EMT to Paramedic

[Guest guest]

Probably because some programs or departments will run out of personnel.

emti911@... wrote:

In a message dated 3/30/2006 10:26:56 A.M. Central Standard Time,

hypnoron@... writes:

Hello everyone,

I am noticing that there are more people moving from EMT, right to

Paramedic. I am not knocking those that have negotiated the program, however

in the

fire service, if I am to understand correctly, you have to be a Fire Basic

FF

for three years BEFORE you can advance to the next level Fire Intermediate.

Why can't TDH have a regulation where as an EMT must be an EMT for at least

a year before they advance to Paramedic? Wouldn't the quality of paramedic

be

higher?

just my .02

Ron

[Non-text portions of this message have been removed]

Yahoo! Groups Links

AMEN

[Guest guest]

Very nicely said Lance, I agree!

Patty Einstein

[Guest guest]

Tater,

that was very well said........

Ron M

In a message dated 3/30/2006 7:55:47 P.M. Central Standard Time,

texaslp@... writes:

I loved working as a field medic, but it just didn’t pay the bills. So, I

had to go to work somewhere that did. I went into the fire service. I get

enough EMS to satisfy that need to help people, and enough pay to keep the

quality if life I deserve.

[Guest guest]

Many employers complain that those " college paramedics " can't think and

act independently or are no better than any other paramedic. There are a

few problems with that comment that pertain to the EMT to Paramedic

progress:

1. Professionals grow in their career as they gain experience within the

context of their work setting, moving from a continuum from novice to

expert.

2. A novice advances along that continuum, they initially rely on the

rules they learned in preparatory education. They only way they 'break'

out of the reliance on those rules is through experience.

3. Recent studies seem to say that another difference between a novice

and an expert is that novices are not able to understand their own

learning processes. Experts are able to understand how they learn, can

teach themselves, and know how to learn from their experiences.

3. Continuing education classes should help develop meta-cognition

(learning how to learn) and help students learn to reflect on their

experiences, not simply do the same thing (mistakes) over and over

again.

So while it may seem like I'm making a case for longer periods of time

between EMT and Paramedic courses, I'm not. I am making a case for

longer periods of time for the paramedic course itself. One of the

issues about learning in EMS is that if we learn from our experiences,

we must have the experience and that typically means more time to gain

those experiences. I don't expect to graduate 'experts', that takes

years of practice often over one's professional lifetime. But there does

seem to be a connection between developing expertise in practice and

developing expertise in learning and that requires time in the

preparatory stage (paramedic school).

But I also understand the argument that going to school for a longer

period of time delays graduates/employees to start work, costs more

money, and currently there's not a market for paying that graduate the

salary deserved.

But in the meantime, I'll keep pushing education but the resistance to

that is strongest amongst our own. It pains me to say it but we're not a

profession. We're more of a trade with an identity crisis. We are

definitely at a cross roads and we make in fact end up regressing!

Lance Villers, MA, LP

Assistant Professor & Interim Chair,

Department of Emergency Health Sciences

The University of Texas Health Science Center at San

7703 Floyd Curl Dr.

San , TX 78229-3900

[Guest guest]

Ron,

Good thoughts. In my utopia, the thought was that with increased time to

medic comes reduced numbers of “quickie medics”. This dramatically increases

the ability for those medics to deliver quality patient care. Burnout never

entered my mind. The excessively high burnout rate is due to lack of a living

wage and shoddy benefits.

While reduced quickie medics means an eventual severe job shortage, a severe

job shortage means employers competing for employees. Competing for employees

means coming up with ways to retain them, like real money and benefits that

actually mean something. Needing more money to stay afloat causes employers to

get together and force increased revenue. Increased revenue means the ability

to pay employees a living wage. A real living wage means decreased burnout and

you’ve some full circle.

I do not believe this will ever happen. So, EMS must become a mandatory

service. In order for that to happen, it is going to have to become government

funded and probably government run, just like Fire Protection and Law

Enforcement. Are there some examples of quality private services and

partnerships? Sure. Overall, I’d say the medics at government funded services

have better pay and benefits though.

