Scope of practice

[Guest guest]

> OK, back to the Scope of Practice for a few minutes.

>

> The impact of this document in its present form could be devastating to

> Texas EMS, especially rural and frontier areas.

>

To play the devil's advocate for just a minute, or due to my sheer

ignorance, how can this document be devasting to Texas EMS?

-Alfonso R. ochoa

[Guest guest]

> OK, back to the Scope of Practice for a few minutes.

>

> The impact of this document in its present form could be devastating to

> Texas EMS, especially rural and frontier areas.

>

To play the devil's advocate for just a minute, or due to my sheer

ignorance, how can this document be devasting to Texas EMS?

-Alfonso R. ochoa

[Guest guest]

,

Do a google search on the NSCOP model. Here is just one link I found. I

think this will have a more profound result on EMS that what most think. We

have

a shortage of medics now. The way I read it there will be regional schools

only and most on Texas would be on the metroplex area. I feel like I'm down

wind from Three Mile Island. Looks good at first but what about long term. Six

months ago I had never heard of NCoP. I never thought Texas would go to

NREMT testing or that TDH as we new would go away.

Barry Meffert

Blackwell

http://216.239.39.104/search?q=cache:x7uUZSeS5t4J:www.wisconsinems.com/docs/Sc

ope%2520of%2520Practice%2520Statement.doc+National+Scope+of+Practice & hl=en & ie=

UTF-8

In a message dated 12/2/2004 4:36:19 AM Central Standard Time,

scotterems@... writes:

Gene,

As much as I enjoyed reading your impassioned (yet cynical) tirade, I can't

say that I agree with most of what you said. Assertions such as " Paramedics

will be doing little more than EMT-Intermediates do now " really make me

wonder if you take us for illiterate fools or if you are just playing the

good demagogue. Unless you consider the only distinguishing characteristics

of paramedic practice to be RSI, surgical airways, and a whole bunch of

other things that you probably don't even do right now, that is patently

untrue. In an event, such tendency toward exaggeration doesn't help your

case one bit in my book. I see many positive things in the Scope of

Practice proposal, including more stringent educational requirements and

true licensure. On the other hand, I am concerned by the fact that a plan

for a smooth transition has not yet been brought forward, and that the

elimination of the EMT-I designation could have an adverse effect on rural

services.

On the whole, I think there is more good than bad. Let's face it. Right

now, there is absolutely no incentive for someone to get an Associates or

Bachelors degree in EMS if that person cannot then provide a higher level of

care. Why? Because as long as the local family practice M.D. signs off on

it, someone who went to class at night for nine months can do the exact same

thing. And in a world where librarians are getting Masters degrees... well,

don't even get me started.

I found the document to be very conciliatory, and it doesn't appear to me

like they are just trying to ram this through. In fact, they asked for

feedback as to whether there is a need for an advanced provider, whether a

resolution to the reimbursement issue is feasible, etc. " The National EMS

Scope of Practice Model Task Force intends for this document to be

'evolutionary' rather than 'revolutionary'. It is important to preserve the

best of what is working well within EMS practice as we move toward a scope

of practice model that more parallels other health care professionals. "

I get the sense that people are just so paralyzed with fear about this that

they make outrageous claims about the impending doom and gloom without

trying to take part in the process in order to shape something that is more

palatable to them. " That's the way things should be because that's the way

we've always done them. " I just hope that its not obstruction of progress

merely for the sake of obstruction.

Warmest Regards,

Lancaster

[Guest guest]

,

Do a google search on the NSCOP model. Here is just one link I found. I

think this will have a more profound result on EMS that what most think. We

have

a shortage of medics now. The way I read it there will be regional schools

only and most on Texas would be on the metroplex area. I feel like I'm down

wind from Three Mile Island. Looks good at first but what about long term. Six

months ago I had never heard of NCoP. I never thought Texas would go to

NREMT testing or that TDH as we new would go away.

Barry Meffert

Blackwell

http://216.239.39.104/search?q=cache:x7uUZSeS5t4J:www.wisconsinems.com/docs/Sc

ope%2520of%2520Practice%2520Statement.doc+National+Scope+of+Practice & hl=en & ie=

UTF-8

In a message dated 12/2/2004 4:36:19 AM Central Standard Time,

scotterems@... writes:

Gene,

As much as I enjoyed reading your impassioned (yet cynical) tirade, I can't

say that I agree with most of what you said. Assertions such as " Paramedics

will be doing little more than EMT-Intermediates do now " really make me

wonder if you take us for illiterate fools or if you are just playing the

good demagogue. Unless you consider the only distinguishing characteristics

of paramedic practice to be RSI, surgical airways, and a whole bunch of

other things that you probably don't even do right now, that is patently

untrue. In an event, such tendency toward exaggeration doesn't help your

case one bit in my book. I see many positive things in the Scope of

Practice proposal, including more stringent educational requirements and

true licensure. On the other hand, I am concerned by the fact that a plan

for a smooth transition has not yet been brought forward, and that the

elimination of the EMT-I designation could have an adverse effect on rural

services.

On the whole, I think there is more good than bad. Let's face it. Right

now, there is absolutely no incentive for someone to get an Associates or

Bachelors degree in EMS if that person cannot then provide a higher level of

care. Why? Because as long as the local family practice M.D. signs off on

it, someone who went to class at night for nine months can do the exact same

thing. And in a world where librarians are getting Masters degrees... well,

don't even get me started.

I found the document to be very conciliatory, and it doesn't appear to me

like they are just trying to ram this through. In fact, they asked for

feedback as to whether there is a need for an advanced provider, whether a

resolution to the reimbursement issue is feasible, etc. " The National EMS

Scope of Practice Model Task Force intends for this document to be

'evolutionary' rather than 'revolutionary'. It is important to preserve the

best of what is working well within EMS practice as we move toward a scope

of practice model that more parallels other health care professionals. "

I get the sense that people are just so paralyzed with fear about this that

they make outrageous claims about the impending doom and gloom without

trying to take part in the process in order to shape something that is more

palatable to them. " That's the way things should be because that's the way

we've always done them. " I just hope that its not obstruction of progress

merely for the sake of obstruction.

