From Bledsoe

[Guest guest]

This is a post from Dr. Bledsoe that was sent to another list, EMS-L.

I think you'll find it interesting.

GG

Dr. Bledsoe wrote:

This discussion points to a far greater problem with EMS in the United

States. First, there is no significant standardization. In some states, such as

Texas, EMS personnel are certified. Licensure requires a legislative mandate to

regulate a profession. While paramedics in many states, such as California are

indeed licensed, the paramedic scope of practice is set by legislation. Thus,

it remains difficult for paramedics in California to add new procedures and

drugs to their armamentarium. It often requires action by the legislature (which

meets infrequently and has many more important things on their schedule than

EMS scope of practice bills). EMS needs to follow the other health professions

(nursing, medicine, dentistry) and have their own licensing boards. The boards

can be appointed by the Governor and have legislative authority to regulate

the profession. The boards should consist of EMTS, EMDs, First Responders,

Paramedics, ED nurses, Physicians, and consumers to oversee the profession. In

the

US, the physicians sit atop the medical pecking order and unlimited medical

practice is allowed them. All less-trained medical providers must function

under the supervision of the highest trained. That will never change and

probably

should not. Paramedics should have detailed and comprehensive standing orders.

This on-line medical control nonsense should be changed to medical

consultation (did you read the recent article in PEC where physicians only

correctly

comprehend few patient reports from paramedics?). These protocols should be the

same for states or regions (unless operational missions differ significantly).

There may need to be a state medical direction board with a designated medical

director. Such things as signing for patient deliveries, narcotic

administration, and such should be abandoned as they have no real purpose. But,

first the

fly-by-night limited hour, limited clinical-contact ALS (EMT-I and paramedic)

programs must go away first. Second, EMS providers must step forward to

regulate themselves and weed out bad providers. Now, it is too easy to shift

that

to the medical director. And, in regard to the physician’s license issue.

First, physicians must have a license to practice medicine. Physicians may

delegate

the practice to appropriate personnel (nurses, RTs, Pas, RNPs, CRNAs, and

paramedics), but they still must maintain some responsibility. And, physicians

cannot delegate without a license. Thus, the license may be at risk if delegated

providers do not practice within their scope or are negligent. If  you don’t

believe this is the case, try operating an EMS operation without a licensed

physician in the loop. The lack of an effective national voice for EMS and the

tendency to take the course of least resistance in terms of training, QI,

oversight, and such must go away. How many EMS services do you know where the

management intentionally seeks out a physician with little EMS oversight

experience

simply “to sign the forms and order the drugs� EMS needs full-time

physician involvement from doctors who understand the profession, the mission,

and

respect and know the providers. This is starting to occur on a limited

basis. Bemoaning the problems on an internet list (as I have just done J) does

little to

change things. It requires national and state organization, lobbying,

cooperation, and so on. The lines of practice must remain clear. Paramedics

should

practice prehospital medicine. Nurses should practice nursing. Dentists should

practice dentistry, and so on. Either change things or go quietly with the rest

of the herd to a future of low pay, poor working conditions, and diminished

respect. That’s my story and I’m sticking to it. BEB  

[Guest guest]

So how do we do it?

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

So how do we do it?

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

I don't believe that " short course " paramedicine programs are the problem.

The problem is the level of dedication to providing care. This means never

letting your education stagnate. Always taking that next step in your education.

Always read and update your knowledge base.

As for the unbearable burnout call volumes. Dare I say the ER nurses and

physicians see sometimes twice the number of patients we in EMS go on. I don't

see a burnout problem with them (I would like others to offer dissension if

my facts are incorrect). Having worked in an Emergency Room I speak from

experience (and this was providing care to patients).

I will agree with the pay statement. EMS professionals do need the pay to

be more substantial (even plumbers make more working on your house pipes than

EMT's do working on their next door neighbors' dysrhythmic heart).

With respect to " years of training " everyone expects that the knowledge and

compassion when being treated by a medical professional is there. I don't

remember ever hearing any patients ask " And how many years have you gone to

school? "

We as an EMS profession have to be more involved with how others in our

field provide care. We need to be more involved in policing our profession and

striving for the education and knowledge to help us take care of our patients.

I would have to agree with Dr. Bledsoe's posting as to the fact that

physician's will probably always be at the top of the food chain. This does not

mean

that just because we are not at the top that we cannot attain the knowledge and

the education to better assist us in providing the top level care that

everyone deserves.