There are tons of for-profit and private EMS services around. I wonder just

how profitable they are. Some claim to be losing money hand over fist. If this

is so, how are they staying in business? I wonder what the top executives at

these firms make. I’ve always believed that the executives of the largest EMS

companies are getting “fat” on the backs of the EMT’s and Paramedics they

employ. If they are being paid these exorbitant salaries, someone else is

getting fat too.

Now, for the real world……I believe there will be a COMPLETE collapse of the

EMS system as we know it before things will get better. I believe, besides us;

insurance companies are our worst enemy. As long as they carry the biggest

sticks, they will rule. As long as they rule, EMS will be a trade. As long as

EMS is a trade, EMT’s and Paramedics will be on government assistance or working

several jobs to make ends meet.

I loved working as a field medic, but it just didn’t pay the bills. So, I had

to go to work somewhere that did. I went into the fire service. I get enough

EMS to satisfy that need to help people, and enough pay to keep the quality if

life I deserve.

My $ .02 worth,

Tater

hypnoron@... wrote:

Waiter tater. Isn't the current burnout rate about 8 years? How can you

demand to " up " the training and demand more time in service, if in 8 years, your

getting out?

Or, do you think that by putting a time restriction on the transition from

EMT to Medic ,for the sole purpose of experience, would change the burnout

time period?

just my .02

Ron M

In a message dated 3/30/2006 2:34:22 P.M. Central Standard Time,

texaslp@... writes:

EMS is a strange in amalgamation of the two. EMS is more than a trade, but

far less than a profession. The real question is… Are we willing to invest

in the, “long and intensive academic preparation†that defines a

profession?

Only time will tell………

[Guest guest]

You know Wes, I tend to agree with you. But untill

the public holds Ambulance work up there with Fire and

Police, it won't happen. Did you read that paragraph

that DR. B put out on this list? It just breaks my

heart that communities do not see us as an essential

service. Untill that time we will be nothing more

than ambulance drivers.

Tom

--- ExLngHrn@... wrote:

---------------------------------

To play devil's advocate, should lawyers spend a few

years as paralegals or as legal secretaries before

becoming lawyers? Should physicians be nurses or

physcians' assistants first?

EMS will never advance as a true profession so long as

we we have a stairstep structure that requires you to

jump through various licenses before reaching the

terminal level of certification/licensure. This is

more like an apprentice plumber becoming a journeyman

plumber who finally becomes a master plumber than it

is a profession.

I will say, however, that I support intensive field

training before one is considered ready to treat

patients without " supervision. " The real problem that

I see is the amount of EMS services that find that " a

patch and a pulse " are all it takes to provide patient

care. Personally, I'd like to see some assurances of

competency before a newly hired paramedic is given the

keys to the ambulance and the the keys to the

controlled drugs.

I'm looking forward to the day when someone has the

option to go to college, get a bachelor's degree and

their paramedic licensure simultaneously. More

importantly, I'm looking forward to the day when we

recognize that EMS education rightfully involves more

than just EMS classes.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

EMT to Paramedic

Hello everyone,

I am noticing that there are more people moving from

EMT, right to

Paramedic. I am not knocking those that have

negotiated the program, however in

the

fire service, if I am to understand correctly, you

have to be a Fire Basic FF

for three years BEFORE you can advance to the next

level Fire Intermediate.

Why can't TDH have a regulation where as an EMT must

be an EMT for at least

a year before they advance to Paramedic? Wouldn't the

quality of paramedic be

higher?

just my .02

Ron

[Guest guest]

Dr. Bledsoe,

I apoligize for taking the below excerpt out of context, but that is

the point that I wanted to address. First, their is no substitute for

experience. I don't think that one could argue effectively that a

brand new Paramedic can have a better grasp on the practical use of

their skills and autonomy than the 5+ year veteran. I am speaking

strictly from an educators point of view.

I have students in my Paramedic classes with every range of

experience, from the fresh out of EMT-B class to the intermediate with

10+ years. I am finding, in my classes, some issues with EMT's with

experience. First, they have developed bad habits and bad attitudes.