Warmest Regards,

Lancaster

[Guest guest]

,

Do a google search on the NSCOP model. Here is just one link I found. I

think this will have a more profound result on EMS that what most think. We

have

a shortage of medics now. The way I read it there will be regional schools

only and most on Texas would be on the metroplex area. I feel like I'm down

wind from Three Mile Island. Looks good at first but what about long term. Six

months ago I had never heard of NCoP. I never thought Texas would go to

NREMT testing or that TDH as we new would go away.

Barry Meffert

Blackwell

http://216.239.39.104/search?q=cache:x7uUZSeS5t4J:www.wisconsinems.com/docs/Sc

ope%2520of%2520Practice%2520Statement.doc+National+Scope+of+Practice & hl=en & ie=

UTF-8

In a message dated 12/2/2004 4:36:19 AM Central Standard Time,

scotterems@... writes:

Gene,

As much as I enjoyed reading your impassioned (yet cynical) tirade, I can't

say that I agree with most of what you said. Assertions such as " Paramedics

will be doing little more than EMT-Intermediates do now " really make me

wonder if you take us for illiterate fools or if you are just playing the

good demagogue. Unless you consider the only distinguishing characteristics

of paramedic practice to be RSI, surgical airways, and a whole bunch of

other things that you probably don't even do right now, that is patently

untrue. In an event, such tendency toward exaggeration doesn't help your

case one bit in my book. I see many positive things in the Scope of

Practice proposal, including more stringent educational requirements and

true licensure. On the other hand, I am concerned by the fact that a plan

for a smooth transition has not yet been brought forward, and that the

elimination of the EMT-I designation could have an adverse effect on rural

services.

On the whole, I think there is more good than bad. Let's face it. Right

now, there is absolutely no incentive for someone to get an Associates or

Bachelors degree in EMS if that person cannot then provide a higher level of

care. Why? Because as long as the local family practice M.D. signs off on

it, someone who went to class at night for nine months can do the exact same

thing. And in a world where librarians are getting Masters degrees... well,

don't even get me started.

I found the document to be very conciliatory, and it doesn't appear to me

like they are just trying to ram this through. In fact, they asked for

feedback as to whether there is a need for an advanced provider, whether a

resolution to the reimbursement issue is feasible, etc. " The National EMS

Scope of Practice Model Task Force intends for this document to be

'evolutionary' rather than 'revolutionary'. It is important to preserve the

best of what is working well within EMS practice as we move toward a scope

of practice model that more parallels other health care professionals. "

I get the sense that people are just so paralyzed with fear about this that

they make outrageous claims about the impending doom and gloom without

trying to take part in the process in order to shape something that is more

palatable to them. " That's the way things should be because that's the way

we've always done them. " I just hope that its not obstruction of progress

merely for the sake of obstruction.

Warmest Regards,

Lancaster

[Guest guest]

,

With total respect, I ask who you are affliated with and your level of EMS

certification along with where in Texas you work. I ask only because I don't

remember you posting in the past and because your post is the only one I have

seen that half way supports the SOP. Generally, I just like to know who I am

listening to.

Henry Barber

scotterems@... wrote:

> Gene,

>

> As much as I enjoyed reading your impassioned (yet cynical) tirade, I can't

> say that I agree with most of what you said. Assertions such as " Paramedics

> will be doing little more than EMT-Intermediates do now " really make me

> wonder if you take us for illiterate fools or if you are just playing the

> good demagogue. Unless you consider the only distinguishing characteristics

> of paramedic practice to be RSI, surgical airways, and a whole bunch of

> other things that you probably don't even do right now, that is patently

> untrue. In an event, such tendency toward exaggeration doesn't help your

> case one bit in my book. I see many positive things in the Scope of

> Practice proposal, including more stringent educational requirements and

> true licensure. On the other hand, I am concerned by the fact that a plan

> for a smooth transition has not yet been brought forward, and that the

> elimination of the EMT-I designation could have an adverse effect on rural

> services.

>

> On the whole, I think there is more good than bad. Let's face it. Right

> now, there is absolutely no incentive for someone to get an Associates or

> Bachelors degree in EMS if that person cannot then provide a higher level of

> care. Why? Because as long as the local family practice M.D. signs off on

> it, someone who went to class at night for nine months can do the exact same

> thing. And in a world where librarians are getting Masters degrees... well,

> don't even get me started.

> I found the document to be very conciliatory, and it doesn't appear to me

> like they are just trying to ram this through. In fact, they asked for

> feedback as to whether there is a need for an advanced provider, whether a

> resolution to the reimbursement issue is feasible, etc. " The National EMS

> Scope of Practice Model Task Force intends for this document to be

> 'evolutionary' rather than 'revolutionary'. It is important to preserve the

> best of what is working well within EMS practice as we move toward a scope

> of practice model that more parallels other health care professionals. "

> I get the sense that people are just so paralyzed with fear about this that

> they make outrageous claims about the impending doom and gloom without

> trying to take part in the process in order to shape something that is more

> palatable to them. " That's the way things should be because that's the way

> we've always done them. " I just hope that its not obstruction of progress

> merely for the sake of obstruction.

> Warmest Regards,

> Lancaster

>

>

>

>

[Guest guest]

,

With total respect, I ask who you are affliated with and your level of EMS

certification along with where in Texas you work. I ask only because I don't

remember you posting in the past and because your post is the only one I have

seen that half way supports the SOP. Generally, I just like to know who I am

listening to.

