Re: National Scope of Practice Final Document

[Guest guest]

Looking at the credits at the end of the document, I have to

wonder why they would want to keep EMS in the domain of the trade school

folks? I saw a lot of folks with nifty titles and lots of letters after

their names, but who chose these folks to draft the document? What was

the selection process, and were these the folks best qualified to draft

this type of document?

Crosby

EMT-B

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________________________________

From: [mailto: ] On

Behalf Of Bledsoe

Sent: Saturday, October 29, 2005 2:38 PM

To: EMS-L@...; ;

Paramedicine

Subject: National Scope of Practice Final Document

I have reviewed the final National Scope of Practice document several

times

and like it less each time. In my opinion, it will hold EMS to trade

status

instead of a profession. Many states, such as Wisconsin, have already

stated

they will not use the document. I have heard similar comments from

other

states. Thus, what is the point of a " consensus " national scope of

practice

document if half of the states all do their own thing? It is hard for me

to

understand the logic behind this document. It certainly does not reflect

the

status of the science as we know it. While we had input as medical

directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard

to

this.

BEB

[Guest guest]

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything that

would limit the Scope of Practice to a trade status. I saw some things that

might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language that

would limit anything being expanded upon. I only saw language that would keep

the, shall I say, " Standard " for initial certification or licensure at a

minimum. There was language there that would still allow for advanced care to

be given. I saw nothing that made a statement about not allowing a Medical

Director the ability to put into play those skills they felt were necessary.

Did I miss something?

Where is it a problem to place all of us across the nation on the same page?

Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language that

would limit what we do embedded in the " Scope of Practice " that I missed? I

don't seem to see where the status of the science is not reflected.

The way the scope is written does initially seem to limit things, but ; I did

not see any key words that would lock anything into place. I have read it a

couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything that

would limit the Scope of Practice to a trade status. I saw some things that

might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language that

would limit anything being expanded upon. I only saw language that would keep

the, shall I say, " Standard " for initial certification or licensure at a

minimum. There was language there that would still allow for advanced care to

be given. I saw nothing that made a statement about not allowing a Medical

Director the ability to put into play those skills they felt were necessary.

Did I miss something?

Where is it a problem to place all of us across the nation on the same page?

Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language that

would limit what we do embedded in the " Scope of Practice " that I missed? I

don't seem to see where the status of the science is not reflected.

The way the scope is written does initially seem to limit things, but ; I did

not see any key words that would lock anything into place. I have read it a

couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything that

would limit the Scope of Practice to a trade status. I saw some things that

might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language that

would limit anything being expanded upon. I only saw language that would keep

the, shall I say, " Standard " for initial certification or licensure at a

minimum. There was language there that would still allow for advanced care to

be given. I saw nothing that made a statement about not allowing a Medical

Director the ability to put into play those skills they felt were necessary.

Did I miss something?

Where is it a problem to place all of us across the nation on the same page?

Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language that

would limit what we do embedded in the " Scope of Practice " that I missed? I

don't seem to see where the status of the science is not reflected.

The way the scope is written does initially seem to limit things, but ; I did

not see any key words that would lock anything into place. I have read it a

couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

In a message dated 10/29/2005 11:26:04 PM Central Standard Time,

petsardlj@... writes:

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read it

a couple of times myself.

therein, I suspect, will be the problem...too many of the bureaucrats will

take the Scope of Practice not as a minimum, but as a maximum....and use it to

set not starting standards, but 'do not cross' limits.

ck

S. Krin, DO FAAFP

[Guest guest]

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

True enough. I have to agree with Dr. B's assessment in addition to

yours. This document seems to more limit what EMS is than describe what

EMS can do. That's my take anyway.

Crosby

EMT-B

________________________________

From: [mailto: ] On

Behalf Of krin135@...

Sent: Sunday, October 30, 2005 8:27 AM

To:

Subject: Re: National Scope of Practice Final Document

In a message dated 10/29/2005 11:26:04 PM Central Standard Time,

petsardlj@... writes:

The way the scope is written does initially seem to limit things, but

; I

did not see any key words that would lock anything into place. I have

read it

a couple of times myself.

therein, I suspect, will be the problem...too many of the bureaucrats

will

take the Scope of Practice not as a minimum, but as a maximum....and use

it to

set not starting standards, but 'do not cross' limits.

ck

S. Krin, DO FAAFP

[Guest guest]

True enough. I have to agree with Dr. B's assessment in addition to

yours. This document seems to more limit what EMS is than describe what

EMS can do. That's my take anyway.