It doesn't matter how they got them. That's not my concern. My issue

is that it clouds their judgement. I get things like, " thats not how we

do it in the field. " To some degree you have to define the " we. "

Are " we " doing things the right way or are " we " taking short cuts that

the new Paramedic student should avoid in order to be successful in

the classroom. I have students that are fresh out of EMT class that

make better scores on written tests and skills because the rote memory

of sequencial steps is fresh on their mind. Though I do not advocate

rote memory in favor of understanding the procedure, that is how most

people learn skills requiring steps. I have students with field

experience that will fail patient assessment stations because they

miss key steps on the skills sheet. Their arguement is usually, " if it

would have been a real patient I wouldn't have missed it. " Well,

maybe, but unfortunately you can't get to the point of field practice

without classroom testing and, ultimately, national registry testing.

I am also seeing an interesting trend in students that are successful

on the NR test. The two groups that seem to be doing best are those

that are either right out of school or those with 6-10+ yrs. of

experience. I have seen a sizable population of those with 2-6 yrs.

having to take it at least twice. Also, those with 0-1 year of

experience are making no more than about 75 on the test while those

with 10+ years are making in the 80+ range. Again, this is just my own

observation.The desired dynamic of the Paramedic student, according to

some opinions in the group, is about 2-5 years as an EMT-B or EMT-I.

When I do have issues relative to grades and skills testing, this is

the group with which have the most problems. Given all this, it

appears, based on personal observation, that experience makes better

field Paramedic but, in some cases field experience makes worse

students. Therefore, my humble opinion to the group is, from a

classroom stand point, it doesn't matter whether they have 2 years or

2 minutes of experience, it won't make you a better student either

way. The newbies are better with testing as long as they have

practiced their skills to mastery. The vets are better with their

internship and effective use of their skills base. A little lengthy,

sorry, but thats how I see it.

>

> ... Before becoming a good paramedic (and I do not mean getting 70 or

> better on paramedic school examinations), you need experience.

Experience

> improves judgment. While I don't think TDSHS should restrict the

practice,

> going from EMT school to paramedic school without an intervening

experience

> in the field promotes problems...

[Guest guest]

Lance,

That was extremely well said.

As a member of this and other lists that emphasize EMS, I have observed that

there are few people on the lists who have active, inquisitive minds and a

real interest in advanced self-learning.

Just look at who replies to the scenarios that are posted from time to time.

Same suspects over and over again.

My further observation is that most paramedics do not wish to learn more than

they know. I teach ACLS refresher courses frequently. I usually probe to

see how much the refreshing students know about pharmacology and the ACLS

drugs. Most don't know the fundamentals. And most are not interested in

learning anything more than which drug the algorithm recommends.

I find this very sad.

On the other hand, occasionally I run into a student who cannot get enough

knowledge. Unfortunately, even these well motivated students do not often

understand how they learn, do not know how to find information on a topic, and

can't deal with conflicting information.

This is the fault of our education system, which has forgotten how to promote

critical thinking. It is also the fault of the EMS system that is unwilling

to pay for professionalism.

We are not a profession. We are far from it. And until there is a sea

change in education, management philosophy, and politics, we never will be.

Gene Gandy

>

> Many employers complain that those " college paramedics " can't think and

> act independently or are no better than any other paramedic. There are a

> few problems with that comment that pertain to the EMT to Paramedic

> progress:

>

> 1. Professionals grow in their career as they gain experience within the

> context of their work setting, moving from a continuum from novice to

> expert.

>

> 2. A novice advances along that continuum, they initially rely on the

> rules they learned in preparatory education. They only way they 'break'

> out of the reliance on those rules is through experience.

>

> 3. Recent studies seem to say that another difference between a novice

> and an expert is that novices are not able to understand their own

> learning processes. Experts are able to understand how they learn, can

> teach themselves, and know how to learn from their experiences.

>

> 3. Continuing education classes should help develop meta-cognition

> (learning how to learn) and help students learn to reflect on their

> experiences, not simply do the same thing (mistakes) over and over

> again.