Henry Barber

scotterems@... wrote:

> Gene,

>

> As much as I enjoyed reading your impassioned (yet cynical) tirade, I can't

> say that I agree with most of what you said. Assertions such as " Paramedics

> will be doing little more than EMT-Intermediates do now " really make me

> wonder if you take us for illiterate fools or if you are just playing the

> good demagogue. Unless you consider the only distinguishing characteristics

> of paramedic practice to be RSI, surgical airways, and a whole bunch of

> other things that you probably don't even do right now, that is patently

> untrue. In an event, such tendency toward exaggeration doesn't help your

> case one bit in my book. I see many positive things in the Scope of

> Practice proposal, including more stringent educational requirements and

> true licensure. On the other hand, I am concerned by the fact that a plan

> for a smooth transition has not yet been brought forward, and that the

> elimination of the EMT-I designation could have an adverse effect on rural

> services.

>

> On the whole, I think there is more good than bad. Let's face it. Right

> now, there is absolutely no incentive for someone to get an Associates or

> Bachelors degree in EMS if that person cannot then provide a higher level of

> care. Why? Because as long as the local family practice M.D. signs off on

> it, someone who went to class at night for nine months can do the exact same

> thing. And in a world where librarians are getting Masters degrees... well,

> don't even get me started.

> I found the document to be very conciliatory, and it doesn't appear to me

> like they are just trying to ram this through. In fact, they asked for

> feedback as to whether there is a need for an advanced provider, whether a

> resolution to the reimbursement issue is feasible, etc. " The National EMS

> Scope of Practice Model Task Force intends for this document to be

> 'evolutionary' rather than 'revolutionary'. It is important to preserve the

> best of what is working well within EMS practice as we move toward a scope

> of practice model that more parallels other health care professionals. "

> I get the sense that people are just so paralyzed with fear about this that

> they make outrageous claims about the impending doom and gloom without

> trying to take part in the process in order to shape something that is more

> palatable to them. " That's the way things should be because that's the way

> we've always done them. " I just hope that its not obstruction of progress

> merely for the sake of obstruction.

> Warmest Regards,

> Lancaster

>

>

>

>

[Guest guest]

,

With total respect, I ask who you are affliated with and your level of EMS

certification along with where in Texas you work. I ask only because I don't

remember you posting in the past and because your post is the only one I have

seen that half way supports the SOP. Generally, I just like to know who I am

listening to.

Henry Barber

scotterems@... wrote:

> Gene,

>

> As much as I enjoyed reading your impassioned (yet cynical) tirade, I can't

> say that I agree with most of what you said. Assertions such as " Paramedics

> will be doing little more than EMT-Intermediates do now " really make me

> wonder if you take us for illiterate fools or if you are just playing the

> good demagogue. Unless you consider the only distinguishing characteristics

> of paramedic practice to be RSI, surgical airways, and a whole bunch of

> other things that you probably don't even do right now, that is patently

> untrue. In an event, such tendency toward exaggeration doesn't help your

> case one bit in my book. I see many positive things in the Scope of

> Practice proposal, including more stringent educational requirements and

> true licensure. On the other hand, I am concerned by the fact that a plan

> for a smooth transition has not yet been brought forward, and that the

> elimination of the EMT-I designation could have an adverse effect on rural

> services.

>

> On the whole, I think there is more good than bad. Let's face it. Right

> now, there is absolutely no incentive for someone to get an Associates or

> Bachelors degree in EMS if that person cannot then provide a higher level of

> care. Why? Because as long as the local family practice M.D. signs off on

> it, someone who went to class at night for nine months can do the exact same

> thing. And in a world where librarians are getting Masters degrees... well,

> don't even get me started.

> I found the document to be very conciliatory, and it doesn't appear to me

> like they are just trying to ram this through. In fact, they asked for

> feedback as to whether there is a need for an advanced provider, whether a

> resolution to the reimbursement issue is feasible, etc. " The National EMS

> Scope of Practice Model Task Force intends for this document to be

> 'evolutionary' rather than 'revolutionary'. It is important to preserve the

> best of what is working well within EMS practice as we move toward a scope

> of practice model that more parallels other health care professionals. "

> I get the sense that people are just so paralyzed with fear about this that

> they make outrageous claims about the impending doom and gloom without

> trying to take part in the process in order to shape something that is more

> palatable to them. " That's the way things should be because that's the way

> we've always done them. " I just hope that its not obstruction of progress

> merely for the sake of obstruction.

> Warmest Regards,

> Lancaster

>

>

>

>

[Guest guest]

Gene is right. The SoP as it is now laid out will not help EMS in Texas.

Let's look at it this way: IN order to be a " real " Paramedic under the SoP,

you will be required to hold a bachelor's degree. That's well and good if

you are young and single, and living at home; have grants or what-not. What

happens to the guys that have been in EMS 20+ years and have families and

work every day and can't afford to go to college or back to college (you

know the type - spouse stays at home to care for their 2.3 kids, lots of

medical bills, a live-in elderly relative, tight finances). What happens to

those medics? They are no longer " worthy " to perform skills they have

perfected? They are no longer a Paramedic?

And what about no-riding a patient based upon your judgment? Are we

suddenly too stupid to know a guy with a bruised elbow or a kid with a

scraped knee (NO OTHER SYMPTOMS/INJURIES) doesn't need an MICU transport to

a Level I Trauma Center? Under the SoP, unless you are an " advanced care

paramedic " , you are. Even an EMT-B first responder won't be able to

disregard a unit when NO INJURIES are apparent, but a police officer with no

medical training can (but won't due to liability). Code III response for NO

injuries (risking a wreck as always), for refusals your first responders

could have written. Sounds kinda like where I started out, where a Basic

couldn't even call for the helicopter, but the Fire Chief (with NO medical

training, mind you) who doesn't like " meat wagons " and " stretcher fetchers "

could.

What about rural services and the citizens they help? Are they now no

longer worthy to provide the care they once provided? What about those

citizens, do they no longer deserve the high standard of care they were

receiving?

How many people will be willing to ride on an ambulance for what they now

get after fighting to get a bachelor's degree? I know several who said they

would NOT be willing to slog through the mud, blood and beer for a pittance

when they could apply that BA/BS (or whatever) to a higher-paying clinical

position. I don't blame them at all. I would be looking for that cozy,

dry, inside-a-building job myself.