We as a profession need to be more involved with legislation, that I know

someday will come; to make our profession mandated. I see years of " coming of

age " before these things will happen. That does not mean that we give up on

the things (knowledge, training, compassion) that we know right now will make a

difference in tomorrow's call.

Just my opinion.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

Way back in December of 1998 a fella by the name of Maguire replied to a

post on EMS-L. The topic at the time was enhanced educational requirements.

Now Mr. Maguire is a fella for whom I have a great deal of respect, and his

message was so poignant that I save it. It seems appropriate and timely to

repost it here now.

Regards,

Donn

Re: Granting Degrees

>Hi ,

>

>I want to applaud you for your interest in, and commitment to, increasing

>the education level of EMS personnel. This increase in education is a

>crucial step in the continuing evolution of EMS from trade to profession.

>

>While we are advancing this cause, it is also imperative that we consider

>both our short and long-term objectives. What is it we really hope to

>accomplish through education? What is it we want educated people to do

>that uneducated people can not do? What skills, knowledge and abilities

>separates those two groups? What does a degree really mean?

>

>In Thursday's (12/10/98) Washington Post, a story titled " Education

>Producing Wider Earnings Gap " by Walsh

>(http://search.washingtonpost.com/wp-srv/WPlate/1998-12/10/1601-121098-idx.

html)

>noted that individuals with bachelor's degrees now earn " 76 percent more

>than their counterparts with less education " .

>

>Why is that true? I believe it is due to two primary reasons. The first is

>that people with degrees have learned some skills that are useful in the

>work place (and in life). They've learned some research skills, and

>analytical skills. They've learned perseverance skills by going through

>the process of facing what seems to be an overwhelming obstacle (eg.

>project, test, degree) and continuing to work at it until they

>accomplish their objective.

>

>The second reason is that education helps people learn how to think

>differently. Through exposure to, and understanding of, science, math,

>art, literature, history and philosophy, the student develops a broad

>perspective of humanity. That perspective gives the student the ability to

>contemplate the bigger picture; to think beyond what is known.

>

>So if these are the objectives of education, our next question is how do

>we accomplish them. We begin with the premise that failing to accomplish

>them is a great disservice to our students (it's like telling them they

>are now paramedics even though they are unable to start an IV or

>understand drug interactions or know why they do what they do or know how

>to relate to other health professionals). We accomplish the objectives by

>requiring them to take certain courses (by saying " you cannot get a

>college degree without humanities any more than you can get a paramedic

>certificate without cardiology " ). As educators we accomplish the

>objectives by setting an example, by nurturing our students, by

>challenging them, by seeing their true potential even when they themselves

>cannot see it. As professionals, we accomplish the objectives by

>constantly pursuing our own education and encouraging those who look up to

>us, to pursue theirs.

>

>I encourage you to continue your pursuit . I encourage you to do

>everything you can to make educational experiences available to

>paramedics. But I implore you, do not coddle them, do not make it " easy "

>to get a degree and, above all, do not tell them they are educated if

>they're not.

>

> J. Maguire

>The Washington University

>Washington, DC

>http://gwis2.circ.gwu.edu/~maguire/

>

>

>

>> Our Paramedicine A.A.S. program is investigating how to grant our degree

>> to persons who already have a paramedic certification (a one year cert

>> most likely) and some work experience. We are trying to formulate a

>> process/procedure to review the portfolio these folks would submit. We

>> are considering having the candidates take some form of written exam and

>> possibly some skill verification test-outs. We are also debating what

>> this " portfolio " should contain.

>>

>> If anyone has any thoughts on this or are involve in a 2 year degree

>> program that has a process in place for this, we would great appreciate

>> any feed-back you may wish to give us.

>>

>> Thank you in advance for sharing your thoughts on this. To avoid undue

>> clutter on the server, please email me directly

>> unless you feel that your response may be

>> a benefit to others on the list.

>>

[Guest guest]

I did not mistake your point. I agree that individuals may indeed better

themselves by seeking further education. My point is that the education must

become a requirement for entry into the profession before we can expect

paramedicine as a whole to gain professional respect. I am trying to look

beyond individuals and see the bigger picture.

Donn

Re: From Bledsoe

Just for clarification. I did not mean to express an opinion that education

is not needed. What I meant to express was that just because you go through

a

" quick course " Paramedic program does not mean you cannot achieve a more

thorough education yourself. Education is what will keep our profession

going and

assisting our patients to have better outcomes.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

Dr. B

Your comments regarding your daughter's required classroom hours reminded me

of the words Joe Tyson, my EMT-P Class Coordinator, said back in the mid

80's.

