Possible Federal office of EMS...what do you think?

[swrr88]

http://cms.firehouse.com/content/article/article.jsp?sectionId=46&id=24624

A task force of EMS professionals is urging the federal government to create a United States Emergency Medical Services Administration within the Department of Homeland Security, akin to but separate from the U.S. Fire Administration.



There is a piece of the article, but basically they want a Federal EMS admin.

I am totally for it. I think its something very lacking in our profession. We are so splintered as there are so many different EMS models in the US each being pulled in the direction of those that run them. Fire based,Hospital based,County based, Volunteer based or Private-For Profit based...each is looking for something different out of their medics and emts.

Its mentioned by the designers that one of the reasons they thought about this is that while teaching at the US Fire Academy they noticed during some budget cuts the EMS classes were the first to go. I see that same thing here where we always seem to get less resources devoted to our training and resources.

This isn't about keeping EMS out of the Fire Service. I don't have a problem with that, but I do have a problem with EMS being overshadowed by the Suppression side of the Service. There is a whole other thread about Turf wars so I don't need to get into that one. However, there is no way to expect that the IAFF, the USFA, the IAFC, or any other Fire based organization is going to give the same amount of attention to EMS as they do fire. We need an agency to over see what is happening in our profession and to keep things moving forward. Someone to make sure we aren't just mutated into some other profession's idea of what they want us to be.

I am totally excited about the idea of an EMS department.

Anyone agree or disagree??

[bigJ164019]

Totally agree!

[Weruj1]

I disagree............this will do not much more than muck something up that is not broke. Bureacrasy at its finest.

[swrr88]

See that's where we have a different look on things....

I definitely think its broke. EMS has been patched together in so many different versions.

You have some states with a 3 year cert with very little CEs to maintain it. You have some with a 2 years license and a bunch of CEs. You have NREMT required in some but not in others.

Some places do this, this, and that procedure...then another place can't even get medical control to allow any of them.

Some measure response times this way, some this way, and another that way. Some keep track of skills and call types. Some don't keep track of anything.

Hopsital based EMS is really in favor of the guys doing a bunch of their stuff, county based is really in favor of the guys doing their stuff, Fire based is really in favor of doing their stuff....

You look at the USA Today feature on the state of EMS in America's biggest Metros and it speaks volumes. There is no standard. Seattle is saving a ton of people, DC is losing a ton of people.

I am usually totally against more government redtape, but something needs to be done. Someone needs to step up and say...ok. This is a paramedic, this is what they do, how they do it, and why they do it. Someone who can put the money behind the words, guide the states in a uniform direction, and set guidelines that apply to us all...not a informal, non-binding guideline that depends on the individual system to keep it up.

Reading that piece from USA Today really shows how things look in EMS right now. You chances of survival in a major medical event totally depend on what region of the country you are in... more specifically what city you are in. The same person may live to see his grandkids in one area, but be stone cold dead in another metro area...with the same medical condition.

As long as EMS allows other professions to guide our profession we are going to be lacking in respect and for good reason.

[rumedic1]

I think this is a GREAT move. I work as a career Paramedic for a county service, we have all paid personnel. There are Grants that we can not get due to the fact they are federal grants for EMS, but only if they are fire based. Here in South Carolina there are a lot of County based EMS agencys we work fine with the Fire Departments overall. In the county I work we are even housed at fire stations. I thinks EMS is in need of a Federal Agency to be able to set national standards and have resources to better EMS care nation wide.

[IAMedic]

I have to agree with rumedic1. There is a huge difference in grants from Firefighting to EMS. The $750 million from last year was not available to 99.95% of the EMS services that help serve this great nation. It is very unfortunate. I am all for a new EMS Dept. EMS needs National recognition and needs to separate from the "oh, their firefighters so they have access to everything the fire depts get" mentality.

The Fraternal Order of Paramedics Society (http://www.foops.org) has written a letter of support last year to the Project USEMSA chairpeople. So now let's just sit back and see what happens!! I think that it can only be a plus for EMS.

[DaSharkie]

I am in agreement here. Emergency Medical Servies needs its own voice. It needs to be on par with fire suppression, and law enforcement. As it is now, EMS is far below the two, which is shameful.

If we, as a profession are to evolve, this is necessary. A manner to raise the standards to become a practicing medical professionsl, for that is what we are, needs to be established. The views of EMS need to be paramount. As the article in the link states, the IAFF says that they already represent EMS and that there are already organizations representing EMS - a VERY arguable statement. The level of care, treatment, and training needs proper representation because the politcians have no idea about what is going on out there.

I am, personally, a major proponent of making a Paramedic certification, an Associate degree minimum, and I feel that this board would be agreat way to aid in accomplishing that goal.

