The same old EMS song and dance

[StreetDoc67]

Maybe I'm just being a cynical old guy, but after reading this article I keep getting a feeling of déjà vu. I don't know how many times over the years I've heard this song and dance from the "leaders" of this profession. To me it's all just the same shit they've been pushing forever just in another package. The biggest joke to me is this whole "degree" track. Oooooh! You mean I could get a fancy degree from one of those learnin places? Pahleeeeese. Unless there's a noticeable increase in my ability to make a decent living without having to work multiple jobs then the degree isn't worth the sheep skin it's printed on. I have a couple paramedic colleagues of mine in the area with BA's in Paramedicine and neither of them receives any pay bonus because of it. Nurses and PA's don't make more money than us because they have degrees; they earn more because they are associated directly with institutions (namely hospitals) that have the ability to generate sufficient income to pay the profession well. The Ambulance industry on the other hand only gets by on the scraps from Medicare, Medicaid and private insurances. Until that changes everything else our leaders try to do is just so much noise to distract us from the fact that we are the bastard, red-headed stepchild of the public safety and the medical professions.

But, like I said, maybe I'm just being unnecessarily grim. I'm curious to know what everybody here thinks.



National EMS Education Standards a Big Step Forward
by Mike Touchstone


The National Highway Traffic Safety Administration has recently released the National EMS Education Standards, a set of guidelines that establish minimum educational competencies for entry-level EMS providers. This marks the next step in implementing the EMS Education Agenda for the Future; a Systems Approach.

The EMS Education Agenda was released in 2000, the It has been guiding the progress of EMS toward an education system based upon five components:

the National EMS Core Content (2004)
National EMS Scope of Practice Model (2006)
National EMS Education Standards (2009)
National EMS Certification (to be released)
National EMS Program Accreditation (to be released)

The Standards replace the National Standard Curricula, which have been the backbone of EMS training for years, and support the ongoing transition from a limited focus on training to a more complete educational perspective.

Let's take a moment to look at exactly what the Standards are, why they are important, and how it will impact both EMS providers and the profession as a whole.

What are the National EMS Education Standards?

“(The Standards) define the competencies, clinical behaviors, and judgments that must be met by entry-level EMS personnel to meet practice guidelines defined in the National EMS Scope of Practice Model." (NHTSA p. 7)

There are four certification levels: emergency medical responder (EMR), emergency medical technician (EMT), advanced EMT (AEMT), and paramedic. The Standards are built upon the premise that each certification level is part of a sequence that culminates in paramedic certification. Each certification level is built upon the knowledge, skills and competencies of the lower levels. Thus, an EMT must meet all of the competencies of an EMR, as well as those specific to the EMT. Likewise, a paramedic must meet all of the competencies of an EMR, EMT, AEMT, as well as those specified for entry-level paramedics.

The Standards are made up of four components: competencies, knowledge required to achieve the competencies, clinical behaviors/judgments, and educational infrastructure. They provide a general framework to support individual programs for developing specific curricula to meet identified training and educational needs in particular regions. The format also allows for ongoing revision when research supports practice changes based on scientific evidence or when standards of care change.

The NHTSA also published instructor guides for each certification level. These include the basic information that programs must deliver in order for their students to meet the described competencies. The guides will serve as the foundations for textbooks and lesson plans. It is important to note that programs will need more than just the instructor guides to deliver a complete program.

Why Are the Standards Important?

The most important aspect of the Standards is the fact that they move EMS, paramedics in particular, one step further along the road to professionalization. The EMS Education Agenda process in general and the Standards in particular are together raising the bar for EMS practitioners. Just as practitioners progress from level to level, so does the discipline progress from a training to an educational perspective. As a consequence of this, many of the individuals who teach EMS will have to become more than simply certified instructors; they will have to become educators.

EMS educators will need to possess a foundation in educational methodology; adult learning theory; curriculum and lesson plan design and development; as well as evaluation, assessment, analysis and communication skills. Our EMS educators must be well-prepared for the transition; education is more than simply training. This change in perspective will make our practitioners better at what they do, and ultimately, will lead to better patient care.

What Will the Standards Mean to Us?

At first glance, it may appear the Standards will have little impact on current practitioners. The Standards solidify the four certification levels so that each level will have a common set of minimum, entry-level competencies across the country. It means that those who learned initial assessment and the four different pathways of secondary assessment may not recognize the concept of "primary and secondary" assessments. For the old school folks like me, it means a return to familiar terminology.