>

> So while it may seem like I'm making a case for longer periods of time

> between EMT and Paramedic courses, I'm not. I am making a case for

> longer periods of time for the paramedic course itself. One of the

> issues about learning in EMS is that if we learn from our experiences,

> we must have the experience and that typically means more time to gain

> those experiences. I don't expect to graduate 'experts', that takes

> years of practice often over one's professional lifetime. But there does

> seem to be a connection between developing expertise in practice and

> developing expertise in learning and that requires time in the

> preparatory stage (paramedic school).

>

> But I also understand the argument that going to school for a longer

> period of time delays graduates/employees to start work, costs more

> money, and currently there's not a market for paying that graduate the

> salary deserved. 

>

> But in the meantime, I'll keep pushing education but the resistance to

> that is strongest amongst our own. It pains me to say it but we're not a

> profession. We're more of a trade with an identity crisis. We are

> definitely at a cross roads and we make in fact end up regressing!

>

> Lance Villers, MA, LP

> Assistant Professor & Interim Chair,

> Department of Emergency Health Sciences

> The University of Texas Health Science Center at San

> 7703 Floyd Curl Dr.

> San , TX 78229-3900

>

>

>

>

>

[Guest guest]

Would the quality be better? Nobody knows, do they?

We have never done the research to be able to say which is better--immediate

movement from EMT to Paramedic or a hiatus between courses.

As one who ran a 2 year AAS Paramedic program for 12 years, my own

observation is that it's better for the student to continue without a break.

But that

was a program where the student was heavily involved in clinicals and

internship from the very beginning, and by the time they finished they had

something

like 800 hours of clinicals/internship under their belt.

I found that invariably medics who took a hiatus from courses learned

extremely bad habits that I then had to correct.

OTOH, if the courses are not structured correctly, and only teach the

minimums, then perhaps a period of work in the field might not be bad.

I point out that physicians in medical school do not take a hiatus between

their course work and their residencies. Neither do nurses.

I think field experience is overrated most of the time. There are immensely

bad practices being carried on every day in ambulances in Texas. These are

being done by Paramedics who deem themselves to be " experts. "

As an educator, I had rather have a student for two years of intensive

instruction and clinicals/internship on a regular basis than a student who gets

the

education piecemeal. I have a lot better luck in instilling professionalism

in the student that I have for a prolonged period of time.

Yet, overall, most Paramedics do not function at the professional level.

They can't break the glass ceiling between tradesman and professional.

Gene G.

> Hello everyone,

>

> I am noticing that there are more people moving from EMT, right to 

> Paramedic. I am not knocking those that have negotiated the program, however

> in  the

> fire service, if I am to understand correctly, you have to be a Fire Basic 

> FF

> for three years BEFORE you can advance to the next level Fire Intermediate.

>

> Why can't TDH have a regulation where as an EMT must be an EMT for at least 

> a year before they advance to Paramedic? Wouldn't the quality of paramedic

> be 

> higher?

>

> just my .02

>

> Ron

>

>

>

[Guest guest]

,

I agree with your vision of the future. But I don't completely agree with

your take on EMS education.

As I have posted before, I believe that an intense two year program with

extensive clinicals/internship experiences from the very beginning can produce a

student who is able to think critically about medicine, who has mastered basic

and advanced skills, and who can begin practice at a high level after the two

year program.

The secret is to start the students on clinical and internship experiences

two weeks into the course, and to continue the clinical and internship

experiences as they gain knowledge. They begin being able to perform basic

skills

such as vital signs monitoring, oxygen administration, bandaging and splinting,

ventilation skills, and so forth almost immediately.

In our program, they spent 256 hours each semester in clinicals and

internship. That's 16 8 hour shifts on ambulance and 16 8 hour shifts in the

hospital

in various locations.

Further, the course should be structured heavily with scenario practices.

This is where the student learns to work with the algorhythms and to think

critically. Scenarios are constructed to duplicate challenging situatioins.

The patient who is coded also happens to be in a bathtub with soap all over him

and he weighs 165 pounds.

Few paramedic programs in the US use this approach, but there are a

significant number of them.

While the Australian program seems good, it is unrealistic to think that

here in the US we would adopt such a program. The sort of program that I

outlined is at the outer limits of what payers will support.