[fiNEWBIEre]

GREAT! Just what we need... The government trying to run everything on its own... We don't need a bunch of people in DC, who know nothing about Emergency Pre-Hospital Care trying to "do what is best"... Taking advise from a group of people who's medical knowledge doesn't go much father than opening a box of bandaids; and the whole bowl of rice is headed by a guy who's had years of expirence stock the shelves at walmart, which included putting an array of first aid kits on the shelves... But don't worry... he looked at the pictures a few times, and doesn't think EMS is all it's cracked up to be... All the people only have splinters and small abbrasions on their knees... They don't need all that money. . . . . . . . . . After all, "anybody" can be an Ambulance Driver...

[MedicNathan2004]

Its a step in the right direction. EMS was formed rather quickly because of a sudden demand. (Guess people went oh ****, we need someone other then Bubba the Mortician.)

I'd like to see EMS get to where nursing is. That means making it so that your a Paramedic anywhere in the US. In Texas you can get an AAS in Emergency Medicine (I believe thats the title.) and become a L.P. now. I'd like to see "Paramedic" become a four year degree like the BSN and eliminate the ECA and EMT-B, and have the EMT-I and EMT-P much like the LVN and RN is.

The only way we are going to see better pay, better respect, and the removal of the "Dumbass Effect" from EMS is if we form a group to set the standards, define the principles, and regulate things. I believe that everyone on this council or what ever it is, should at least be an EMT-P.

We need more grant money so that Volunteer EMS can become paid EMS, because there are a lot of places in Texas that can't afford Paramedics, and the patients shouldn't have to suffer from a lower level of care because they live in the country and not the big city. (I'm not knocking lower patch levels or volunteers.)

This would also help with all of the Medicare/Medicaid fraud with the private services. Fire and EMS are two different worlds, sometimes ran under the same department, but its time EMS started advancing. I'm sick of being called an ambulance driver (I don't even drive!) and seen as worthless in the eyes of doctors because it only takes two years to become a paramedic in Texas.

End Rant....

Nate

[EMTfarmer]

I'm all for getting some uniformity and a universal voice for EMS but in the back of my mind I still have the vision of a man in an expensive suit strolling into my office saying, "I'm from the government and I'm here to help you.":confused:

[MedicNathan2004]

Originally posted by EMTfarmer
I'm all for getting some uniformity and a universal voice for EMS but in the back of my mind I still have the vision of a man in an expensive suit strolling into my office saying, "I'm from the government and I'm here to help you.":confused:

An't gonna happen, get a three bay station, considered youself spoiled. I can now work an entire 24 hour shift wearing only my boxers and a t-shirt and never leaving the confines of my house or station.;) (Nice when the dispatcher forgets about the new station._

Grant money, they will pay for a kid to learn English instead of buying a new ambulance to save lives with. Go figure.

[ALS142]

This has been way overdue. For the past 15 years, we've been talking about the need for a uniform medical report, similar to the uniform crime report and the uniform fire report.

National registry was supposed to have been a universal "licesning" device whereby you could move from state-to-state and have all you credentialing automatically accepted instead of the patchwork network we have now. Hopefully, an agency like this will resolve this problem.

All-in-all, I think that this will be a good thing for EMS.

[DaSharkie]

National registry was supposed to have been a universal "licesning" device whereby you could move from state-to-state and have all you credentialing automatically accepted instead of the patchwork network we have now.

Not trying to start a p*ssing match here, but from what I hear (it's not my job to start rumors - only perpetuate them) this has been fought, along with 2 year degrees for EMS, by a few organizations and states.

Many states feel that they need their own revenue (My state: Massachusetts, among them) and you should not be able to just walk into their state, because EMS is different once you cross into their state, it is like nowhere else - boy have they got that one right!

One should be able to pick up and move to another state and have to do nothing more than get acquainted with the new protocols, and jump through the individual service's hoops to get hired. It really is pretty sad. I am fortunate to have my national which makes my pending relocation much easier, and I have a certain amount of pride in having obtained my national cert, as opposed to my Massachusetts cert, which was a pathetic joke to obtain.

A major thing we also have to do for EMS is ensure that programs out there are teaching quality people to become paramedics and are giving them a high calibre of training and education. I am sure we all know of some shady programs out there or those that teach specifically to the test and not a whole lot more.

I know there are nationally credentialling organizations for programs out there, and this is the level that all programs should strive to achieve. We owe it to our patients, nevermind ourselves, to demand nothing less.

[historyjunkie]

I'm all for a universal system, I'm also all for this idea of grants for new equipment... I don't have hair on the bottom of my arms anymore after years of stoking fires to prepare for 6 to 10 hour chicken BBQ's in snow or 110 degree weather.

I also know there's quite a few "winners" out there as far as "trained" personnel go. But even though I'd do anything for my volunteer ambulance or Fire Company... I won't go to college for 4 years for them. If I wanted to be a paramedic, I'm not going to learn ancient literature for a year before we even get into medical classes. I won't say that it isn't worth it b/c it will **** people off, but I hope we're all professional enough to respect each others opinions. Understanding that my voice doesn't mean much, I'm no more powerful than any other person. I'm just another face among people who want to be there to help (and maybe get an adrenaline rush).