For those who hope to become paramedics, it means that you will need to know more information at a greater depth and breadth. Paramedic programs may include such course work as ethics, special operations, incident management, leadership, as well as more in-depth pathophysiology cardiology and pharmacology. Practitioners will learn much more about the "why" we do what we do.

As a result of more formal education, I predict that paramedics will eventually be recognized as a more independent practitioner, rather than one who simply collects data, reports the findings, and follows a physician’s orders. Practitioners will then be better prepared to practice in the field.

The biggest impact the Standards will have on current and future paramedics is that many will receive college credits and Associate’s Degrees in the process of achieving paramedic certification (some will even attain Bachelor's Degrees). This increased standard level of education will make it more challenging for the "dinosaurs" to keep up with the "young Turks."

The Future

As we move toward achieving the last two components of the EMS education agenda -- national EMS certification and national accreditation of EMS programs -- we may see some resistance. Some states have two or more levels of certification between EMT and paramedic. They may choose not to comply with the Scope of Practice Model. Some places may see the need to add advanced practice paramedics, such as in Wade County, NC. Some states currently do not accept or recognize the National Registry of EMTs, which may pose barriers to national certification. Some training programs may not be able to meet the national accreditation requirements and may cease to exist.

Even considering all of the potential barriers, the goal of the EMS education agenda and EMS practitioners is, and must always be, continually improving the care we provide for the people who call for our help. Much has changed since 1967, when Dr. Frank Pantridge's paper lead to the development of mobile cardiac care units and his invention of the portable defibrillator. It's time for our educational programs to catch up with our practice. It's time for program graduates to be more "work ready," and better prepared to be prehospital practitioners who have a stronger understanding of why they do what they do. The Standards provide one more step toward that destination.

[cwl3gemt]

IDPH BEMS has this up on their website, and as i was reading through it, there were quite a few things that bothered me. first thing is it leaves all of our iowa paramedics in limbo if they choose to remain at their level (i99) instead of going over to Paramedic Specialist, where right now they still have the obtion of a bridge class to go to PS. Second thing that really bothered me is it appeared to take the combitube away from the emt-b's like me. I personally like knowing I have the option of using that or a King airway if previous steps failed and we needed it. For the most part in rural Iowa, a good majority of providers dont like the changes.

[lerue]

In Brit land, we have operated under this type of system for many years, roughly 1978, when the national body NHSTD (national health service training directorate) was instituted, in an attempt to formalise training throughout Britain, possibly the only advantage is I can work for any Ambulance Service in Britain, without having to recertify. Recently paramedics were given membership of a professional body, HPC (health professions council) the upshot of this now means I have to find professional fees £120 a year, and get very little in return, they do have a wonderful little committee that can strike you off if you fuck up, denying you the opportunity to work as a medic ever.

[jozak78]

The most important aspect of the Standards is the fact that they move EMS, paramedics in particular, one step further along the road to professionalization. The EMS Education Agenda process in general and the Standards in particular are together raising the bar for EMS practitioners. Just as practitioners progress from level to level, so does the discipline progress from a training to an educational perspective. As a consequence of this, many of the individuals who teach EMS will have to become more than simply certified instructors; they will have to become educators.

For those who hope to become paramedics, it means that you will need to know more information at a greater depth and breadth. Paramedic programs may include such course work as ethics, special operations, incident management, leadership, as well as more in-depth pathophysiology cardiology and pharmacology. Practitioners will learn much more about the "why" we do what we do.

these were all specific classes in my paramedic program. if i had chosen to take the BS in emergency medicine that the college offered the paramedic program would have been 40 credit and my entire junior year. should i decide to go back to school i can still make use of those credits and this institution accepts the emergency medicine BS as premed for entry into medical school and they give preference to the EM majors over the biology and chem majors and all that stuff. i believe that there should be a level above medic i believe one of those national credential papers suggested an advanced practice paramedic, that would be on a similar level as a PA or CRNP. that could possibly add new revenue streams to current EMS systems, and be a benefit to public health in general, and give those of us in emergency medicine a better career path.

[CombatMedic]

For those who hope to become paramedics, it means that you will need to know more information at a greater depth and breadth. Paramedic programs may include such course work as ethics, special operations, incident management, leadership, as well as more in-depth pathophysiology cardiology and pharmacology. Practitioners will learn much more about the "why" we do what we do.

Noooooooooooooooo

[jozak78]

Noooooooooooooooo

patho is not that bad. go to class and read the book it's not rocket surgery.