And without the sort of mentors you mention in Australia, who would provide

the mentoring that EMTs would need during their journey toward critical care

medic?

I agree that the short critical care courses done in the U.S. are inadequate.

When I was a program chair, I taught a 48 hour initial ACLS Provider

course, and that wasn't enough for some. But those can be changed.

I hope that before I die I'll see a requirement for at least an associate

degree for every Paramedic, and if I had my druthers, it would be a BS degree.

But, let's face it: The University folks can't even develop a BS degree

program that's successful. Much work needs to be done before that comes to

pass.

Perhaps the greatest impediment to improved Paramedic education is the rest

of the medical community. When Paramedics are denied the ability to learn

intubations in the OR because anesthesiologists refuse to allow them there,

that's a problem. When every single area of most hospitals refuses to admit

Paramedic students, that's a problem.

Until we are able to get the rest of the medical community to recognize us,

we're spitting into the wind with all this dialog. How do we do that? Which

came first, the chicken or the egg? We will get no respect from the medical

community until they begin to see us as professionals; we refuse to act like

professionals. So there you have it.

Gene G.

> Wes:

>

> That is an apples and oranges comparison. Currently, clinical exposure in

> EMT school (per the DOT) is about 24-48 clinical hours and a 24-hour

> ride-along. This often coincides or follows a fairly intense didactic

> session. Before becoming a good paramedic (and I do not mean getting 70 or

> better on paramedic school examinations), you need experience. Experience

> improves judgment. While I don't think TDSHS should restrict the practice,

> going from EMT school to paramedic school without an intervening experience

> in the field promotes problems. First, the most important prehospital skills

> (BLS skills) are never mastered. Second, the greater time commitment and

> depth of paramedic education will foster a practice where ALS skills are

> assumed to be necessary. Most paramedic programs never require practice of

> BLS skills to the point of mastery.

>

> Then, there is the absurd.  Most will complete paramedic school and then

> take one of the myriad CCEMT programs. Now, you have an individual

> presumably trained in numerous skills although mastery was never achieved in

> most.  In Canada and Australia EMTS may wait years before becoming

> paramedics. Then, after several years of paramedic experience the best are

> selected for critical care education which usually lasts a year (unlike the

> Mickey Mouse CCEMT programs we have in the States). It is totally

> unreasonable to take even a bright 18-year-old and send them to EMT school,

> immediately followed by paramedic school, and immediately followed by CCEMT.

> They never develop the required judgment, skills mastery and experience.

> Good EMTs and Paramedics must be independent thinkers. Relying on protocols

> and other cookbook-type rules makes for bad patient care. The EMT must be

> able to problem solve when the patient does not fit the protocols. We (EMS

> educators and regulators) did EMS a great disservice many years ago by

> dumbing down the EMT curriculum and we are now suffering the consequences.

> With all due respect, I would not want a 20-year-old EMT-P/CCEMT-P putting a

> central line in my patient or trying to aspirate a pericardial sac. Once

> they have gained experience and wisdom, and I have verified this, then

> certainly.

>

> We in EMS are like Boy Scouts. The more merit badges the better. In

> emergency medicine, we are saying the opposite. We are board-certified in

> emergency medicine and gaining additional merit badges is a waste of time.

>

> I see EMS going this way:

>

> 1. There will be a greater emphasis on BLS with several major fire

> departments and urban EMS systems going primarily BLS. There is no way big

> cities like Dallas, Houston and San can maintain skills mastery for

> thousands of firefighter/paramedics.

> 2. There will be fewer paramedics in the urban setting usually assigned to

> rapid response vehicles.

> 3. There will be a push for more paramedics in the rural setting if the

> problems with initial education and skills maintenance can be addressed.

> 4. True critical care paramedics will be few and far between. They will only

> enter education after a period of experience and education and certification

> will only be offered if there is a position available on a critical care

> transport vehicle or helicopter. Education will approach that of the CCRN

> and approach a year in length. Before long, many of these helicopter

> operators will go away and there will be a renewed emphasis on ground

> transport and the remaining helicopter operations will be better and become

> a part of the EMS system.