What I'd like to see is a Universal Standard; I know that every state has a different system. I don't even know what some of the EMS titles mean. EMT, EMTA, EMTB, EMTI, EMTP, EMTIV, EMTIVT, EMTCT, EMTSTT, CFR, FR, CCA, ECA, PHRN; and god know what else... Those are just the ones I know. Three levels would be perfect, get rid of "First Responder" in PA that's 80 hours, and they can do pretty much all of the EMTB skills w/ exception of a few. I say if you’re going for 80, why not go the extra miles for 120 @EMTB..?

Level 1 EMT - Skills of EMT-Intermediate
Level 2 EMT - Skills of EMT-Paramedic
Level 3 EMT - Skills of Registered Nurse.

Don't make it any more difficult for people to achieve the classes, i.e., don't make them all 4-year college. I'd just like to have more skills for our citizens. PA doesn't have the benefit of EMT upgrades for IV's, EKG, Intubation; as many states do... And it is my -opinion- as an EMT is a state classified "Rural Ambulance", these skills could be critical in survival of cardiac arrest patients. We've had two saves in three years. I know people in area cities that haven't had that many in a decade, but it would never hurt to give someone an extra chance. Ya know, help us sleep better at night.

To me, that's what it’s all about... Making the system as a whole better so that people in the smallest towns have the same chance of survival as people in the largest cities! Everything else is immaterial; if my pager goes off right now, I want to be damn sure that I can provide that person with the most rapid, and top rate care that they deserve. And every person in this country deserves that same rapid, quality care set by standards...

I'm all for all paid services; but I'm not against volunteers... I am one. If people want to volunteer, and not get paid, let them. I couldn't accept payment, maybe it's just me. I'm also all for not having to worry about things so much b/c of the cost of -COMPLETELY, TOTALLY, RIDICLOUS OVER PRICING OF EMS SUPPLIES- ... I wish they'd give every service $$$ to replace or buy new AED's, I'd like never to see or use a wooden backboard again, I'd also like new stair chairs, traction splints (We do have six or more Hare and Sager Splints combined and the like amount of Thomas splints, but things like straps go missing so often.), and maybe some of those stretchers w/ the rugged wheels b/c I've yet to see a home in my area that is easy to access.

:p I can't help it, I held this in too long...

On a lighter note, I'd appreciate if the Bucks Central Ambulance & Rescue in Doylestown, PA would return my HARE ankle strap... It was nice of the TJU Hospital to send the splint back, but really, Bucks Central should have taken their stickers off... They're covering mine, you know how hard it is to get those stickers off anyway, try taking them off others that are already on there w/ out tearing them... Guess that's why they didn't take mine off? On the like note, how you'd miss them big stickers while putting yours over them, or the service name on all the straps, I'll never know. Maybe it's time to buy some glasses b4 ya cop some ones gear next time; and try to make sure it doesn't get back to the real owner, eh??? I'd send your big green stickers back, but I can't find your address. :rolleyes: :p

[eyeOthestorm]

I am all for it!

I'd like to mention that if we cut the FR out and require folks to become EMT-B then you are gonna lose a lot of great volunteers. I say this because I know that many of my friends had a hard time balancing family, working full time, fire dept. duties and FR class. I also know for a fact the some folks don't want to be an EMT they are happy being a FR. 80 hours is a long time to some folks and 120 may be too much for some.

Just my $.02 worth. :rolleyes:

[MedicNathan2004]

Originally posted by DaSharkie
I am, personally, a major proponent of making a Paramedic certification, an Associate degree minimum, and I feel that this board would be agreat way to aid in accomplishing that goal.

In the State of Texas the LP patch, or License Paramedic is an Associates degree. It use to mean ust a paramedic with a degree, but now you have to have a degree in EMS/Emergency Medicine to obtain this patch.

San Jacinto College, which features one of the best paramedic programs in my eyes requires you to take EMS Operations, a class that goes into more of the rescue side of EMS, and not only explains the different sides of EMS, but it gets you hands on. (We actually did the rope rescue, rock climbing, swift water rescue, cut the cars up, and everything else in there. We didn't just read about it. Not only do you have to have the normal basic core classes to get the degree, but you also have to have A&P 1 and they suggest you take A&P 2. (As well as EMT-B through EMT-P and we are offered the BTLS, ACLA, and PALS classes, however, you don't have to pass them to graduate, but they effect your grade.)

We are taught that there is no excuse for not knowing something, that you are expected to keep abreast of the latest news and national standards. The funny thing is, we are taught the way the DOT outlines it, but the state doesn't require this way. (The college has choosen to go above and beyond what is required by the state.)

There is nothing that says you have to go to a college to become an ECA, EMT-B, EMT-I, or EMT-P, only that you go to one to become an LP. I'm sorry, but how would you feel if your nurse went to "Bubba's Nursing Skool" to learn?

