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DrParasite
05-11-2008, 09:03 PM
Bipartisan Legislation to Help Veterans Become Civilian Paramedics

U.S. Senator Amy Klobuchar introduced legislation today that is designed to relieve the shortage of emergency medical personnel, especially in rural areas, by streamlining civilian paramedic training for returning veterans who already have emergency medical experience from the military.

Senators Mike Enzi (R-WY) and Tom Harkin (D-IA) joined Klobuchar in introducing the bill, and Representatives Stephanie Herseth Sandlin (D-SD) and Jerry Moran (R-KS) introduced Klobuchar’s bill in the House.

"On the one hand, we have a severe shortage of emergency medical personnel in rural communities," said Klobuchar. "On the other hand, we have an abundance of returning veterans who have significant training and experience. They’re an ideal talent pool to relieve the shortage."

"The medical training that many of our service-members receive is of great value both on the battlefield and when they return home," said Enzi. "This legislation will recognize that value by promoting a smooth transition into the civilian emergency medical service workforce. This bill will help our returning soldiers along rewarding career paths, while addressing the health care worker shortage in rural areas like Wyoming."

"I have long believed we have an obligation to ensure that men and women returning from Iraq and Afghanistan are provided with every opportunity to continue their education and training when they return to the United States, in recognition of their service," said Harkin "The Veterans-to-Paramedics Transition Act will not only further that effort, it will also help our rural communities who are currently experiencing health provider shortages."

"The Veterans-to-Paramedics Transition Act will not only help service members obtain employment that recognizes their military training, but will also help relieve a shortage of emergency medical personnel in rural states such as South Dakota," said Herseth Sandlin. "This is a common sense bill that does right by our nation’s veterans by helping to ease the transition from the military to civilian life."

"Kansas and many states are facing a severe shortage of EMS providers," Moran said. "Kansas EMS has taken the initiative and is working to address this issue. I am hopeful we can serve as a model for other states to help veterans secure employment while providing valuable health care to our communities."

The legislation, S. 2993, is called the "Veterans-to-Paramedics Transition Act." It would accelerate and streamline the transition to civilian employment for returning veterans who already have emergency medical training.

Klobuchar explained: "When we have soldiers who are trained to save lives on the front lines of combat, they should also have the opportunity save lives on the front lines right here at home."

Specifically, the bill would provide federal grants for universities, colleges, technical schools, and State EMS agencies to develop an appropriate curriculum to train these veterans and fast-track their eligibility for paramedic certification. A standard paramedic training program can take one to two years to complete.

This bipartisan legislation has already been endorsed by the American Ambulance Association as well as the Minnesota Ambulance Association and the National Rural Health Association.

There are more than 300 licensed ambulance services in Minnesota, with 85 percent of them located outside the Twin Cities and other urban areas like Rochester, Duluth and St. Cloud.

Rural communities have long faced critical shortages in emergency medical personnel. A Minnesota Department of Health study several years ago described it as a "quiet crisis." In that study, 75 percent of rural emergency medical service providers said they needed to add more staff, and 67 percent reported having difficult covering their shifts.

"We very much welcome this legislation to address Minnesota’s shortage of emergency medical personnel," said Buck McAlpin, president of the Minnesota Ambulance Association. "Every year, one to two ambulance service operations close in rural Minnesota and, in some places, there is growing concern about whether an ambulance will even be available when someone calls 911. Minnesotans have a right to expect that a well-trained emergency responder will be there for them."

Meanwhile, thousands of men and women in the military receive emergency medical training as part of their duties. For example, most Army combat medics are currently certified as Emergency Medical Technicians (EMTs) at the basic level.

When these veterans return to civilian life, however, their military-based medical training is not counted toward training and certification as civilian paramedics. Many existing programs require all students to begin with an entry-level curriculum. For veterans, this means spending extra time and money for training that, in effect, they have already received.

Klobuchar first announced the legislation in Minneapolis in April, when she was joined by Jesse Folk, a Minnesota National Guard member from Ortonville who served in Iraq for one year and received training as a combat medic. He described his emergency medical training and experience, as well as his frustration at trying to find a civilian paramedic education program that would recognize and build on the training he already received in the military.

"We cannot afford to squander this wealth of skill and experience, especially when rural communities have such a shortage of emergency medical personnel," said Klobuchar. "Our nation has invested in developing the skills of our servicemen and women. We need to make the most of this investment when they return to civilian life.’’

May 8, 2008
http://www.defrance.org/artman/publish/article_2092.shtml

LasVegasEMS
05-11-2008, 10:03 PM
Ok, so before I reply, it is not an attack on Veterans.