Crosby

EMT-B

________________________________

From: [mailto: ] On

Behalf Of krin135@...

Sent: Sunday, October 30, 2005 8:27 AM

To:

Subject: Re: National Scope of Practice Final Document

In a message dated 10/29/2005 11:26:04 PM Central Standard Time,

petsardlj@... writes:

The way the scope is written does initially seem to limit things, but

; I

did not see any key words that would lock anything into place. I have

read it

a couple of times myself.

therein, I suspect, will be the problem...too many of the bureaucrats

will

take the Scope of Practice not as a minimum, but as a maximum....and use

it to

set not starting standards, but 'do not cross' limits.

ck

S. Krin, DO FAAFP

[Guest guest]

I have read the document again and this is what I found.

Under " Role of State Government " the wording states: " Each State has the

statutory authority and responsibility to regulate EMS within its borders and to

determine the scope of practice of State Licensed EMS personnel. The National

Scope of Practice Model is a concensus-based document that was developed to

improve the consistency of EMS personnel levels and nomenclature among states:

it does not have any regulatory authority. By that statement it limits the

authority of the document. This could be a good thing. The legislature or

others may attempt to interpret this to mean " You must be licensed or we can

make changes. " If EMS personnel are licensed within the state that cannot be

done. A good thing?

There does appear to be wording associated with going above the minimum set

skill levels and not skipping levels, again this only suggests not to do this it

does not specifically limit it.

There is also wording that can be construed as to what a Paramedic is, namely

" an allied health professional " . I see this only as a possible description such

as " grouper " , " cod " , and " Bass " they are still all " Fish " . Is this type of

wording really all that important?

I see a level not unlike EMT-Intermediate, it is called an AEMT or " Advanced

Emergency Medical Technician " . Where is the big difference?

Throughout the whole document I see only minimum set standards. There appears

to be nothing in the minimum standards that are not at the level of what we have

now. These standards are what we teach in EMS classes now.

Maybe there is still something I am missing or is it that I say potato (

po-tay-toe) and you say potato (po-ta-toe)?

Bledsoe wrote:

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

I have read the document again and this is what I found.

Under " Role of State Government " the wording states: " Each State has the

statutory authority and responsibility to regulate EMS within its borders and to

determine the scope of practice of State Licensed EMS personnel. The National

Scope of Practice Model is a concensus-based document that was developed to

improve the consistency of EMS personnel levels and nomenclature among states:

it does not have any regulatory authority. By that statement it limits the

authority of the document. This could be a good thing. The legislature or

others may attempt to interpret this to mean " You must be licensed or we can

make changes. " If EMS personnel are licensed within the state that cannot be

done. A good thing?

There does appear to be wording associated with going above the minimum set

skill levels and not skipping levels, again this only suggests not to do this it

does not specifically limit it.

There is also wording that can be construed as to what a Paramedic is, namely

" an allied health professional " . I see this only as a possible description such

as " grouper " , " cod " , and " Bass " they are still all " Fish " . Is this type of

wording really all that important?

I see a level not unlike EMT-Intermediate, it is called an AEMT or " Advanced

Emergency Medical Technician " . Where is the big difference?

Throughout the whole document I see only minimum set standards. There appears

to be nothing in the minimum standards that are not at the level of what we have

now. These standards are what we teach in EMS classes now.

Maybe there is still something I am missing or is it that I say potato (

po-tay-toe) and you say potato (po-ta-toe)?

Bledsoe wrote:

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

I have read the document again and this is what I found.

Under " Role of State Government " the wording states: " Each State has the

statutory authority and responsibility to regulate EMS within its borders and to

determine the scope of practice of State Licensed EMS personnel. The National

Scope of Practice Model is a concensus-based document that was developed to

improve the consistency of EMS personnel levels and nomenclature among states:

it does not have any regulatory authority. By that statement it limits the

authority of the document. This could be a good thing. The legislature or

others may attempt to interpret this to mean " You must be licensed or we can

make changes. " If EMS personnel are licensed within the state that cannot be

done. A good thing?