There are a group of us that are mix of volunteers and paid crew that would like to see a four year degree offered, much like they have in nursing. The only way we are going to gain the respect, set the standards, and provide increasinly better care is if we step up to the plate and do it.

Most of the people in Congress and the government have no idea what all we are capable of doing, what all we know, and further more, just how hard this job can be at times. It isn't their fault, it isn't anyone's fault, we have only been around for a little over 30 years, and we need to educate them just like the nursing profession did.

I do not see a paramedic as lower then a nurse, but equal to one. In fact, many of the classes we take, they take two, we just focus more on the emergency aspect.

The nursing profession has two levels, LVN, and RN. We need to do the same. EMT-I (Can assist the paramedic with IV/Airway and some drugs.) and EMT-P. I would like to see us make the move so that an EMT-I is an Associates degree, with the EMT-P being a Bachlors. (Both in science.) I feel that this would not only improve care, but increase the level of respect and care we are able to obtain. (The average paramedic makes between $30,000 and $50,000 with one job.)

We all know there are a lot of bad apples out there, and a four year degree, higher standards, and the elimination of the EMT-B and ECA will help weed out some of these bad apples. Yes I know that it will strain our EMS system to some degree, but we can cope with it and make do with what we have. (After all, isn't that our job?)

I'm not trying to start a ****ing match, and I was once a volunteer, but to say that we shouldn't increase the standards and aim for a degree program simply because we would lose volunteers isn't reason to stop this from happening. When I see a volunteer, I see someone that is egar to help, kind, and caring. Someone that is willing to leave their family at 2:00 AM and go help a stranger that others might look upon as a waste, now thats a damn good person right there.

However, the local city council sees volunteers as cheap labor and a way to keep spending down. They in turn don't ask for more money and the state and federal government don't spend more money because they aren't asked to.

Granted I understand the need for volunteers, and I see how they are of great help in small areas where thats all they have, the doctors they have have to take the same tests that the ones I have here in Houston. (Home of some of the world's best hospitals.)

So in my eyes, a patient that doesn't have access to a paramedic isn't getting the same level of care as one who does, and we need to end that make it so that every patient has the same chances of a good life as the other guy.

So this is what I'd like to see happen:

1. An agency that is ran by people who are at least paramedics.
2. Higher standards, and the elimination of state to state standards which would make a paramedic in Houston the same as one in Chicago.
3. Elimination of the ECA, EMT-B, and making all ambulances have at least one paramedic on board.
4. A four year degree with a heavy back ground in A&P so that the paramedic has a better understanding of the human body, which would eliminate the "Cook Book Medic" syndrome.
5. Making Nathan God. (Sorry, had to have some humor.)
6. The start of eliminating volunteer EMS and moving towards paid departments.(Except in areas where they might run like 50 calls a year.)Before anyone starts to get upset, I don't see any volunteer hospitals, and like someone up above said, they refuse to go to college for their service. This is a career, not a hobby.
7. More funding set aside for CE, supplies, and expansion.
8. ALS Fire Trucks, to provide ALS care instead of BLS care. (First responder program is great, lets give them more room to play.)

I knwo a lot of people will object to this, but I've been a volunteer, and I'm a paid medic now. I did this because I felt that BLS wasn't enough, and that every patient should get ALS care. The schooling to become a paramedic is growing longer and longer every year, and its time that EMS became a respected as the profession that we are. Paramedics are NOT LOWER then a nurse, and to tell you the truth, if we expanded the pharmacology base, and taught more long term care, we would have something that could replace nurses. (More and more paramedics are doing that.)

Nate

[DaSharkie]

if we expanded the pharmacology base, and taught more long term care, we would have something that could replace nurses.

Oh my gosh. If the nurses around here heard you say that you would be lynched in front of the hospital. But your point is made. The Medic '99 curriculum was devised to include a lot more skills that are performed in a hospital as was the pharmacology, this is beginning to be an expanded area for Paramedics. I know many nurses and nurses unions who fight the very notion of putting Paramedics in the ED because they do not understand what we are capable of AND see us as replacements for nurses instead of part of the team. Unfortuantely, it is the patient who suffers, the very person we should all care about. I won't challenge you on some of youru statements because this is not the forum for that, no pun intended, and we do need to repect everyone elses opinion.

[MedicNathan2004]

I wasn't saying we are better then nurses, I was saying we aren't lower then nurses. Thats why when a nurse trys to talk down to me, I'll word something to trip them up, and it usually works.

Times are changing, and EMS is expanding and becoming more and more a part of the other medical fields and daily life.

(I wasn't trying to offend anyone with my little soap box stand above.:D ;) )

[historyjunkie]

I also know for a fact the some folks don't want to be an EMT they are happy being a FR. 80 hours is a long time to some folks and 120 may be too much for some.

Good point.