> 5. By 2010, paramedics will need some sort of degree.  The National Registry

> has already stated that by 2010 they will probably mandate that all people

> sitting for their exams be graduates of fully-accredited programs (not

> simply state-approved programs, but programs who are accredited by a

> national organization).

> 6. There will be an expansion in advanced practice paramedics in the areas

> of occupational medicine, sports medicine, tactical medicine, and primary

> care. There may be some sort of merger between PA and paramedic.  Again, a

> bachelors or masters degree will probably be required.

>

> I'll bet I am more right than wrong. But then I also thought Bucky would

> have been kicked off American Idol last night. 

>

> EMT to Paramedic

>

>

> Hello everyone,

>

> I am noticing that there are more people moving from EMT, right to 

> Paramedic. I am not knocking those that have negotiated the program, however

> in 

> the

> fire service, if I am to understand correctly, you have to be a Fire Basic

> FF

> for three years BEFORE you can advance to the next level Fire Intermediate.

>

> Why can't TDH have a regulation where as an EMT must be an EMT for at least

>

> a year before they advance to Paramedic? Wouldn't the quality of paramedic

> be 

> higher?

>

> just my .02

>

> Ron

>

>

>

[Guest guest]

In a message dated 02-Apr-06 02:43:34 Central Daylight Time,

wegandy1938@... writes:

I point out that physicians in medical school do not take a hiatus between

their course work and their residencies. Neither do nurses.

no, they don't...they also have a minimum of 2 years (AD RN) training with

proctored 'patient contact time' measured in months.

Even the LPNs who are closest to the standard mode 'Basic to Paramedic in

one fell swoop' that I am familiar with have classes that last far longer and

patient care time measured in weeks...they often spend a half day in the

hospital setting and the other half in the class room during the last 6 of

their

18 month training, and the level of Anatomy, Physiology, Pathophysiology and

Pharmocology that they get exceeds anything that I have seen in the Paramedic

world except perhaps Dr. Bledsoe's fine five volume set.

And despite having what's almost the equivalent of an Associates' Degree,

LPNs are barely considered 'Professional Nurses' in some quarters of upper

level nurses...

ck

S. Krin, DO FAAFP

[Guest guest]

In a message dated 02-Apr-06 02:43:34 Central Daylight Time,

wegandy1938@... writes:

As an educator, I had rather have a student for two years of intensive

instruction and clinicals/internship on a regular basis than a student who

gets the

education piecemeal. I have a lot better luck in instilling

professionalism

in the student that I have for a prolonged period of time.

Yet, overall, most Paramedics do not function at the professional level.

They can't break the glass ceiling between tradesman and professional.

Meant to include this in my previous missive.

From my 33 years of experience and practice, two years of education and

proctored patient care is the minimum for Paramedicine to start being viewed as

more 'professional' than 'trade.' I'd add in another 6 months of work under a

specially trained and highly experienced Field Training Officer as the

equivalent of an 'internship'...Medicine has used this model for years, and

many

Hospitals are now designating and training selected experienced nurses to guide

and mold brand new RNs as they start their professional lives as 'Real

Nurses'....

And with the idea that an AD Paramedic program would contain *at least* the

equivalent of 20 weeks 'full time' (800 plus hours) experience in the field

and hospital, I would agree that it would be very possible to take someone of

reasonable intelligence and dexterity right out of high school who had the

desire and aptitude, and turn them into a good Paramedic in two years.

S. Krin, DO FAAFP

[Guest guest]

In a message dated 02-Apr-06 03:18:59 Central Daylight Time,

wegandy1938@... writes:

I hope that before I die I'll see a requirement for at least an associate

degree for every Paramedic, and if I had my druthers, it would be a BS

degree.

But, let's face it: The University folks can't even develop a BS degree

program that's successful. Much work needs to be done before that comes to

pass.

Grayson might remember some conversations that he and I and a few

others had about 5 years ago now...our Basic program was run at the local

VoTech,

we were setting up the standards for a new P program (the previous P program

had gotten in trouble with both the VoTech and the State, and we were having

to start from the beginning) and the State had decreed that Monroe Louisiana

was to be the site of a new Jr College.

