Scope of Practice

December 1, 2004

Well, Alfonso,

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

skills you'll be able to perform.

Unless you have a Bachelor's degree specifically in EMS, you will not be able

to perform any advanced Paramedic skills such as RSI, surgical airways,

administering certain drugs, making a transfer with certain drips running,

employing a ventilator in your transports, or even no-riding a patient based

upon your

judgment.

You will be limited to performing those skills set forth in the scope of

practice rule, no matter what your medical director wants you to do, you will

not

be able to even teach skills outside the scope of practice, you will be

subject to NATIONAL control, not state control, if you step out of line in

teaching

or practice, you can lose your certificate or license, there will be no more

EMT-Intermediates in Texas, no more ECAs, and a lot more stuff that will impact

you.

Please go to the websites and read the scope of practice model in its

entirety. Then see if this is what you want to have in place in Texas. If it

comes into Texas, it will be a giant step backward for all of us.

We will in essence lose local control and be subject to control from

invisible folks living in places like Washington, DC, Pittsburg, PA, and who

know

where else.

I am, today, in Sacramento, California. California has always had a

legislated scope of practice. EMS service SUCKS in California. It is so tied

up

in bureaucratic bull that the kind of service we routinely supply in Texas

almost never happens in California.

Adoption of the Scope of Practice rule will put us squarely in the same place

CA is, with a bureaucratically mandated scope of practice, no local control,

and horrible service.

The people who are pushing this are basically fire department based EMS

people who are now and always have been providing lousy service. They want to

legitimize the level that they are providing and build a wall against having to

ever do better. They know who they are, and they never have the guts to

challenge me on this. They know they cannot make a case for state of the art

service. So they keep their mouths shut.

If the Scope of Practice comes into law in Texas, Paramedics will be doing

little more than EMT-Intermediates do now, and there will be a legal

justification for it.

Much has been said about this SoP providing an opportunity for folks to

achieve advanced degrees and be able to practice as an advanced level. Pie in

the

Sky. Ain't gonna happen. No money for it; no political support for it at

the levels that it's needed, namely, rural.

So those of us who are practicing advanced skills at the rural level will

have to stop, while the big city FD folks can crow that they're STATE of the ART

based upon the limited Paramedic practice they want to have put into place.

Some folks are gonna be awful mad at me for saying that. But believe me,

that's what's at work here. It's all about limiting the scope of practice for

big city fire department EMS services and legitimizing what they do. These

people couldn't care less about what happens in rural areas. It's politics,

son! And politics corrupts almost everybody who gets into it. Nuff said.

There are those who really believe that this is an opportunity for a new

level of paramedic practice to emerge, for us to branch out into primary care,

clinic care delivered on scene, Treat and Street! Utopian. Ain't gonna

happen. No political support for it among those who pay for our services.

Until that happens, SoP will never fly. Now, can we make Treat and Street

happen? Well, why don't you just pick up your phone and call the CEO of

Blue Cross Blue Shield and say, " Hey, buddy, why don't you let us treat patients

on the street, thereby saving you the hospital bills incurred when we

transport them? " Know what he's gonna say? " When the physicians and the

hospital

administrators tell me that's what they want, we'll talk to you. " Until then,

there's no reimbursement for Treat and Street. No reimbursement, it ain't

gonna happen.

They tried this in Red River, New Mexico. It was a resounding failure.

They couldn't figure out a way to get compensated for what they did. So it

went away.

Physicians who are out in front of their brethren tell me that eventually

this will come to pass. But it ain't gonna happen in my lifetime. Bet ya!

Show me one hospital or one physician who will tell you that they'd rather you

stitch up that little laceration, do that little test for strep and give 'em a

scrip for amoxicillin, so that they don't have to see them, and I'll buy you

the biggest steak dinner in Austin. Ain't gonna happen. Not now, not in 10

years. Maybe in 20 years.

So, you say, we have to start somewhere. OK, let's start, but let's not

throw the backstrap out with the guts. We must maintain the good things we

have going while we try to encourage the changes that need to happen.

The SoP Model is NOT the vehicle for that. Yes, it will be a great

improvement for New Jersey, Rhode Island, and some other places where they're

where we

were 20 years ago. But we don't need it.

Texas EMS ain't broke, at least as far as scope of practice is concerned.

Yes, it's broke in the regulatory system. Regulation is CTD (circling the

drain). We better get our own Board or Commission, or we'll be less respected

than the chicken pluckers.

DSHS is hanging on for us in the personages of Kathy, Mr. Janda, Terry B.,

and those remaining troopers who have a clue about EMS. But after the coming

legislature, look for even more wrenching changes. We're in extremis but most

don't know it.

The Great Guru of Scope of Practice, Greg Margolis, also the co-director of

NREMT, said that the STATE OF TEXAS had signed off on the SoP. Who did that?

Nobody will take the credit or blame. Where did that person, whoever it

is, get the guts and authority to do that? Answer that question and you'll

know and understand a lot more than I do about what's happening to Texas EMS.

We're not in a pretty situation. We're fighting for our lives, but only a

handful of us are even aware of it. Wake up. We're headed downhill at

breakneck speed.

The summary is to say to join an organization. But I won't because that

would be blatant spam. Figure it out for yourselves. If yer not a part of

the

solution, yer a part of the problem. Nuff said.

GG

So please think carefully about this. Please.

Best,

Gene

>

> > 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 devastating to Texas EMS?

>

> -Alfonso R. ochoa

>

December 2, 2004

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

December 2, 2004

I worked in a state with a scope of practice. It took 2 YEARS to get IO

infusion put in to the SoP, even though PALS was a common course. If

you did IOs before then the state police had full authority to arrest

you and imprison you. That very statement was in the 'preamble' of the

SoP. Let's say a medical director wanted CPAP.... can't do it, not in

the SoP - want to do it - see the 'preamble'.

I got my AAS in Parmedicine in 1983, and have a BS/MS in Health

Science. In 1983 it was thought that Paramedicine would keep pace with

nursing, resp. therapy, etc., as far as degree requirements and salary.

However, somebody forgot to tell health insurance providers, city

managers, fire chiefs, private service owners, volunteer administrators

and the like.

These folks need to be brought into the fold before we even conceive a

national SoP. I was at a national conference and heard one of the major

proponents of the national SoP state that it was a done deal - further

described it as a big locomotive on a big track screaming though the

nation.

It's up to the drivers of this locomotive to slow down and tell us all

DIRECTLY, not by www. what the true intentions of the national SoP are.

aloha,

mikey

>>> scotterems@... 12/2/04 4:32:01 AM >>>

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

December 2, 2004

As a side note , I would venture to say that if we adopt the SOP as

currently written, you will basically make the Flight Paramedic and the

off-shore medic without a BS the equivelant of an EMT-B with a few special

skills. We cannot lower the SOC for the sake of being politically correct and

playing nice with others.

Lee

Re: Re: Scope of Practice

,

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

>

December 2, 2004