There isn't enough money in EMS, especially in the rural setting, to afford

the fancy stuff this SoP is going to put on Texas pre-hospital care. How

many services have the income to pay for $70K/year STARTING salaries now?

It will only get WORSE after the new Medicare EMS reimbursement schedule

goes into effect. Private insurance will follow Medicare's lead, as will

Medicaid. Would your service like to hire collection agencies to drain dry

your already broke patients? How about getting some " knee cappers "

(pinstriped suits, no necks, named Luigi and Tony, or Seamus and ) to

force your customers to pay what Medicare/insurance won't, even going so far

as to place liens on property to get the money to pay for these " SUPER

MEDICS " you now need, in order to provide the same care you provided the

year before? I bet sending collection agencies after Granny, and after Lucy

and her 5 children will do wonders for your PR. You'll have to do so, in

order afford " real " Paramedics under the SoP, coupled with the new Medicare

reimbursement schedule.

How many times have you had a shift full of calls that were MICU-level, and

you FINALLY had a patient you could release to your EMT-I partner (needs an

IV, or Albuterol, let's say)? Guess what - you don't have an EMT-I partner

any more. It's just you and a Basic, thanks to SoP. There goes report

number 12 to write. What about the rural service that only has enough

Paramedics to cover their line units, and the off-duty Paramedics are out of

town. Another call (or two) drops, and they recall off-duty personnel to

cover the reserve truck(s). Oops, sorry Grandma, you're gonna die because

we no longer have EMT-I's that we had last month to cover, because they no

longer exist! Sorry about that blood sugar of 40 we can't fix, since all

our Medics are out of town or busy, since we can't start that IV and can't

give you D50 (and Oh boy!), it's RAINING and the helicopter service can't

fly! I guess you don't deserve the best possible care, and are stroke out

and die, because you live in East Podunk. Too bad. If you live, maybe you

should move to San or Austin.

Am I overstating a little? Maybe a little bit.

Is the SoP a threat to Texas EMS as we know it? Yes.

Do we need to do SOMETHING to prevent the rape of Texas EMS and the

destruction of the BEST pre-hospital care system in the USA? Yes.

Is it too late to do something? Probably, but I'm not going down without a

fight. But it's a good thing I know how to be a bartender - retirement may

be coming a lot sooner for me than I expected.

Stay Safe,

Barry E. McClung, Paramedic/Crew Chief

North Blanco County EMS

City, Texas

_____

From: wegandy1938@...

Sent: Thursday, 02 December, 2004 02:59

To: Asclapius@...;

Subject: Re: Re: Scope of Practice

Well, Alfonso,

It will prevent your medical director from being able to determine what

skills you'll be able to perform.

[Guest guest]

Gene is right. The SoP as it is now laid out will not help EMS in Texas.

Let's look at it this way: IN order to be a " real " Paramedic under the SoP,

you will be required to hold a bachelor's degree. That's well and good if

you are young and single, and living at home; have grants or what-not. What

happens to the guys that have been in EMS 20+ years and have families and

work every day and can't afford to go to college or back to college (you

know the type - spouse stays at home to care for their 2.3 kids, lots of

medical bills, a live-in elderly relative, tight finances). What happens to

those medics? They are no longer " worthy " to perform skills they have

perfected? They are no longer a Paramedic?

And what about no-riding a patient based upon your judgment? Are we

suddenly too stupid to know a guy with a bruised elbow or a kid with a

scraped knee (NO OTHER SYMPTOMS/INJURIES) doesn't need an MICU transport to

a Level I Trauma Center? Under the SoP, unless you are an " advanced care

paramedic " , you are. Even an EMT-B first responder won't be able to

disregard a unit when NO INJURIES are apparent, but a police officer with no

medical training can (but won't due to liability). Code III response for NO

injuries (risking a wreck as always), for refusals your first responders

could have written. Sounds kinda like where I started out, where a Basic

couldn't even call for the helicopter, but the Fire Chief (with NO medical

training, mind you) who doesn't like " meat wagons " and " stretcher fetchers "

could.

What about rural services and the citizens they help? Are they now no

longer worthy to provide the care they once provided? What about those

citizens, do they no longer deserve the high standard of care they were

receiving?

How many people will be willing to ride on an ambulance for what they now

get after fighting to get a bachelor's degree? I know several who said they

would NOT be willing to slog through the mud, blood and beer for a pittance

when they could apply that BA/BS (or whatever) to a higher-paying clinical

position. I don't blame them at all. I would be looking for that cozy,

dry, inside-a-building job myself.

There isn't enough money in EMS, especially in the rural setting, to afford

the fancy stuff this SoP is going to put on Texas pre-hospital care. How

many services have the income to pay for $70K/year STARTING salaries now?

It will only get WORSE after the new Medicare EMS reimbursement schedule

goes into effect. Private insurance will follow Medicare's lead, as will

Medicaid. Would your service like to hire collection agencies to drain dry

your already broke patients? How about getting some " knee cappers "

(pinstriped suits, no necks, named Luigi and Tony, or Seamus and ) to

force your customers to pay what Medicare/insurance won't, even going so far

as to place liens on property to get the money to pay for these " SUPER

MEDICS " you now need, in order to provide the same care you provided the

year before? I bet sending collection agencies after Granny, and after Lucy

and her 5 children will do wonders for your PR. You'll have to do so, in

order afford " real " Paramedics under the SoP, coupled with the new Medicare

reimbursement schedule.