There does appear to be wording associated with going above the minimum set

skill levels and not skipping levels, again this only suggests not to do this it

does not specifically limit it.

There is also wording that can be construed as to what a Paramedic is, namely

" an allied health professional " . I see this only as a possible description such

as " grouper " , " cod " , and " Bass " they are still all " Fish " . Is this type of

wording really all that important?

I see a level not unlike EMT-Intermediate, it is called an AEMT or " Advanced

Emergency Medical Technician " . Where is the big difference?

Throughout the whole document I see only minimum set standards. There appears

to be nothing in the minimum standards that are not at the level of what we have

now. These standards are what we teach in EMS classes now.

Maybe there is still something I am missing or is it that I say potato (

po-tay-toe) and you say potato (po-ta-toe)?

Bledsoe wrote:

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

My skepticism with this document, as with similar documents, comes into play

because many (if not most) that read it will not define the word minimum

properly, but will instead use this as the bar that they seek to achieve. We

can all name numerous EMS Education programs that strive to meet the minimum

standards. On the other hand, how many programs can be named that have

consistently set their standards higher and higher in spite of the exceedingly

low standards set by the various regulatory and testing agencies?

I wasn’t a fan of this document even before the first draft was released. I

have major problems with the use of the phrase “Scope of Practice”. Legally,

this phrase (and this document) can and will serve as restraints on our up and

coming profession. You can rest assured that the personal injury lawyers can’t

wait for documents such as these to appear so they can use them against those

being regulated.

They said there would not be another release of the “DOT NSC”. Government loves

to take something that works (even somewhat), break it up, reorganize it, clap a

shiny new cover on it and call it “the cure all to end all cure alls”. Instead

of taking the last thing we had and updating it to meet the needs of EMS today,

we threw it out, and wrote a document that in my humble opinion sets us back at

least 10 years. Keep in mind that this documents may have the effect of

increasing standards in some areas of the country, but I feel it’s detrimental

to us here in Texas. I find it rather amusing that this is being sold as the

“National” Scope of Practice, but it appears that less than 50% of the states

will adhere to it.

E. Tate, LP

Danny wrote:Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything that

would limit the Scope of Practice to a trade status. I saw some things that

might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language that

would limit anything being expanded upon. I only saw language that would keep

the, shall I say, " Standard " for initial certification or licensure at a

minimum. There was language there that would still allow for advanced care to

be given. I saw nothing that made a statement about not allowing a Medical

Director the ability to put into play those skills they felt were necessary.

Did I miss something?

Where is it a problem to place all of us across the nation on the same page?

Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language that

would limit what we do embedded in the " Scope of Practice " that I missed? I

don't seem to see where the status of the science is not reflected.

The way the scope is written does initially seem to limit things, but ; I did

not see any key words that would lock anything into place. I have read it a

couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

My skepticism with this document, as with similar documents, comes into play

because many (if not most) that read it will not define the word minimum

properly, but will instead use this as the bar that they seek to achieve. We

can all name numerous EMS Education programs that strive to meet the minimum

standards. On the other hand, how many programs can be named that have

consistently set their standards higher and higher in spite of the exceedingly

low standards set by the various regulatory and testing agencies?

I wasn’t a fan of this document even before the first draft was released. I

have major problems with the use of the phrase “Scope of Practice”. Legally,

this phrase (and this document) can and will serve as restraints on our up and

coming profession. You can rest assured that the personal injury lawyers can’t

wait for documents such as these to appear so they can use them against those

being regulated.

They said there would not be another release of the “DOT NSC”. Government loves

to take something that works (even somewhat), break it up, reorganize it, clap a

shiny new cover on it and call it “the cure all to end all cure alls”. Instead

of taking the last thing we had and updating it to meet the needs of EMS today,

we threw it out, and wrote a document that in my humble opinion sets us back at

least 10 years. Keep in mind that this documents may have the effect of

increasing standards in some areas of the country, but I feel it’s detrimental

to us here in Texas. I find it rather amusing that this is being sold as the

“National” Scope of Practice, but it appears that less than 50% of the states

will adhere to it.