So, now we have federal legislation that is trying to offer incentives to Medic Mills. I view this as a huge set back to those of us who want to expand Paramedic education, both pre-reqs and actual curriculum. I agree that veterans should be given some credit for their military training, but from my understanding a majority of them are only trained to the BLS level. And let’s face it, battlefield assessments are trauma, probably not very much medical; I'll be the first one to say that there are probably military basics that would run circles around field paramedics when it comes to trauma calls. However, the most credit I think I would be comfortable with someone getting would be to test out of the trauma class in Paramedic school. The medical part is a huge part of what we do and I just don’t think there is any credit to be given there.

I work with several guys who worked or continue to serve tours of duty and every time they come back they have to recredential in our system. They will be the first ones to tell you that even though they are field providers, after coming back from duty, it takes them a month or so to get back into the medical swing of things.

The other thing I find funny about this bill supporters is their optimism about available jobs. Is there a lack of immediately available resources in rural areas, YES, does training these Veterans in a fast track paramedic program help alleviate that, HELL NO! The reasons these communities lack is because they can't afford to pay for a staff 24 hours a day. What kind of rewarding career are these legislators thinking these guys and gals are going to fill, being paid $4-50 per call? In response to this article, unless changes are made, I hope this bill bites the big one.

croaker260
05-11-2008, 11:32 PM
Well, I have a couple of suggesstions. If congress would fund EMS jobs in underserved and high risk areas like it does the assistance to firefighters grants and law enforcement gransts, partnered with this program, it may work.

Also, I dont see this as helping the medic mills, this gives funding to establishing a curricula for a bridge program..since it will likely be partnered with existign VA benifits as well, and managed by the VA almost certainly, then I would be surprised if anything by accreditited universities and colleges would qualify for the $$$ for tuition..

In addition, since the NREMT is on tract for mandating degree programs by 2012....that is the death knell of the medic mills.

LasVegasEMS
05-12-2008, 12:21 AM
Well, I have a couple of suggesstions. If congress would fund EMS jobs in underserved and high risk areas like it does the assistance to firefighters grants and law enforcement gransts, partnered with this program, it may work.
As optimistic as I like to be, do you think certain groups would allow a shift of funding from them to EMS? Not without a huge long fight I would think, but you're right.


Also, I dont see this as helping the medic mills, this gives funding to establishing a curricula for a bridge program..since it will likely be partnered with existign VA benifits as well, and managed by the VA almost certainly, then I would be surprised if anything by accreditited universities and colleges would qualify for the $$$ for tuition..
I hear what you're saying, but I was specifically focusing on this part of the article. The part where they say <b>"Specifically, the bill would provide federal grants for universities, colleges, technical schools, and State EMS agencies to develop an appropriate curriculum to train these veterans and fast-track their eligibility for paramedic certification.</b>
I think the Medic Mills could try to qualify themselves as a technical school and, since they already have fast-track paramedic programs set-up, would be in the perfect spot to take advantage of this money.

I still stand by my statement that only a small part of the paramedic curriculum could be tested out of by those with experience from the military.


In addition, since the NREMT is on tract for mandating degree programs by 2012....that is the death knell of the medic mills.
Didn't know this, I need to pay closer attention. The question is, will they require them for recert as well, to catch up everyone else :)

AZCEP43
05-12-2008, 02:04 AM
This is a feel-good story that doesn't take into account the specialization that military providers are subject to, and won't cross into the civilian world very well.

They are very good at penetrating/blunt trauma management, but beyond that they are, with a few exceptions, lacking in transferrable education. Allow them to take the full program, then allow them to test the same way. Perhaps give preferential entrance to them. Do not just give them a few months of medical emergency refresher and expect them to be able to perform.

croaker260
05-12-2008, 05:31 AM
I actually agree. Im not saying give them shorter education at the ALS level Im saying develop a bridge for the BLS level (amny are /have had their NREMT basic at one point or another) , and then added scholarship programs for the paramedic level, followed by job position funding on the streets.

croaker260
05-12-2008, 05:35 AM
In addition, since the NREMT is on tract for mandating degree programs by 2012....that is the death knell of the medic mills.

I should correct myself, specifically accredited (as in university) programs but perhaps not pecifically degrees (yet), as well as an "Advanced Practice Paramedic" Endorsement of some kind too.

armymedic571
05-15-2008, 07:41 AM
I have to agree with AZCEP on this one. Letting Military Medics bridge to Paramedics is the wrong answer. Having both a Military and Civilian Medic education, I can account for first hand the major differences between teh two. It would serve the veterans and communities better to make the medics go through a FULL accredited program.