How many times have you had a shift full of calls that were MICU-level, and

you FINALLY had a patient you could release to your EMT-I partner (needs an

IV, or Albuterol, let's say)? Guess what - you don't have an EMT-I partner

any more. It's just you and a Basic, thanks to SoP. There goes report

number 12 to write. What about the rural service that only has enough

Paramedics to cover their line units, and the off-duty Paramedics are out of

town. Another call (or two) drops, and they recall off-duty personnel to

cover the reserve truck(s). Oops, sorry Grandma, you're gonna die because

we no longer have EMT-I's that we had last month to cover, because they no

longer exist! Sorry about that blood sugar of 40 we can't fix, since all

our Medics are out of town or busy, since we can't start that IV and can't

give you D50 (and Oh boy!), it's RAINING and the helicopter service can't

fly! I guess you don't deserve the best possible care, and are stroke out

and die, because you live in East Podunk. Too bad. If you live, maybe you

should move to San or Austin.

Am I overstating a little? Maybe a little bit.

Is the SoP a threat to Texas EMS as we know it? Yes.

Do we need to do SOMETHING to prevent the rape of Texas EMS and the

destruction of the BEST pre-hospital care system in the USA? Yes.

Is it too late to do something? Probably, but I'm not going down without a

fight. But it's a good thing I know how to be a bartender - retirement may

be coming a lot sooner for me than I expected.

Stay Safe,

Barry E. McClung, Paramedic/Crew Chief

North Blanco County EMS

City, Texas

_____

From: wegandy1938@...

Sent: Thursday, 02 December, 2004 02:59

To: Asclapius@...;

Subject: Re: Re: Scope of Practice

Well, Alfonso,

It will prevent your medical director from being able to determine what

skills you'll be able to perform.

[Guest guest]

Gene is right. The SoP as it is now laid out will not help EMS in Texas.

Let's look at it this way: IN order to be a " real " Paramedic under the SoP,

you will be required to hold a bachelor's degree. That's well and good if

you are young and single, and living at home; have grants or what-not. What

happens to the guys that have been in EMS 20+ years and have families and

work every day and can't afford to go to college or back to college (you

know the type - spouse stays at home to care for their 2.3 kids, lots of

medical bills, a live-in elderly relative, tight finances). What happens to

those medics? They are no longer " worthy " to perform skills they have

perfected? They are no longer a Paramedic?

And what about no-riding a patient based upon your judgment? Are we

suddenly too stupid to know a guy with a bruised elbow or a kid with a

scraped knee (NO OTHER SYMPTOMS/INJURIES) doesn't need an MICU transport to

a Level I Trauma Center? Under the SoP, unless you are an " advanced care

paramedic " , you are. Even an EMT-B first responder won't be able to

disregard a unit when NO INJURIES are apparent, but a police officer with no

medical training can (but won't due to liability). Code III response for NO

injuries (risking a wreck as always), for refusals your first responders

could have written. Sounds kinda like where I started out, where a Basic

couldn't even call for the helicopter, but the Fire Chief (with NO medical

training, mind you) who doesn't like " meat wagons " and " stretcher fetchers "

could.

What about rural services and the citizens they help? Are they now no

longer worthy to provide the care they once provided? What about those

citizens, do they no longer deserve the high standard of care they were

receiving?

How many people will be willing to ride on an ambulance for what they now

get after fighting to get a bachelor's degree? I know several who said they

would NOT be willing to slog through the mud, blood and beer for a pittance

when they could apply that BA/BS (or whatever) to a higher-paying clinical

position. I don't blame them at all. I would be looking for that cozy,

dry, inside-a-building job myself.

There isn't enough money in EMS, especially in the rural setting, to afford

the fancy stuff this SoP is going to put on Texas pre-hospital care. How

many services have the income to pay for $70K/year STARTING salaries now?

It will only get WORSE after the new Medicare EMS reimbursement schedule

goes into effect. Private insurance will follow Medicare's lead, as will

Medicaid. Would your service like to hire collection agencies to drain dry

your already broke patients? How about getting some " knee cappers "

(pinstriped suits, no necks, named Luigi and Tony, or Seamus and ) to

force your customers to pay what Medicare/insurance won't, even going so far

as to place liens on property to get the money to pay for these " SUPER

MEDICS " you now need, in order to provide the same care you provided the

year before? I bet sending collection agencies after Granny, and after Lucy

and her 5 children will do wonders for your PR. You'll have to do so, in

order afford " real " Paramedics under the SoP, coupled with the new Medicare

reimbursement schedule.

How many times have you had a shift full of calls that were MICU-level, and

you FINALLY had a patient you could release to your EMT-I partner (needs an

IV, or Albuterol, let's say)? Guess what - you don't have an EMT-I partner

any more. It's just you and a Basic, thanks to SoP. There goes report

number 12 to write. What about the rural service that only has enough

Paramedics to cover their line units, and the off-duty Paramedics are out of

town. Another call (or two) drops, and they recall off-duty personnel to

cover the reserve truck(s). Oops, sorry Grandma, you're gonna die because

we no longer have EMT-I's that we had last month to cover, because they no

longer exist! Sorry about that blood sugar of 40 we can't fix, since all

our Medics are out of town or busy, since we can't start that IV and can't

give you D50 (and Oh boy!), it's RAINING and the helicopter service can't

fly! I guess you don't deserve the best possible care, and are stroke out

and die, because you live in East Podunk. Too bad. If you live, maybe you

should move to San or Austin.

Am I overstating a little? Maybe a little bit.

Is the SoP a threat to Texas EMS as we know it? Yes.

Do we need to do SOMETHING to prevent the rape of Texas EMS and the

destruction of the BEST pre-hospital care system in the USA? Yes.

Is it too late to do something? Probably, but I'm not going down without a

fight. But it's a good thing I know how to be a bartender - retirement may

be coming a lot sooner for me than I expected.

Stay Safe,

Barry E. McClung, Paramedic/Crew Chief

North Blanco County EMS

City, Texas

_____

From: wegandy1938@...

Sent: Thursday, 02 December, 2004 02:59

To: Asclapius@...;

Subject: Re: Re: Scope of Practice

Well, Alfonso,

It will prevent your medical director from being able to determine what

skills you'll be able to perform.