E. Tate, LP

Danny wrote:Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything that

would limit the Scope of Practice to a trade status. I saw some things that

might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language that

would limit anything being expanded upon. I only saw language that would keep

the, shall I say, " Standard " for initial certification or licensure at a

minimum. There was language there that would still allow for advanced care to

be given. I saw nothing that made a statement about not allowing a Medical

Director the ability to put into play those skills they felt were necessary.

Did I miss something?

Where is it a problem to place all of us across the nation on the same page?

Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language that

would limit what we do embedded in the " Scope of Practice " that I missed? I

don't seem to see where the status of the science is not reflected.

The way the scope is written does initially seem to limit things, but ; I did

not see any key words that would lock anything into place. I have read it a

couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

What do the lawyers on this list think? I would be interested to hear

their take.

Crosby

EMT-B

Clipped for courtesy...

RE: National Scope of Practice Final Document

\

There is also wording that can be construed as to what a Paramedic is,

namely " an allied health professional " . I see this only as a possible

description such as " grouper " , " cod " , and " Bass " they are still all

" Fish " . Is this type of wording really all that important?

[Guest guest]

What do the lawyers on this list think? I would be interested to hear

their take.

Crosby

EMT-B

Clipped for courtesy...

RE: National Scope of Practice Final Document

\

There is also wording that can be construed as to what a Paramedic is,

namely " an allied health professional " . I see this only as a possible

description such as " grouper " , " cod " , and " Bass " they are still all

" Fish " . Is this type of wording really all that important?

[Guest guest]

How many times have you read on this list that paramedics want parity with

nurses? " I can do what they do. " " We should be paid the same. " However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire departments

like their personnel to have degrees in fire science or similar disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking out

more paramedics than their are jobs. Good for me as they will buy books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 10:00 AM

To:

Subject: RE: National Scope of Practice Final Document

I have read the document again and this is what I found.

Under " Role of State Government " the wording states: " Each State has the

statutory authority and responsibility to regulate EMS within its borders

and to determine the scope of practice of State Licensed EMS personnel. The

National Scope of Practice Model is a concensus-based document that was

developed to improve the consistency of EMS personnel levels and

nomenclature among states: it does not have any regulatory authority. By

that statement it limits the authority of the document. This could be a good

thing. The legislature or others may attempt to interpret this to mean " You

must be licensed or we can make changes. " If EMS personnel are licensed

within the state that cannot be done. A good thing?

There does appear to be wording associated with going above the minimum

set skill levels and not skipping levels, again this only suggests not to do

this it does not specifically limit it.

There is also wording that can be construed as to what a Paramedic is,

namely " an allied health professional " . I see this only as a possible

description such as " grouper " , " cod " , and " Bass " they are still all " Fish " .

Is this type of wording really all that important?

I see a level not unlike EMT-Intermediate, it is called an AEMT or

" Advanced Emergency Medical Technician " . Where is the big difference?

Throughout the whole document I see only minimum set standards. There

appears to be nothing in the minimum standards that are not at the level of

what we have now. These standards are what we teach in EMS classes now.

Maybe there is still something I am missing or is it that I say potato (

po-tay-toe) and you say potato (po-ta-toe)?

Bledsoe wrote:

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

How many times have you read on this list that paramedics want parity with

nurses? " I can do what they do. " " We should be paid the same. " However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire departments

like their personnel to have degrees in fire science or similar disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking out

more paramedics than their are jobs. Good for me as they will buy books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 10:00 AM

To:

Subject: RE: National Scope of Practice Final Document

I have read the document again and this is what I found.

Under " Role of State Government " the wording states: " Each State has the

statutory authority and responsibility to regulate EMS within its borders

and to determine the scope of practice of State Licensed EMS personnel. The

National Scope of Practice Model is a concensus-based document that was

developed to improve the consistency of EMS personnel levels and

nomenclature among states: it does not have any regulatory authority. By

that statement it limits the authority of the document. This could be a good

thing. The legislature or others may attempt to interpret this to mean " You

must be licensed or we can make changes. " If EMS personnel are licensed

within the state that cannot be done. A good thing?

There does appear to be wording associated with going above the minimum

set skill levels and not skipping levels, again this only suggests not to do

this it does not specifically limit it.

There is also wording that can be construed as to what a Paramedic is,

namely " an allied health professional " . I see this only as a possible

description such as " grouper " , " cod " , and " Bass " they are still all " Fish " .