But, if they aren't willing to go for 120 hours, are they going to go for the 2 or 4 -year- programs with over 1000 hours of clinicals and field requirements? That is, if everyone is required to be at least a Paramedic? Plus, you can make more money working in a 7-11 than in an ambulance in a good portion of the states; that is, if your supporting a family. So, in the long run, does anyone suppose this would lead to even worse manpower shortages than we currently have?

After all, 58% of the population do favor the EMT course; while only 17% the EMTP course. Costs 18,000.00 to Take Paramedic course locally here. If all of our crew had to be paramedics, it'd add up to 306,000.00 Who's going to pick up that tab? The cost of the EMT course, locally, is 155.00 @ 2,635.00 that sounds a whole lot better on paper, especially since we only have to BBQ 878.3 Chickens to pay for the EMT course. Or 102,000 Chickens to pay for Paramedic classes. To see the whole picture, you look at it that way, I suppose.

[MedicNathan2004]

The only way pay is going to go up is to make the education requirements higher so as to have a reason to warrant better pay. If EMS personal refused to ride for chicken feed, then the pay would also go up. I know several paramedics that drive new trucks, have boats, and live in $100,000 to $150,000 houses.

If someone has a problem with taking 120 hours of schooling, then they don't need to be in this field. The nursing field requires it, and so why can't we? Are we going to stay back in the Cave Man days because people are to lazy to go to school for longer?

To many people are in EMS because they couldn't get jobs in anything else and they saw "Easy Money", I've seen these people come and go. So we have to do something to eliminate that aspect much like nursing has done, and we also have to redirect the train of thought towards being professional, not a hobby.

If your paying $2,000 plus dollars for your EMT course, then there is something wrong and you might want to have a talk with who ever setting those prices. All of the ones around here are running from $300 to $800 depending on if your getting CE time or college credit.
I think my paramedic course in the end is $4,800 with books and the uniform. That was roughly about five semesters. (You should really have a talk with your local college about their prices and ask them if your patch is gold.;))

The reason why we have man power shortages is because the pay isn't good enough and the quality of people ranges from great to crap. The schooling isn't standard from state to state, and we aren't seen as a "profession" but more as a trade. We need to make it more uniform and ditch the "trade" and become a "profession."

As far as who pays for it? Tax payers, and those that whine and bitch about it, have two options. Do you want a damn good EMS service, or do you want an okay EMS service? If we can pay for illegal kids to learn English, have mayors and officals in the government living in $1,000,000 homes and making what they make, then we can afford EMS. We don't skimp out on our police, children's education, so why should we do that with our health?

So how about the next time your BBQ chickens you try to educate the public on why your service needs more money for staffing. How about you try talking to your local college and ask them why they charge so much?

You know why 17% (Which your percentages don't add up by the way.) of the public don't like the EMT-P as you put it? Because they are afraid of it, and so was I, but once you get into it, it really all makes sense. Once you hit that upper level, you look back on your lower patch days and are greatful that you know what you know now. Its a good feeling.
:cool:

We are here to save lives, and we are dedicating our time and energy to doint this job. Not wanting to become a paramedic because it takes to long is not an excuse, and I'm sorry, not trying **** you off, but the next time you run a code with a BLS crew, tell the family you didn't feel like taking the paramedic course because it takes to long. I bet they will have a nice letter for your city council asking that they pay for you to become one.;)

Nate

[historyjunkie]

Before you criticize me, read it... B/c the information you got was wrong...

My numbers don't add up? Blame JEMS, Jan. 2004 issue.

58.36% of 840,669 Providers are EMT-B's
17.02% of 840,669 Providers are EMT-P's
05.56% of 840,669 Providers are EMT-I's
19.06% of 840,669 Providers are FR's.

Doesn't say that EMT P Class costs 306,000 or an EMT Class costs 2,635... It says """If all of our crew had to be paramedics"""...

17 EMT-P's at 18,000.00 = 306,000.00
17 EMT's at 155.00 = 2,635.00


Who'd-a thunk it... Last I knew volunteers are uncompensated... And I'm a volunteer. As for the city council, I don't plan on leaving the sticks or the boondocks. Guess you can say we're conveniently located in the middle of nowhere.

:eek: :(
Come on now... That last paragraph is unjustified, rude, out of line and unprofessional...

[MedicNathan2004]

You didn't say where you got your stats and all I saw was 56% and 17%. If you would have informed everyone reading it that you got your information from JEMS then I would have known there was some extra % left over.

I wasn't criticizing you at all either. Its just that time after time I hear VEMS complain about money, and the more and more I see, its becoming an excuse not to advance. I'm sorry my last paragraph offended you, but its the truth. If I get into a wreck in your district and I need a paramedic because I am suffering from a pneumothorax, massive bleeding from a femur and hip fracture, and then while your removing me, I suddenly go from A&O x 3 to 0, wouldn't you agree that a paramedic would be able to do a hell of a lot mroe then a basic could?