" It only takes %^# hours for you to become a Paramedic and to save a life.

It takes *#^ hours to learn to dye a little old ladies hair blue.

If you don't like the fact that this class goes well beyond the TDH minimum,

you have signed up for the wrong class. "

Glad I stayed in that class. Thanks Joe!

Britton Waldron

Re: From Bledsoe

>

> To all,

> If I may interject my 2 cents worth here. I just gave a presentation

to

> our local Lions Club on EMS Education. May I point out that the state

sets

> the minimums of 40 hours for ECA, 140 for B, 160 for I and 624 for P, all

of

> which is supposed to include field and clinical time. The Instructor

course

> provided by Texas Tech stresses minimum entry level competence as the

level

> to which you should strive to educate your students. Do you see a problem

> here? To my knowlege, the state provides no such minimums for nursing,

the

> BNE is the agency that approves programs and sets the standards of

> education.

> There is no way you can even hope to cover the National Standard

> curriculum in those few mandated hours. TX DOT funding unfortunately is

> predicated on those same minimum hours. For those of us who are not under

> the aegis of a community college or university, funding is a big issue.

How

> many of you teach for free because that is the only way you will get

medics

> to fill the slots on your services? How many of you slave over grant

> proposals to get the advanced training equipment needed to adequately

> prepare your students?

> Yes I agree with Dr. Bledsoe. We need to rethink our view of

education

> and regulation but we need to do it in a manner that will benefit our

entire

> population, not just the urban areas with access to colleges and

> universities. I agree that we are at a turning point, a necessary

struggle

> if we are to become the profession we desire to be, and that there are no

> easy answers. We must begin to work together to find the solutions we

need.

> I am open to any and all suggestions.

> Jeanne E. Amis, RN, LP

> Education Director

> Marfa City/County EMS

>

>

>

>

>

>

>

>

[Guest guest]

As the owner of a training center, and with 17 years experience teaching

EMS and Emergency Care, it pains me to say so, but I believe this to be

true. There is no room in EMS for a privately run training program.

Not that privately run training programs can't be good. Having taught

at a university, I think private firms can and should provide BETTER

education than these largely bureauacratically organized and politically

motivated institutions. Small business has an edge in that they can

stay focused on what they are about, and not in perpetuating the

organization like larger businesses and schools. So private education

is really a better way in many cases.

BUT, it comes down to money, as Jeanne pointed out. I'd LOVE there to

be a structure that (1) standardized the education required at a higher

level, (2) provided strict oversight of that education, and (3) Allowed

me to teach at that level, provided I had the credentials, and make a

living at it. But, 1 out of 3 ain't good enough! There is no way for

oversight of these small training programs to be ensured, largely

because of monetary issues (or a license to operate would be $10,000 a

year to pay for the oversight). And, even if there were, there's no way

to make money and still do everything that is required to provide a good

education. Not counting equipment and facilities, look at instructional

time. At 1500 CLASSROOM hours or so (maybe more or less would be

required) needed to adequately train a Paramedic for semi-independent

practice (not to mention another 1000 or so of clinicals), plus

management of the clinicals and other non-classroom stuff, to pay

instructors a living wage, you'd need to charge a LOT more than the

market will bear for this education. Universities have other funding

sources, other than tuition, and STILL tuition is pretty high. A

private concern would likely need to charge a lot more just to make it.

So, we DO need more education. If you look at the sheer SCOPE of what

we're expected to do in the EMS field, compared to the SCOPE of what

many other medical professionals do, and then compare the HOURS of

education we get versus them (RTs? Xray Techs? PTs? Med Techs?

Nurses? pick one), you'll get the feeling it ought to take a LOT more

time to learn to do what we do. Even a layperson can see that. But,

unfortunately, there's no real way to make money at it.

I would LOVE to teach EMS through my center on an ongoing basis. But

economically, and logistically, it's really becoming infeasible. So

maybe we SHOULD " just go gently into that good night " . Or at least find

some other way to teach. We've moved more into Initial Emergency Care,

helping to build the system from the ground up, teaching bystanders,

Emergency Responders, etc.

I don't know the answer, but we gotta do something. We need to GROW UP

as a profession, and growing is always painful.

=Steve=

=Steve , EMT-P=