Is this type of wording really all that important?

I see a level not unlike EMT-Intermediate, it is called an AEMT or

" Advanced Emergency Medical Technician " . Where is the big difference?

Throughout the whole document I see only minimum set standards. There

appears to be nothing in the minimum standards that are not at the level of

what we have now. These standards are what we teach in EMS classes now.

Maybe there is still something I am missing or is it that I say potato (

po-tay-toe) and you say potato (po-ta-toe)?

Bledsoe wrote:

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

How many times have you read on this list that paramedics want parity with

nurses? " I can do what they do. " " We should be paid the same. " However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire departments

like their personnel to have degrees in fire science or similar disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking out

more paramedics than their are jobs. Good for me as they will buy books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 10:00 AM

To:

Subject: RE: National Scope of Practice Final Document

I have read the document again and this is what I found.

Under " Role of State Government " the wording states: " Each State has the

statutory authority and responsibility to regulate EMS within its borders

and to determine the scope of practice of State Licensed EMS personnel. The

National Scope of Practice Model is a concensus-based document that was

developed to improve the consistency of EMS personnel levels and

nomenclature among states: it does not have any regulatory authority. By

that statement it limits the authority of the document. This could be a good

thing. The legislature or others may attempt to interpret this to mean " You

must be licensed or we can make changes. " If EMS personnel are licensed

within the state that cannot be done. A good thing?

There does appear to be wording associated with going above the minimum

set skill levels and not skipping levels, again this only suggests not to do

this it does not specifically limit it.

There is also wording that can be construed as to what a Paramedic is,

namely " an allied health professional " . I see this only as a possible

description such as " grouper " , " cod " , and " Bass " they are still all " Fish " .

Is this type of wording really all that important?

I see a level not unlike EMT-Intermediate, it is called an AEMT or

" Advanced Emergency Medical Technician " . Where is the big difference?

Throughout the whole document I see only minimum set standards. There

appears to be nothing in the minimum standards that are not at the level of

what we have now. These standards are what we teach in EMS classes now.

Maybe there is still something I am missing or is it that I say potato (

po-tay-toe) and you say potato (po-ta-toe)?

Bledsoe wrote:

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

So what is the answer? I'm not trying to be a ninny here, but really,

what will it take? The FD's want EMS in the step child role, the

drafters of the Scope document want EMS in the step child roll, so what

are those who want to see a better EMS to do?

Crosby

EMT-B

RE: National Scope of Practice Final Document

How many times have you read on this list that paramedics want parity

with

nurses? " I can do what they do. " " We should be paid the same. "

However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire

departments

like their personnel to have degrees in fire science or similar

disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking

out

more paramedics than their are jobs. Good for me as they will buy

books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB

[Guest guest]

So what is the answer? I'm not trying to be a ninny here, but really,

what will it take? The FD's want EMS in the step child role, the

drafters of the Scope document want EMS in the step child roll, so what

are those who want to see a better EMS to do?

Crosby

EMT-B

RE: National Scope of Practice Final Document

How many times have you read on this list that paramedics want parity

with

nurses? " I can do what they do. " " We should be paid the same. "

However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire

departments

like their personnel to have degrees in fire science or similar

disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking

out

more paramedics than their are jobs. Good for me as they will buy

books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB

[Guest guest]

Get a degree in accounting.

_____

From: [mailto: ] On

Behalf Of Crosby, E

Sent: Sunday, October 30, 2005 10:36 AM

To:

Subject: RE: National Scope of Practice Final Document

So what is the answer? I'm not trying to be a ninny here, but really,

what will it take? The FD's want EMS in the step child role, the

drafters of the Scope document want EMS in the step child roll, so what

are those who want to see a better EMS to do?

Crosby

EMT-B

RE: National Scope of Practice Final Document

How many times have you read on this list that paramedics want parity

with

nurses? " I can do what they do. " " We should be paid the same. "

However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire

departments

like their personnel to have degrees in fire science or similar

disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking

out

more paramedics than their are jobs. Good for me as they will buy

books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB

[Guest guest]

I'll never forget the 1st day of the Fire Academy. The Dean came into the

classroom and " laid down the law " . If you fail 4 tests (daily exams) during the

next 12 weeks, you fail the program. If you.... yada, yada, yada.