If I'm not mistaken, you come across as being in a rural area in the middle of no where. Where is the nearest trauma facility? I'm going to assume that it is a bit of a drive.

Now if I died I wouldn't be mad because there was no paramedic because you guys hadn't gotten your funding, really couldn't afford one, or some how, everyone had failed their test. I would be mad if I found out that there was no attempt to bring paramedics into the area, I would be mad if I knew that my crew simply didn't want to go to school longer to become a paramedic.

EMS has a really big problem, its called being a LAZY *** and I'm not saying you are one. I don't know you as a medic to say if your good or bad, lazy or not.

We finally have a chance to make our profession better, and while things would be come tougher on VEMS, would it really bother you if a man in a suit walked up and said here is 2.5 million dollars, make yourself a paid department with paramedics? I don't think it will, because I'm going to assume you love this job and don't really look at it as a job, just like most of us don't. I would probably assume that you would either become a paramedic since you were going to get paid to do it, or you'd work part time as a basic.

So tell me Sir, what is wrong with EMS becoming more of a profession and our medics on the street knowing more, becoming better in the field, and saving more lives? We have gone from an industry in the 70's that if presented with the patient above would have just thrown them in the back and headed for the hospital.

Now we can stablize these kinds of patients, splint the fractures, needle decompress the chest, start fluids to combat the fluid loss. We have advanced quite a bit in just over 30 years, and I would like to see EMS continue to grow.

Something you should know, EMS is the only profession that is loved 100%. People get mad at the FD, people get mad at cops, people get mad at the army, but no one ever dogs us really. I bet you could have a town meeting and tell the folks that you'd like to put a paramedic on every truck, explain to them why you want a paramedic on every truck, and I bet they will have no problem with paying more.

And to answer your question, no, I wasn't trying to make you feel bad, just trying to have a conversation with you.;) :)

Nate

[Bones42]

bet you could have a town meeting and tell the folks that you'd like to put a paramedic on every truck, explain to them why you want a paramedic on every truck, and I bet they will have no problem with paying more.
Let's see, we, as volunteers, ran 1400+ calls last year...needed ALS care on about 100 of them....yup, everyone being paid ALS makes sense to me. :rolleyes:

[MedicNathan2004]

Originally posted by Bones42

Let's see, we, as volunteers, ran 1400+ calls last year...needed ALS care on about 100 of them....yup, everyone being paid ALS makes sense to me. :rolleyes:

We at least hook up the four lead to all of our patients, start a saline lock, draw blood, and there is more to it then sipmply having a paramedic.

Paramedics are taught to think in a different way then the basic is. As a basic I was tought to treat what I see, as a medic I was taught to think about the different causes, to look for signs & symptoms of cardiac events to come, and other things that a basic doesn't have the background to look for.

The only time I don't at least check out the heart on the 4 lead is if it is something like a cut finger or a stubbed toe. But I had a woman who's CC was "pain in my leg." Now as a basic I just checked out her leg, did an assessment, and then checked her viatls. I wouldn't have ever thought to think about a thrombus making its way thourgh her leg which could lead to a pulmonary embolism. She was an older woman who was confined to a bed, and din't move her legs for days at a time.

It wasn't till after I got her to the ER and came back about two hours with another patient that was what she had. Now as a medic I know that pain in leg, bed confined, possible thrombus. Paramedics do more then just shock people, push drugs, and poke holes in people's veins.

Just because the majority of the calls are BLS, doesn't mean I don't think ALS.;)

[Bones42]

The only time I don't at least check out the heart on the 4 lead is if it is something like a cut finger or a stubbed toeBingo! Living near a boardwalk, I find it is amazing how many people can't walk on 2x6 boards without tripping and getting splinters. Plesae don't think I am disregarding medics and their skills, that is not my intention. I just believe everyone has their place.

Question about standard levels across the nation...it seems people are using the fire service as an example of standards. How many states have their own level of FF1 that does not mean beans in the next state over? I know NJ is one of them. If EMS made nationwide standards, they would be way ahead of the fire service.

[eyeOthestorm]

Originally posted by MedicNathan2004

Something you should know, EMS is the only profession that is loved 100%. People get mad at the FD, people get mad at cops, people get mad at the army, but no one ever dogs us really. I bet you could have a town meeting and tell the folks that you'd like to put a paramedic on every truck, explain to them why you want a paramedic on every truck, and I bet they will have no problem with paying more.


Nate, how long have you been a medic? Have you ever travled or listened to other EMS folks from around the world? EMS is not 100% loved in all areas. Yes we are sometimes dogged and folks around here only want a medic on every truck if they can pay them $8.00 an hour. They are aware that the closest trauma center is over an hour away...25 minutes by air...They do not want to spend the $$$$ if they dont have to. I am just saying that you need to understand not everyting is like it is in Texas.

As for my comment about the folks not wanting to do 120 hours....I stated that they did not want to be EMTs they only wanted to be FR's so yes I think 80 hours is enough for volly FR's and yes they have to do CE in this state. There a plenty FR's here that I would gladly put my life in their hands and have before....

