the class.

    As far as students using the education as a stepping stone, well, I would too if I could only make 15 bucks an hour if I'm lucky in some places.
    I think you misunderstood something. It wasn't about working as a Paramedic while working towards something else, like MD. The ones I referred to were taking the Paramedic class for the course credits instead of taking a semester or two of regular college courses. They never actually tested for the Paramedic certification.

    [/quote] But, if there were only degrees, the laws of supply and demand would raise salary and benefits, and it would eliminate many of the Ricky Rescues and whackers who just want to do it for the lights and sirens and adrenaline rush. Look on any EMS forum and there are many threads on what lights they should get for their POV, what they should carry on their belt, where they can get EMS vanity license plates, etc.[/QUOTE]

    It may not reduce the number of Ricky Rescues, they just might stay EMTs.

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    A Canadian Primary Care Paramedic, which is the minimum level required to transport a patient, take a 2-year degree to get, and they don't even have as many meds or procedures as a 6-month American medic mill grad. Going to the ALS level requires another year of school depending on where you are.

    I've been told that in the Netherlands, Paramedic school is a Graduate-level course only available to experienced ICU nurses (which of course takes a degree itself).

    Are Canadians sicker than Americans? Are the Dutch? Or do they just know something that we don't? Or, is it because they don't have national-level special interest groups with a vested interest in keeping standards as low as possible and a lot of money to be spent making that happen?

    One thing I do know, you won't find a paramedic working for $10 an hour in Canada or the Netherlands.

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    [QUOTE=edpmedic;1253745]How is it a shame to become a paramedic for a pay raise? I thought about what I would like to do that pays well, and being a paramedic was what fit the bill. If the pay was lousy, I would have had to go into another career, as my family prefers to be clothed and fed.

    If you like doing it and it pays better... That's good. Thats not quite what I meant.

    There are 2 students in my class that have openly stated that the only reason that they are here is that they will get 5-6000 more a year and just want to get enough to pass the test.
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    Quote Originally Posted by FireMedic049 View Post
    Right it doesn't, but it's been our experience with the students that came to our service to precept, a lot were not proficient at all with their BLS skills.

    Unfortunately, not enough address it by requiring the students to actually demonstrate proficiency with BLS skills before being enrolled in the class.

    I think you misunderstood something. It wasn't about working as a Paramedic while working towards something else, like MD. The ones I referred to were taking the Paramedic class for the course credits instead of taking a semester or two of regular college courses. They never actually tested for the Paramedic certification.
    But, if there were only degrees, the laws of supply and demand would raise salary and benefits, and it would eliminate many of the Ricky Rescues and whackers who just want to do it for the lights and sirens and adrenaline rush. Look on any EMS forum and there are many threads on what lights they should get for their POV, what they should carry on their belt, where they can get EMS vanity license plates, etc.[/QUOTE]

    It may not reduce the number of Ricky Rescues, they just might stay EMTs.[/QUOTE]

    I was under the impression that the core courses within the EMS AAS curriculum could only be taken if you're in the program, similar to the RN classes.

    At least the Ricky Rescues could be kept in check by the medics.
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    [QUOTE=L-Webb;1254166]
    Quote Originally Posted by edpmedic View Post
    How is it a shame to become a paramedic for a pay raise? I thought about what I would like to do that pays well, and being a paramedic was what fit the bill. If the pay was lousy, I would have had to go into another career, as my family prefers to be clothed and fed.

    If you like doing it and it pays better... That's good. Thats not quite what I meant.

    There are 2 students in my class that have openly stated that the only reason that they are here is that they will get 5-6000 more a year and just want to get enough to pass the test.
    There are two things that are beyond me:

    First, why do certain depts insist on making everyone become a medic? It costs for the class, the increased compensation, and also for CME's and such. ALS isn't for everyone, either. Pushing drugs and providing electrical therapy, and the education that comes with that is serious business. If you carry an apathetic attitude toward that side of the job, people are going to get hurt and killed.

    Second, in medic saturated regions such as FL and OH, why don't these depts require that their applicants, who typically have to be medics to even apply, have EMS degrees as a hiring condition? In these regions, the competition for fire jobs are like the competition for non-ALS fire positions elsewhere. If the applicant has the EMS degree, that would imply a certain amount of proficiency in EMS, and they'll be less likely to drop their cert after getting on as well.
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    Quote Originally Posted by emt161 View Post
    Are Canadians sicker than Americans? Are the Dutch? Or do they just know something that we don't? Or, is it because they don't have national-level special interest groups with a vested interest in keeping standards as low as possible and a lot of money to be spent making that happen?
    Can you expand on your meaning of the above statement?

    I come from a state that doesn't have medic mills either - our programs are no less than a year, generally 18+ months. The programs are associated with a college (generally a community college), so the student is eligible for a AAS in EMS at the end of the program should so they so choose. A&P? You're getting two full semesters of it.

    However, I don't care what country you're in, taking actions to restrict paramedicine to someone with ICU experience is a bit extreme. While I don't condone a 6-month EMT-P canned program, I don't see that getting a graduate-level education is paramount to treatment & diagnosis of what we encounter daily.
    Last edited by BoxAlarm187; 03-12-2011 at 07:58 PM.
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    Quote Originally Posted by BoxAlarm187 View Post
    Can you expand on your meaning of the above statement?
    What emt161 is getting at is that some blame the IAFF for keeping EMS educational standards low, the reason being that it would lower the supply of medics. In reality, we can blame most private, hospital based, and third service EMS employers of the same thing. How many of these employers require degrees to apply? How many even give preference to someone with a degree? Usually to get hired it's just a P-card or I-card, a pulse, a couple of alphabet cards, a good driving record, no felonies, and you're good. These non fire based EMS employers far outnumber the fire based services. I don't see them making any noticeable push for increasing EMS educational standards.

    Edit: Who either requires or gives weight towards promotional scores for having degrees? The fire service does. What's the easiest degree for a medic to get? The EMS AAS. It only takes a year if you have the P-card. Who sends their medic students to college (NVCC)? Fairfax County does. Just sayin'
    Last edited by edpmedic; 03-12-2011 at 09:43 PM.
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    In our area there aren't enough P's that a degree makes a big difference. In fact, most of the P's are working at several agencies, because there is the need.
    Opinions my own. Standard disclaimers apply.

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    Quote Originally Posted by edpmedic View Post
    I was under the impression that the core courses within the EMS AAS curriculum could only be taken if you're in the program, similar to the RN classes.
    Can't speak to that in general, nor what the exact degree discipline that is offered. I just know that this particular has long offered a stand-alone paramedic program that was very highly regarded in the industry. This program is integrated into the degree program such that you spend a year doing the paramedic program, then the next finishing the other requirements for the degree, however you are able to practice as a paramedic upon completion of that portion and the applicable certification hoops.

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