My idea was to set things up so that the B students would share Anatomy,

Physiology and Pathophys with the LPN students, and that I was willing to give

a

series of lectures to the LPN students as a quid pro quo in return for the

Nursing Department staff for including our kids. I wanted the P program to be

actually associated with the Jr College and take the same Anatomy, Phys,

Pathophys and Pharm classes as the AD RN students (as well as taking the same

prerequisite science, math and English classes as the AD students).

predicted that I would have moved away before the first AD Nursing class got

off

the ground....and that the VoTech system would find some way to screw the Basic

program over before they were done...he was right on both counts.

Perhaps the greatest impediment to improved Paramedic education is the rest

of the medical community. When Paramedics are denied the ability to learn

intubations in the OR because anesthesiologists refuse to allow them there,

that's a problem. When every single area of most hospitals refuses to

admit

Paramedic students, that's a problem.

We've actually had some luck with that in Louisiana, at least partially

because there is a Charity Hospital in Monroe...so we don't get all of the guff

about 'risk assumption'. I'm not into the system here in St Louis yet, so I

don't know how well it works up here, but I do know that the major hospital I

am associated with is proud that they do sponsor substantial training for the

B and P students, both from straight ambulance services and from FD

departments which provide EMS and transport service.

Until we are able to get the rest of the medical community to recognize us,

we're spitting into the wind with all this dialog. How do we do that?

Which

came first, the chicken or the egg? We will get no respect from the

medical

community until they begin to see us as professionals; we refuse to act like

professionals. So there you have it.

No, we are not 'Pissing in the Wind', Gene...it's due to efforts of folks

like you and Dr. Bledsoe, as well as the elevated expectations of folks like

myself, which will eventually push things toward more professionalism. It is

within my professional life span to remember the use of 'hearse' style

ambulances that still had Pulomotor resuscitator devices on board as the

primary

transport of bandaid boxes...with the highest level of training available as

" Red

Cross Advanced First Aid " ...which barely meets the standard for First

Responder...and the spread of Closed Chest Cardiac Massage (one of my First Aid

instructors over 30 years ago, Winicki, was reportedly one of the first

non

physicians in the state of New Jersey to be certified in the then new

technique) to develop into the system that can put a First Responder on scene

in

minutes armed with an AED and a BVM with high flow oxygen...one of the few

things that has been shown to substantially increase the chances of not only

Return Of Spontaneous Circulation, but Return to Activities of Daily Living

after

a Sudden Cardiac Event.

We as a profession (Emergency Medical Services) have not advanced as far as

much of medicine and some of nursing for several reasons...the first being

that being down in the mud and the blood does not have the glamour that bright

lights, electronic beeps and cold steel hold....and attracts a far different

sort of personality.

The second reason is that there is no one place, not even centers like Ben

Taub, Parkland or UT San , where there is a sufficient concentration of

EMS patients of any given sort to do effective research in most cases...and

it is practically impossible and humanely difficult to do the sort of

randomized controlled trial (much less a blinded or double blinded trial) that

is

the hall mark of modern medicine. While large multicenter studies have been

done, they are difficult to coordinate and tougher to interpret, even when all

the centers are in the same general geographic region, due to the subtle

differences between two facilities even in the same group.

The third and perhaps the most important reason why the Profession is not

advancing is that there is no overall desire (as demonstrated by the low

percentages of people who belong to professional groups such as EMSAT or the

National Association) TO ADVANCE the profession...

The nurses figured this out around 20 years ago, and as a result, in some

urban areas, BSN nurses with 10 years of experience are earning as much as

doctors with half again as much training and experience!

ck

S. Krin, DO FAAFP

[Guest guest]

Yet, most still make more than seasoned paramedics.......

krin135@... wrote:

And despite having what's almost the equivalent of an Associates' Degree, LPNs

are barely considered 'Professional Nurses' in some quarters of upper

level nurses...

ck

S. Krin, DO FAAFP

E. Tate, LP

Whitehouse, Texas

What’s stopping you from joining EMSAT? http://www.TexasEMSAT.org

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