[pfd3501]

Having the Federal Government in charge of EMS would be bad. Think of the National Registry cluster multiplied by 1 million.

The Founding Fathers had the right idea. The purpose of the Federal Goverment should be to protect an association of states, not control them.

Do you think I want a group of goofy beaurocrats from the coasts determining what we need to do in "flyover country"

Do you really want to create a Medic Welfare state? Do you think that an infusion of Federal Dollars will fix a problem? Get a grip and look at schools, inner cities, and other beneficiaries of the tax dollar sugar tit.

I'm in favor of even lower taxes, and less federal dollars for programs. Stuff gets fixed fast locally when it has to.

Bad,bad,bad,bad,bad idea.

[pfd3501]

While I'm ranting, I'll compare this to personal disarmament laws, like the "assault weapons ban".

To the best of my knowledge, the National Registry program is tied into Federal DOT. They can't tie it together, and make the registry program work? So create another agency instead of making what is in place work like it is supposed to?

How much effect has the so called "assault weapons ban" had on crime? None, zero, zilch. Both sides say that the law is innefective. One side says that the innefectiveness is reason to do away with it altogether. The other wants more controls. Which won't work.

Get it?

[MedicNathan2004]

Originally posted by pfd3501
Having the Federal Government in charge of EMS would be bad. Think of the National Registry cluster multiplied by 1 million.

The Founding Fathers had the right idea. The purpose of the Federal Goverment should be to protect an association of states, not control them.

Do you think I want a group of goofy beaurocrats from the coasts determining what we need to do in "flyover country"

Do you really want to create a Medic Welfare state? Do you think that an infusion of Federal Dollars will fix a problem? Get a grip and look at schools, inner cities, and other beneficiaries of the tax dollar sugar tit.

I'm in favor of even lower taxes, and less federal dollars for programs. Stuff gets fixed fast locally when it has to.

Bad,bad,bad,bad,bad idea.

Just think if they would give the cash they spend on teaching kids English that don't know it and all of the cash from Welfare, give that to EMS and we would be driving BMW Ambulances with 24" spinners. Haha.:cool: ;) Maybe I could get my ambulance with that sparkley paint.

[Ohiovolffemtp]

Nate,
After reading all of your posts, I wish I had more time to respond. There are many points where I have a radically different perspective from you.

First, concerning the role of medics in trauma. There are a large number of studies which show the highest survival to discharge rates in patients who were transported by private vehicle vs EMS, lower with BLS care, and lowest with ALS care. Serious trauma needs surgical interventions, not field or ER interventions. C-spine immobilization, rapid transport, and airway & breathing support. Except the rare tension pneumo's which needle decompression or intubation is needed, especially RSI, there just aren't a lot of ALS interventions for trauma that are that critical. So, in your scenario, no, there isn't a lot more a medic could do.

Second, volunteer EMS, whether at the EMT-Basic, EMT-Intermediate, or in rare cases, the EMT-P level is often all that many communities can afford. The choice is simply volunteer vs. none. The new EMT-I corriculums I think offer an excellent compromise between attainable levels of time commitment for certification and providing key interventions quickly.

Third, as an EMS educator, I'm simply not sold on the value of the college education as a way to truly raise the level of service we deliver in the field. Many of the courses you cite are excellent - but the reflect the diversity of rescue you need in many communities not medical training. Often, the best courses in those specialties are not college based. I've seen good people come out of both college and vocational school programs - and I've been a student and a faculty member in both.

Before we talk about increasing educational requirements, pushing for only career providers, etc., let's talk about which patients will benefit from what assessments and interventions in the field vs. in the facility. Then let's talk about the education needed to get folks ready to deliver them.

I'd like to repeat the question about the number of years and type of experience you've had. I'm coming from a point of view of 20+ as provider, 8+ as an educator, and 10+ as an officer.

[DaSharkie]

This is the second time that I have read people criticising the inadequacy of the National Registry. I am curious as to where this comes from. I have been a registered EMT or Medic for 6 years and have never had a problem dealing with them. All questions are answered when I call and speak with them, all correspondence has been handled well and professionally. I am just curios where this sentiment orignates from.

[MedicNathan2004]

Originally posted by Ohiovolffemtp
Nate,
After reading all of your posts, I wish I had more time to respond. There are many points where I have a radically different perspective from you.

First, concerning the role of medics in trauma. There are a large number of studies which show the highest survival to discharge rates in patients who were transported by private vehicle vs EMS, lower with BLS care, and lowest with ALS care. Serious trauma needs surgical interventions, not field or ER interventions. C-spine immobilization, rapid transport, and airway & breathing support. Except the rare tension pneumo's which needle decompression or intubation is needed, especially RSI, there just aren't a lot of ALS interventions for trauma that are that critical. So, in your scenario, no, there isn't a lot more a medic could do.