[Guest guest]

Maxine,

Just to add to your train of thought. Who pays for law enforcement in your

county? Who pays for fire service?

Gandy's theorem: All services must be based upon need.

Gandy's First Corollary to Gandy's Theorem: A service which does not have

enough incidents to support it should cease to exist. Therefore: Unless

there are a sufficient number of fires per year to warrant a FD, it should cease

to exist; unless there is sufficient crime, the law enforcement services

should cease to exist.

Gandy's 2nd Corollary, et cetera: Unless you died during the past year, you

have no need for life insurance; unless you were sick or injured during the

past year, you have no need for health insurance.

GG

>

> In our entire service area of approximately 150

> square miles, there is not a single doctor's

> office.  Why?  I suspect that it is because there is

> not enough business (patients) to provide the

> required/desired financial results.  In other words,

> if the need/desire/customers (patients) don't exist

> that are necessary to support a business, the

> business won't exist.  In other words, if you (or an

> area) can't support or pay for something, you won't

> have it.

>

> Relevant to this discussion or not?  You decide for

> yourselves.  I'm just expressing some rambling

> thoughts.

>

> Maxine Pate

>

> ---- Original message ----

>

>   Date: Fri, 3 Dec 2004 14:42:39 -0600

>   From: " Tinker " jtinker@...

>

>   > Look at nurses, docs, etc. They

>   have standardization. They are strong and >they

>   get paid a hell of a lot better than we do and

>   they get treated better too.

>

>

>

[Guest guest]

Maxine,

Just to add to your train of thought. Who pays for law enforcement in your

county? Who pays for fire service?

Gandy's theorem: All services must be based upon need.

Gandy's First Corollary to Gandy's Theorem: A service which does not have

enough incidents to support it should cease to exist. Therefore: Unless

there are a sufficient number of fires per year to warrant a FD, it should cease

to exist; unless there is sufficient crime, the law enforcement services

should cease to exist.

Gandy's 2nd Corollary, et cetera: Unless you died during the past year, you

have no need for life insurance; unless you were sick or injured during the

past year, you have no need for health insurance.

GG

>

> In our entire service area of approximately 150

> square miles, there is not a single doctor's

> office.  Why?  I suspect that it is because there is

> not enough business (patients) to provide the

> required/desired financial results.  In other words,

> if the need/desire/customers (patients) don't exist

> that are necessary to support a business, the

> business won't exist.  In other words, if you (or an

> area) can't support or pay for something, you won't

> have it.

>

> Relevant to this discussion or not?  You decide for

> yourselves.  I'm just expressing some rambling

> thoughts.

>

> Maxine Pate

>

> ---- Original message ----

>

>   Date: Fri, 3 Dec 2004 14:42:39 -0600

>   From: " Tinker " jtinker@...

>

>   > Look at nurses, docs, etc. They

>   have standardization. They are strong and >they

>   get paid a hell of a lot better than we do and

>   they get treated better too.

>

>

>

[Guest guest]

Maxine,

Just to add to your train of thought. Who pays for law enforcement in your

county? Who pays for fire service?

Gandy's theorem: All services must be based upon need.

Gandy's First Corollary to Gandy's Theorem: A service which does not have

enough incidents to support it should cease to exist. Therefore: Unless

there are a sufficient number of fires per year to warrant a FD, it should cease

to exist; unless there is sufficient crime, the law enforcement services

should cease to exist.

Gandy's 2nd Corollary, et cetera: Unless you died during the past year, you

have no need for life insurance; unless you were sick or injured during the

past year, you have no need for health insurance.

GG

>

> In our entire service area of approximately 150

> square miles, there is not a single doctor's

> office.  Why?  I suspect that it is because there is

> not enough business (patients) to provide the

> required/desired financial results.  In other words,

> if the need/desire/customers (patients) don't exist

> that are necessary to support a business, the

> business won't exist.  In other words, if you (or an

> area) can't support or pay for something, you won't

> have it.

>

> Relevant to this discussion or not?  You decide for

> yourselves.  I'm just expressing some rambling

> thoughts.

>

> Maxine Pate

>

> ---- Original message ----

>

>   Date: Fri, 3 Dec 2004 14:42:39 -0600

>   From: " Tinker " jtinker@...

>

>   > Look at nurses, docs, etc. They

>   have standardization. They are strong and >they

>   get paid a hell of a lot better than we do and

>   they get treated better too.

>

>

>

[Guest guest]

Kenny,

[Guest guest]

Kenny,

[Guest guest]

Kenny,

[Guest guest]

Kenny,

I would like to engage you in a little debate. Please address the questions

that I have placed into the body of your post. And thanks for providing a

different perspective that we can debate.

Best,

GG

In a message dated 12/3/04 11:41:55, kenneth.navarro@...

writes:

>

>

> >> Kenny, You are among the few.  <<

>

> There are more of us than you know.

>

What do you think the ratio of supporters vs. those opposed is? I'm sure

that all your colleagues support it, but who else does?

>

>

> >>  Texas does NOT NEED a SOP, as it would only bring the level of

> care EMS provides in Texas down to an ECA level of care for ALL

> levels of care. <<

>

> Could it be that I have a different draft of the National Scope of

> Practice?  The document I'm reading does not limit all care within

> the state of Texas to the ECA level. 

>

Correct. Somebody is misreading.

> I still see a paramedic

> category with providers who function as they do today.

>

> Aha. There's the rub. You see, paramedic practice as you're familiar with

it in the urban area you serve would not be affected much. It is in those

places where paramedics are now functioning far above that level who would be

affected. So you seem to want to " dumb down " paramedic practice except as

it's carried on in your urban area, right? Or not? Please address that

issue.

>

> >> It shows that you are a College because this would make your

> collge more money, as you would have to provide the advanced

> education for those that would want to spend the money on a degree.<<

>

That, to me, is beside the point. It's the economics of getting a degree

that's worthless for generating a decent living that's the point.