Having been involved with one of the most well respected EMS Education programs

in the state for the previous 7 years, I was impressed that the fire service

wasn’t at all like I had heard with their minimum educational standards. I sat

there in my seat thinking this was going to be a hard program, and that I was

going to learn how to become a firefighter. Then, he paused………and said, “Our

job is NOT to teach you to become a firefighter, our job IS to teach you how to

pass the state exam.” With that single sentence my darkest thoughts of fire

service “education” were exhumed. I sat there worried about the program and how

difficult it was going to be because they had made it out to be something

difficult. It turned out to be one of the easiest courses I ever took, I

scoff……

The National EMS Scope of Practice Model - Setting the Minimum Standards for EMS

Training Programs for the Minumim EMS of the 21st Century.

Tater

Bledsoe wrote:How many times have you read on

this list that paramedics want parity with

nurses? " I can do what they do. " " We should be paid the same. " However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire departments

like their personnel to have degrees in fire science or similar disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking out

more paramedics than their are jobs. Good for me as they will buy books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 10:00 AM

To:

Subject: RE: National Scope of Practice Final Document

I have read the document again and this is what I found.

Under " Role of State Government " the wording states: " Each State has the

statutory authority and responsibility to regulate EMS within its borders

and to determine the scope of practice of State Licensed EMS personnel. The

National Scope of Practice Model is a concensus-based document that was

developed to improve the consistency of EMS personnel levels and

nomenclature among states: it does not have any regulatory authority. By

that statement it limits the authority of the document. This could be a good

thing. The legislature or others may attempt to interpret this to mean " You

must be licensed or we can make changes. " If EMS personnel are licensed

within the state that cannot be done. A good thing?

There does appear to be wording associated with going above the minimum

set skill levels and not skipping levels, again this only suggests not to do

this it does not specifically limit it.

There is also wording that can be construed as to what a Paramedic is,

namely " an allied health professional " . I see this only as a possible

description such as " grouper " , " cod " , and " Bass " they are still all " Fish " .

Is this type of wording really all that important?

I see a level not unlike EMT-Intermediate, it is called an AEMT or

" Advanced Emergency Medical Technician " . Where is the big difference?

Throughout the whole document I see only minimum set standards. There

appears to be nothing in the minimum standards that are not at the level of

what we have now. These standards are what we teach in EMS classes now.

Maybe there is still something I am missing or is it that I say potato (

po-tay-toe) and you say potato (po-ta-toe)?

Bledsoe wrote:

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

I'll never forget the 1st day of the Fire Academy. The Dean came into the

classroom and " laid down the law " . If you fail 4 tests (daily exams) during the

next 12 weeks, you fail the program. If you.... yada, yada, yada.

Having been involved with one of the most well respected EMS Education programs

in the state for the previous 7 years, I was impressed that the fire service

wasn’t at all like I had heard with their minimum educational standards. I sat

there in my seat thinking this was going to be a hard program, and that I was

going to learn how to become a firefighter. Then, he paused………and said, “Our

job is NOT to teach you to become a firefighter, our job IS to teach you how to

pass the state exam.” With that single sentence my darkest thoughts of fire

service “education” were exhumed. I sat there worried about the program and how

difficult it was going to be because they had made it out to be something

difficult. It turned out to be one of the easiest courses I ever took, I

scoff……

The National EMS Scope of Practice Model - Setting the Minimum Standards for EMS

Training Programs for the Minumim EMS of the 21st Century.

Tater

Bledsoe wrote:How many times have you read on

this list that paramedics want parity with

nurses? " I can do what they do. " " We should be paid the same. " However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire departments

like their personnel to have degrees in fire science or similar disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking out

more paramedics than their are jobs. Good for me as they will buy books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 10:00 AM

To:

Subject: RE: National Scope of Practice Final Document

I have read the document again and this is what I found.

Under " Role of State Government " the wording states: " Each State has the

statutory authority and responsibility to regulate EMS within its borders

and to determine the scope of practice of State Licensed EMS personnel. The

National Scope of Practice Model is a concensus-based document that was

developed to improve the consistency of EMS personnel levels and

nomenclature among states: it does not have any regulatory authority. By

that statement it limits the authority of the document. This could be a good

thing. The legislature or others may attempt to interpret this to mean " You

must be licensed or we can make changes. " If EMS personnel are licensed

within the state that cannot be done. A good thing?