Second, volunteer EMS, whether at the EMT-Basic, EMT-Intermediate, or in rare cases, the EMT-P level is often all that many communities can afford. The choice is simply volunteer vs. none. The new EMT-I corriculums I think offer an excellent compromise between attainable levels of time commitment for certification and providing key interventions quickly.

Third, as an EMS educator, I'm simply not sold on the value of the college education as a way to truly raise the level of service we deliver in the field. Many of the courses you cite are excellent - but the reflect the diversity of rescue you need in many communities not medical training. Often, the best courses in those specialties are not college based. I've seen good people come out of both college and vocational school programs - and I've been a student and a faculty member in both.

Before we talk about increasing educational requirements, pushing for only career providers, etc., let's talk about which patients will benefit from what assessments and interventions in the field vs. in the facility. Then let's talk about the education needed to get folks ready to deliver them.

I'd like to repeat the question about the number of years and type of experience you've had. I'm coming from a point of view of 20+ as provider, 8+ as an educator, and 10+ as an officer.

So its okay to not to push for further education because communities can't afford it?

[rumedic1]

I think this is being looked at from the wrong perspective. I beleive the intent of the new federal office would mirror the one that fire has. EMS is already regulated by government and this office would give continuity to EMS nationwide, this is where National Registry has failed. The problem with the existing federal agencys that control EMS is that we are buried in the fire service government plan. The new agency would give EMS stand alone agency so EMS services in the states could be represented in washington and have a way to fund EMS out side the fire service. There are MANY EMS agencys that are not part of a fire service. In the area I am from almost all EMS agencys are what is called third service (I hate that name) we are a county EMS agency. But have no representation in federal government except in the fire service ranks or the D.O.T. I have no problem with either but I am sure that the concerns of EMS are not at the top of their list. I do not see this as a extreme change just a chance to have a voice. Fire and D.O.T. must be sure that they do not upset the primary roles of there organization when they speak. If EMS had its own voice our message would not get buried in red tape. I do not think of this as a bad thing. One way I can tell is the way the fire service as responded.

[DaSharkie]

EMS is already regulated by government and this office would give continuity to EMS nationwide, this is where National Registry has failed.

While I agree with the majority of your statement, the only thing I see is this part. The national registry has a great many ideas but I think the states just do not wish to release their control over anything. I know Massachusetts is not a NR state and you still have to jump through some incrdeible hoops to get reciprocity here. Many other states are the same as well.

[pfd3501]

Originally posted by DaSharkie
This is the second time that I have read people criticising the inadequacy of the National Registry. I am curious as to where this comes from. I have been a registered EMT or Medic for 6 years and have never had a problem dealing with them. All questions are answered when I call and speak with them, all correspondence has been handled well and professionally. I am just curios where this sentiment orignates from.

The National Registry works well as a Registry service. It fails as a reciprocity service.

Once again, I use Ohio as an example

The registry is based in Reynoldsburg, Ohio, but from what I've gathered, Ohio does not recognize the registry cards from other states. The state makes new students take the registry coursework. When you pass, and get a "National Registry Card", it still is not a certificate that allows you to practice in Ohio. You still have to have your state card processed.

quick quiz for everyone
1. List the states that require National Registry curriculum

2. List the states that accept your registry card and allow you to be a EMT without any further state testing?

List #2 is much, much shorter, isn't it?

and that's my biggest beaf with the NREMT

[pfd3501]

EMS is one thing that needs local guidance and not the hand of the nanny state.

My point is that typical thinking at the federal level is "if the registry doesn't work, we'll rename it, roll it into another department, add a billion dollars of smoke and mirrors, and it's fixed."

[DaSharkie]

The National Registry works well as a Registry service. It fails as a reciprocity service.

As I said, this is a state issue about not realizing that the standard set by the National Registry practical and, especially, the written are very hihg, but they refuse to relinquish any control of this.

Here in Massachusetts, if you are a nationally registered Paramedic, you do not have to take the practical portion of the exam. You are required to take one hell of a joke of a written examination that is so messed up it has no credibility.

As for obtaining reciprocity, I have looked into a few states and North Carolina, South Carolina, and Pennsylvania do not seem to have many problems, if any, obtaining reciprocity.

What needs to occur here is that all 50 states, and the possessions of guam, etc.., need to set a bar and allow for people to be able to obtain reciprocity. You are right, there is no reason that I cannot go from Massachusetts to Alaska, or any other state, and not have to take another exam, especially if one is a practicing Paramedic. The only exam I will give you is a protocols exam because some states wish to use a variety of medications that others do nto, for varying reasons. This is perfectly understandable and acceptabel, at least to me.

As for a curriculum produced by the National Registry, I do not know of one. I know that they consult on the DOT curriculum constantly and then base their examinations off of the curriculum, inculding rewriting exams and re-evaluting those exams when problems and challenges present themselves.

The problems you state do not appear to be a problem with the registry.