>

> If no one will invest the years to acquire the education (as has

> been proposed by various members of this listerver), then who is

> going to come to " my " school?  There will still be a paramedic

> category with the new SOP and most EMS providers will still attend

> that type of class.

>

Once again, those paramedic providers will be providing a standard of care

that is far below what is needed in rural and frontier areas.

>

> BTW, " my " school could already offer a 4-year degree in EMS, as

> could many colleges.  We wouldn't need a National Scope of Practice

> for that.

>

So why doesn't your institution offer a 4 year BS in EMS or Paramedicine?

Who's knocking down your door asking for it?

>

> Regardless of the tone of some of the messages posted here, the EMS

> sky is not falling.

>

Of course the sky is not falling, but unless the EMS community wakes up, the

secret cabal of those who are trying to foist this off on us will be

successful. We'll wake up with a set of rules that will decimate rural EMS in

Texas.

This debate has been good, one of the best that has ever happened in Texas

EMS.

We all have our own particular interests. The interests of Dallas FD and UT

Southwest's EMS program are not those of the vast majority of us in other

parts of the state, now are they? Would you concede that the document fails to

address the needs of rural and frontier providers? Are you aware that the

overwhelming majority of comments from providers in rural states has been

against the document?

Finally, do you agree with me that the SoP document fails to address the

changes that will be necessary in EMS reimbursement for the goals set forth in

the document to be achieved? Do you have any insights as to how, if the SoP

were adopted as written, the economics of EMS would ever change in such a way

as to encourage anyone to get an advanced degree in EMS?

Let's debate these issues. I would love to wake up tomorrow and find that

if I could get a BS in EMS I could start to work at $30.00 an hour, the current

average for entry level RNs in California. I'd be completing those courses

quicker than a Texan can open a beer. How do we make that happen?

Advanced practice Bachelor Degreed Paramedics are a figment of the

imagination unless a pay structure exists to support them. It does not exist,

and I,

for the life of me, cannot see how it is going to emerge given the current

fiscal environment in government and in reimbursement in medical care. Do you

see it? If so, what's your vision for how it will occur?

Gene G.

>

> Kenny Navarro

>

>

>

>

>

>

>

>

[Guest guest]

After reading Gene's response and reading the Scope of Practice Draft

for myself, I feel that this could be the shining light for EMS.

Before I get flamed, allow me to explain myself. I believe that the

lack of respect garnered by EMS personnel can be due in part to a lack

of education. In this day and age, a piece of paper from an

accredited college/university either goes a long way or is required.

The more hoops a paramedic candidate is required to jump through will

make that person much more marketable when s/he finishes the program.

Granted, there are certain issues that need to be worked out like the

average salary for an advanced practice paramedic.

In response to this gentleman's remarks about the rural/frontier

areas, I say this: doctors and nurses working in these areas are

required at the bare minimum a college degree (more for doctors, of

course) and be licensed by the state to work even in these areas. Why

shouldn't paramedics be held to the same standard?

Any comments, remarks, opinions, etc. are very welcome in this ongoing

debate.

Regards,

Alfonso R. Ochoa

> >> With total respect, I ask who you are affliated with and your

> >level of EMS certification along with where in Texas you work. I ask

> >only because I don't remember you posting in the past and because

> >your post is the only one I have seen that half way supports the

> >SOP. <

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Though I cannot read the minds of those who wrote the document in question,

I do wonder why it was written in the first place?

[Guest guest]

Though I cannot read the minds of those who wrote the document in question,

I do wonder why it was written in the first place?

[Guest guest]

Though I cannot read the minds of those who wrote the document in question,

I do wonder why it was written in the first place?

[Guest guest]

Continuing on with the train of thought:

Our local PD badly needs a couple of more

officers--It's not unusual for there to be only one

officer on duty--but there's no money for more in

the current budget. The area FDs are all

volunteer--the operating expenses and capital

expenditures are paid for with tax dollars or

through a lot of fundraising on the part of the

volunteers.

Do I pay my taxes? You bet! Do I support the

fundraising efforts? You bet! Do I make sure that

LE and FD know that I understand the problems they

face and appreciate what they do? You bet! Do I

wish the FD had newer equipment and more personnel?

You bet! Do I wish the PD could hire more

officers? You bet! Do I want my taxes to go up to

make all this possible? It's not so easy to say

" You bet! " to that--I'd rather see the mayor's

salary go down!

Who pays? Be it LE or FD or EMS, or even goods and

services we purchase from private businesses,

ultimately it's the taxpayer/consumer that pays--you

and me. Whether our EMS bills are paid by

government programs (Medicare, Medicaid, etc),

insurance, or the patient, it's the

taxpayer/consumer that pays. Even when the bill

does not get paid at all, the taxpayer/consumer pays

because the less we receive in payments the more we

need from tax dollars.

Folks, the taxpayer/consumer is US! I can't speak

for the rest of you, but this taxpayer has just

about reached the limit of what she is willing and

able to pay. I don't expect to have what I can't

afford to pay for. I don't expect government to

supply everything I think I need or want, because I

don't expect YOU to support ME.

There's been (rightfully so) much discussion about

higher education, various levels of certification/

licensure, and the desired resultant higher

salaries. Believe me, I have no problem with higher

education or with higher salaries--you can put my

name and those of my coworkers at the top of the

list of those who want and deserve better pay.

However, no one has yet figured out where the money

will come from. There's been much talk about a need

for increased payments from Medicare, Medicaid, and

insurance and increased funding from tax sources.

Ultimately, what that actually means is that YOU and

ME will pay, and sometimes " YOU and ME " just flat

can't pay any more.

Enough of my rambling thoughts for now. Next?

Maxine

---- Original message ----

Date: Fri, 3 Dec 2004 22:05:40 EST

From: wegandy1938@...

Subject: Re: Re: Scope of Practice

To: bpate717@...,

> Maxine,

>

> Just to add to your train of thought. Who pays

for

> law enforcement in your

> county? Who pays for fire service?