[fire medic 328]

As a result of more formal education, I predict that paramedics will eventually be recognized as a more independent practitioner, rather than one who simply collects data, reports the findings, and follows a physician’s orders. Practitioners will then be better prepared to practice in the field.

The multiple level progression sounds good in theory each building from the one before. However that leads to a wide variety of cert levels at what point will they allow these to actually work. Currently in Tn you can go from no EMS training at all to paramedic in 16 months (without actually being in the field except for the required clinicals) if it is timed right and many of the schools here encourage new EMT's to progress straight thru to get their medic as a source of continued income for the school. The state has no waiting time or required time in the field anymore. The progression will not turn out more medics ready to practice in the field unless they require a certain amount of field time be preformed. A degree will not help with this transition either. Most people will agree that the real education is done in the field which is why it is called practicing medicine.

[Mogollon]

I agree with the push somewhat in theory. The execution is suboptimal however. Obviously, at some point for professional recognition, EMS should advocate for a degreed paramedic. In addition, I support removing the EMT from paramedic. Paramedics can never be seen as true professionals if they have "technician" attached to the title. In addition, I hope this is the beginning of the end for "shake and bake" medic schools that pump out zero to hero providers in a matter of weeks. I suspect; however, the states will take steps to ensure some of these programs remain operational.

Once EMS has professional recognition, then I hope to see strong EMS lobby groups pushing for change regarding pay and compensation. This is what makes nurses so powerful when considering compensation. They have a huge lobby and constantly advocate and push nursing issues. Many nurses take much interest and an active role in the healthcare system. Hence, many MS and PhD educated providers are making policy and being involved in upper level research that ultimately benefits nursing. I simply do not see this involvement among my EMS colleagues.

You may not like what I have to say; however, pushing for standardized educational standards from a "learning" place among many other concepts such as strong professional and political involvement at the local, state, and federal level is a step foreword. We need to be seen as a proper profession, and have the strength and validity as a profession to push for all of these changes we desperately need. Obviously, unity is an important consideration as well.

[jozak78]

The multiple level progression sounds good in theory each building from the one before. However that leads to a wide variety of cert levels at what point will they allow these to actually work. Currently in Tn you can go from no EMS training at all to paramedic in 16 months (without actually being in the field except for the required clinicals) if it is timed right and many of the schools here encourage new EMT's to progress straight thru to get their medic as a source of continued income for the school. The state has no waiting time or required time in the field anymore. The progression will not turn out more medics ready to practice in the field unless they require a certain amount of field time be preformed. A degree will not help with this transition either. Most people will agree that the real education is done in the field which is why it is called practicing medicine.

i took my EMT class on a whim and i liked it, so i signed up for the next medic class that started about 7 months later, i never used my EMT card. i tell everyone that has asked me about it that they should spend at least a year in the field as a basic before moving up. when i got out into the real world i was more or less competent with the medical aspect, but operationally it was a nightmare, radio operations, rescue work, and i can't even remember what else i was clueless and it took me at least 6 months before i started to feel a little comfortable with that stuff. and if they do put in a level above paramedic i think there should be a minimum of 3-5 years of active duty to even be considered.

[GaHazMedic]

As a result of more formal education, I predict that paramedics will eventually be recognized as a more independent practitioner, rather than one who simply collects data, reports the findings, and follows a physician’s orders. Practitioners will then be better prepared to practice in the field.

The multiple level progression sounds good in theory each building from the one before. However that leads to a wide variety of cert levels at what point will they allow these to actually work. Currently in Tn you can go from no EMS training at all to paramedic in 16 months (without actually being in the field except for the required clinicals) if it is timed right and many of the schools here encourage new EMT's to progress straight thru to get their medic as a source of continued income for the school. The state has no waiting time or required time in the field anymore. The progression will not turn out more medics ready to practice in the field unless they require a certain amount of field time be preformed. A degree will not help with this transition either. Most people will agree that the real education is done in the field which is why it is called practicing medicine.

The original medic schools were like this. There were no requirements to even be an EMT in the beginning. These programs turned out some quality medics. Required time as an EMT has never worked because there are too many variables. If you are in a busy system, then you get great experience in a year. If you are in a slow rural system, then you don't. Instead of requiring time BEFORE someone can become a paramedic, I am for making everyone complete an internship AFTER they finish school. Put them alongside of an experienced medic who can turn them into a competent provider.