There does appear to be wording associated with going above the minimum

set skill levels and not skipping levels, again this only suggests not to do

this it does not specifically limit it.

There is also wording that can be construed as to what a Paramedic is,

namely " an allied health professional " . I see this only as a possible

description such as " grouper " , " cod " , and " Bass " they are still all " Fish " .

Is this type of wording really all that important?

I see a level not unlike EMT-Intermediate, it is called an AEMT or

" Advanced Emergency Medical Technician " . Where is the big difference?

Throughout the whole document I see only minimum set standards. There

appears to be nothing in the minimum standards that are not at the level of

what we have now. These standards are what we teach in EMS classes now.

Maybe there is still something I am missing or is it that I say potato (

po-tay-toe) and you say potato (po-ta-toe)?

Bledsoe wrote:

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

I'll never forget the 1st day of the Fire Academy. The Dean came into the

classroom and " laid down the law " . If you fail 4 tests (daily exams) during the

next 12 weeks, you fail the program. If you.... yada, yada, yada.

Having been involved with one of the most well respected EMS Education programs

in the state for the previous 7 years, I was impressed that the fire service

wasn’t at all like I had heard with their minimum educational standards. I sat

there in my seat thinking this was going to be a hard program, and that I was

going to learn how to become a firefighter. Then, he paused………and said, “Our

job is NOT to teach you to become a firefighter, our job IS to teach you how to

pass the state exam.” With that single sentence my darkest thoughts of fire

service “education” were exhumed. I sat there worried about the program and how

difficult it was going to be because they had made it out to be something

difficult. It turned out to be one of the easiest courses I ever took, I

scoff……

The National EMS Scope of Practice Model - Setting the Minimum Standards for EMS

Training Programs for the Minumim EMS of the 21st Century.

Tater

Bledsoe wrote:How many times have you read on

this list that paramedics want parity with

nurses? " I can do what they do. " " We should be paid the same. " However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire departments

like their personnel to have degrees in fire science or similar disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking out

more paramedics than their are jobs. Good for me as they will buy books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 10:00 AM

To:

Subject: RE: National Scope of Practice Final Document

I have read the document again and this is what I found.

Under " Role of State Government " the wording states: " Each State has the

statutory authority and responsibility to regulate EMS within its borders

and to determine the scope of practice of State Licensed EMS personnel. The

National Scope of Practice Model is a concensus-based document that was

developed to improve the consistency of EMS personnel levels and

nomenclature among states: it does not have any regulatory authority. By

that statement it limits the authority of the document. This could be a good

thing. The legislature or others may attempt to interpret this to mean " You

must be licensed or we can make changes. " If EMS personnel are licensed

within the state that cannot be done. A good thing?

There does appear to be wording associated with going above the minimum

set skill levels and not skipping levels, again this only suggests not to do

this it does not specifically limit it.

There is also wording that can be construed as to what a Paramedic is,

namely " an allied health professional " . I see this only as a possible

description such as " grouper " , " cod " , and " Bass " they are still all " Fish " .

Is this type of wording really all that important?

I see a level not unlike EMT-Intermediate, it is called an AEMT or

" Advanced Emergency Medical Technician " . Where is the big difference?

Throughout the whole document I see only minimum set standards. There

appears to be nothing in the minimum standards that are not at the level of

what we have now. These standards are what we teach in EMS classes now.

Maybe there is still something I am missing or is it that I say potato (

po-tay-toe) and you say potato (po-ta-toe)?

Bledsoe wrote:

You should really read the comments on some of the other lists. The only

people in support of the document are those who wrote it. Texas has a lot to

lose in this. In Texas, the medical directors have the authority to

establish the practices. For example, a medical director may want EMTs to

use EpiPens and nebulizers. Thus document would give the lawyers,

politicians and regulators a somewhat legal opportunity to stop such a

decision.