>

> Gandy's theorem: All services must be based upon

> need.

> Gandy's First Corollary to Gandy's Theorem: A

> service which does not have

> enough incidents to support it should cease to

> exist. Therefore: Unless

> there are a sufficient number of fires per year

to

> warrant a FD, it should cease

> to exist; unless there is sufficient crime, the

law

> enforcement services

> should cease to exist.

> Gandy's 2nd Corollary, et cetera: Unless you

died

> during the past year, you

> have no need for life insurance; unless you were

> sick or injured during the

> past year, you have no need for health

insurance.

>

> GG

>

[Guest guest]

Continuing on with the train of thought:

Our local PD badly needs a couple of more

officers--It's not unusual for there to be only one

officer on duty--but there's no money for more in

the current budget. The area FDs are all

volunteer--the operating expenses and capital

expenditures are paid for with tax dollars or

through a lot of fundraising on the part of the

volunteers.

Do I pay my taxes? You bet! Do I support the

fundraising efforts? You bet! Do I make sure that

LE and FD know that I understand the problems they

face and appreciate what they do? You bet! Do I

wish the FD had newer equipment and more personnel?

You bet! Do I wish the PD could hire more

officers? You bet! Do I want my taxes to go up to

make all this possible? It's not so easy to say

" You bet! " to that--I'd rather see the mayor's

salary go down!

Who pays? Be it LE or FD or EMS, or even goods and

services we purchase from private businesses,

ultimately it's the taxpayer/consumer that pays--you

and me. Whether our EMS bills are paid by

government programs (Medicare, Medicaid, etc),

insurance, or the patient, it's the

taxpayer/consumer that pays. Even when the bill

does not get paid at all, the taxpayer/consumer pays

because the less we receive in payments the more we

need from tax dollars.

Folks, the taxpayer/consumer is US! I can't speak

for the rest of you, but this taxpayer has just

about reached the limit of what she is willing and

able to pay. I don't expect to have what I can't

afford to pay for. I don't expect government to

supply everything I think I need or want, because I

don't expect YOU to support ME.

There's been (rightfully so) much discussion about

higher education, various levels of certification/

licensure, and the desired resultant higher

salaries. Believe me, I have no problem with higher

education or with higher salaries--you can put my

name and those of my coworkers at the top of the

list of those who want and deserve better pay.

However, no one has yet figured out where the money

will come from. There's been much talk about a need

for increased payments from Medicare, Medicaid, and

insurance and increased funding from tax sources.

Ultimately, what that actually means is that YOU and

ME will pay, and sometimes " YOU and ME " just flat

can't pay any more.

Enough of my rambling thoughts for now. Next?

Maxine

---- Original message ----

Date: Fri, 3 Dec 2004 22:05:40 EST

From: wegandy1938@...

Subject: Re: Re: Scope of Practice

To: bpate717@...,

> Maxine,

>

> Just to add to your train of thought. Who pays

for

> law enforcement in your

> county? Who pays for fire service?

>

> Gandy's theorem: All services must be based upon

> need.

> Gandy's First Corollary to Gandy's Theorem: A

> service which does not have

> enough incidents to support it should cease to

> exist. Therefore: Unless

> there are a sufficient number of fires per year

to

> warrant a FD, it should cease

> to exist; unless there is sufficient crime, the

law

> enforcement services

> should cease to exist.

> Gandy's 2nd Corollary, et cetera: Unless you

died

> during the past year, you

> have no need for life insurance; unless you were

> sick or injured during the

> past year, you have no need for health

insurance.

>

> GG

>

[Guest guest]

Would it be sufficient to add a level of Paramedic between the SoP levels of

Paramedic and Advanced level Paramedic, and allow that level to function at

what we do now?

If we change the names to Paramedic I, II, and III; level I being the

Paramedic described in the SoP, level III being the Advanced Practice

Paramedic described in the SoP, and add level II.

Paramedic II, Build upon the foundation of the Paramedic I, and add the

special skills that are being requested by the more rural departments.

important to note that those services not wishing to utilize the Paramedic

II level, can always upgrade their services by training their staff. This

level of paramedic has the training necessary to perform the follwowing

skills, including, but not limited to, RSI, initiate and maintain blood

products, retrograde intubation, and the use of colloid solutions. Further,

with additional training which is offered according to nationally accepted

standards, needed skills could be authorized by Medical Directors, offering

the autonomy that we are looking for. A ceiling may be needed here. Create a

list of 'special skills' and set forth a minimum requirement for annual

training, based upon nationally accepted standards.

paramedic I will placate the large metro areas and the large FD based EMS

services looking to offer lower MICU level or tiered response. Advanced

practice stays in to placate the colleges and universities, and level II

will allow the rural areas to continue to offer what they now consider the

minimum acceptable standard of care.

Medical Directors still have autonomy TO A DEGREE, just as they do now.

Education is the key to this, minimum standards MUST BE MET. CE programs and

educational opportunities must be brought up to nationally accepted

standards. Skills training and evaluation must be according to a nationally

accepted standard. higher education is in the air, but level II could

probably be lsited as an AS degree while level III could easily be defined

as a BS degree.

Education is the key, and the sticking point, the further out of town we

get, the more training we need, the more training we need, the more

education we need, the more education we need, the more money we need, yet

the further we are from town, the less money there is to spend, vicous

circle.

I don't particularly like the prohbited skills verbiage, there is just

something I don't like about it. May be the fact that I just can't stand

being told I 'can't' do something (boy would my mother be proud to hear me

finally admit that). But in reality, some ceiling must be made. As

Paramedics, we don't suture in the field, why are we afraid to put that in

writing? It's walking on eggshells to get everyone to agree, but it might

need to be done.

OK, OK, probably not as creative as Mr. Bledson, but it's an alternative.

Right now, that's what we need, we all agree that there are specific

problems with the SoP, but we need to make some quick movement in getting

our opinions known, as well as any suggestions that we have.

Mike