But, the fundamental problem is much deeper. A Scope of Practice document

should be a general overview of a profession. This reads like a trade. For

example, a welding SOP document might saw, " a certified welder must

understand the nature of various metals and demonstrate mastery of brazing,

gas welding, stick arc welding, wire fed arc welding, TIG welding and so

on. " This is exactly what we have in this document. An EMT has these

skills, a paramedic these, and so on. The document should make a general

statement:

" An EMR should have the education and skills to care for a patient with

critical injuries for the first 10 minutes. "

A paramedic should have the education and skills to care for all types of

emergency patients for the first hour "

Leave the decision as to skills and education to the state and medical

directors. In medicine (DO or MD), the students learn pretty much the same

stuff. However, some schools are oriented toward training generalists and

others specialists. Also, the schools vary their curricula to meet their

perceived needs. In rural states, medical graduates may need better OB

skills than in urban states. The schools and states have the ability to

adapt accordingly.

The National SOP is really the same thing we have. It was a trade-off to

the big fire departments who have the dilemma of keeping their employees

current in both EMS and firefighting (also haz-mat, bombs, inspections,

etc). After all, they are first charged with operating fire trucks and the

EMS education has to take a back seat. When someone on another list wrote, "

This project had the potential to boost EMS education and in turn practice

several notches by requiring paramedic training to be at the associate

degree level. Unfortunately, the medical component of EMS lost out to the

public safety component. This is truly a shame. " , Dave Cone, MD (who was

involved in the document) wrote, " We tried. Believe me, we tried. "

BEB

_____

From: [mailto: ] On

Behalf Of Danny

Sent: Sunday, October 30, 2005 12:26 AM

To:

Subject: Re: National Scope of Practice Final Document

Dr. Bledsoe;

Perhaps you could expand on your comments, please. I did not see anything

that would limit the Scope of Practice to a trade status. I saw some things

that might put all of EMS on the same " beginning " page.

I believe that this might be something to start with. I saw no language

that would limit anything being expanded upon. I only saw language that

would keep the, shall I say, " Standard " for initial certification or

licensure at a minimum. There was language there that would still allow for

advanced care to be given. I saw nothing that made a statement about not

allowing a Medical Director the ability to put into play those skills they

felt were necessary. Did I miss something?

Where is it a problem to place all of us across the nation on the same

page? Is there a real problem or is it a territory issue?

Is there something else that needs to be added to this? Is there language

that would limit what we do embedded in the " Scope of Practice " that I

missed? I don't seem to see where the status of the science is not

reflected.

The way the scope is written does initially seem to limit things, but ; I

did not see any key words that would lock anything into place. I have read

it a couple of times myself.

Please share your perspective.

Bledsoe wrote:

I have reviewed the final National Scope of Practice document several times

and like it less each time. In my opinion, it will hold EMS to trade status

instead of a profession. Many states, such as Wisconsin, have already stated

they will not use the document. I have heard similar comments from other

states. Thus, what is the point of a " consensus " national scope of practice

document if half of the states all do their own thing? It is hard for me to

understand the logic behind this document. It certainly does not reflect the

status of the science as we know it. While we had input as medical directors

and providers, I don't think much of the input was heeded.

Anyway, I was just wondering what the prevailing thoughts are in regard to

this.

BEB

[Guest guest]

Go to nursing school, pharmacy school, law school, medical school (this list can

go on forever) like all the best and smartest medics before you........

" Crosby, E " wrote:

So what is the answer? I'm not trying to be a ninny here, but really,

what will it take? The FD's want EMS in the step child role, the

drafters of the Scope document want EMS in the step child roll, so what

are those who want to see a better EMS to do?

Crosby

EMT-B

RE: National Scope of Practice Final Document

How many times have you read on this list that paramedics want parity

with

nurses? " I can do what they do. " " We should be paid the same. "

However,

all nurses have an Associate's degree. The original scope of practice

required an associate's degree for paramedic (like virtually every other

country in the world). But, the lobby from the big fire departments were

successful in getting certificate programs put through. Thus, kiss your

chances of parity with nursing and increased salaries good bye. This

document relegates EMS to the stepchild role it has had for

years--especially in regard to the fire service. Sure, the fire

departments

like their personnel to have degrees in fire science or similar

disciples.

But, a degree in EMS is worthless to them.

There will continue to exist a market for certificate programs cranking

out

more paramedics than their are jobs. Good for me as they will buy

books.

Bad for EMS as the simple equation of supply and demand will keep the

salaries low.

BEB