As someone already stated, when it comes to trauma, most Military medics are equal to if not more advanced in that arena, however... when it comes to Medical Emergencies, they have not caught up to our Civilian counterparts. They are making headway, but we as a community are not there yet. And... it will probably be some time before we get there.

anywho, that's just my take on the subject.

VentMedic
05-15-2008, 06:12 PM
I should correct myself, specifically accredited (as in university) programs but perhaps not pecifically degrees (yet), as well as an "Advanced Practice Paramedic" Endorsement of some kind too.


In addition, since the NREMT is on tract for mandating degree programs by 2012....that is the death knell of the medic mills.

This is the deadline established for NREMT-P exam testing requirements that candidates be a graduate of a school accedited by the Committee on Accreditation for EMS Educational Programs (CoAEMSP).

A medic mill (or non-traditional) can achieve accreditation if it meets the standards established by CoAEMSP.

There is so much more knowledge and training needed to adequately make the transition. Cardiac care, OB, Geriatric medicine, pediatrics, etc are rarely covered in a Military Medic's course.

Also, when many of the civilian Medic Mills lack gravely in education and training standards as well as the diverse credentialing process of each state, it is difficult to set any measurable standard for the Military Medic's entrance into the system.

veneficus
05-20-2008, 01:37 AM
Not to sound too much like Yoda or something, but as my first post I figured I would chime in on this.

Disclaimer: I am very appreciative of military persons from all countries I have had the fortune to be in.

But now the bad news: In my not always humble opinion, I do not believe military persons should get anything a civillian doesn't. Now before you get out the pitchforks and torches, hear my arguement.

If a person serves as a civillian EMT, firefighter, police officer, or road worker, does he serve his country any less than a soldier? So why on many civil service exams I have seen are military persons given more bonus points than educated (4 year degree or better) or experienced applicants? Will we start creating accelerated programs for experienced police officer to medic? Will they receive a discount or edcational grant?

I have never been a military medic, but I will lay my next paycheque on the line that there are very few in the military that have seen trauma patients with significant medical problems that complicate civilian trauma care, which is far more nuanced than the prescreened, physically fit 21 year old. So this will ccreate issues with letting military people be exempted from even this topic.

Those of you who know me, have heard this several times, I beg once again your indulgence. I have met drug abusers who have IV skills to match any provider. A machine can recognize and defib a lethal heart rhythm. What makes a medic is not a set of psychomotor skills. It is knowledge obtained through formal education.

What is in a title? How many civilian medics have the same educational standards? The same scope of practice? I could pull a guy off the street and teach him to run a code in about 3 days utilizing the least common denominator. I strongly suspect that is what these "accelerated programs" would become. Call me a pessimist. Is creating this plethora of "skilled" rather than "educated" providers going to benefit the EMS profession when politicians see "paramedics" as those soldier guys who start IVs and drive to the hospital?

How about the legal/standard of care issues? Not too many lawyers with adverts like: "Were you the victim of medical errors made by your military care providers? Call Dewy, Chetum, and Howe for your free consultation today."

Joseph Stalin once said "quantity is a quality all of its own." Stalin and I do not agree on much. I don't think saturating the EMS field with undereducated providers in order to increase "advanced provider" quantity is not going to improve patient outcomes. Not to mention, once you have these new providers, where is the patient going to go to? The overcrowded ubran ED? Maybe the small community hospital? It is pointless to use resources to fix only one part of a broken system.

The poster who inquired if there would be funding for livable wages for these new positions to be filled had a great point. Sure it sounds great to educate former military members to civilian jobs. But when this member uses up his educational assistance/time and is working at the local food place because it pays better will that solve the provider shortage problem? Last I heard the guy working the grill down at Moe's diner didn't have health insurance for him and his family. Seems better to reenlist that take a job for "we care" ambulance service paying medics $10 an hour with a $180 a month employee copay for 80/20 insurance with a $2500 deductable; routine care and drugs not covered. Who is paying for the deisel to drive "rural/remote" patients to the hospital? Where and what is the availability of con ed to these providers? Are these new providers going to be relocated to where the need is or will they join the 10,000 applicants for the next fire test establishing a list to hire 5 people? will they get screened out by civilian EMS agencies using "employment testing" focused on medical theory which becomes more common as standards for paramedics do not keep pace with industry demands?

Maybe we could go one further, medic to MD accelerated program. Biology? Chemistry? Who needs it? (sounds extreme, but consider: Why teach somebody the difference between chrystaloid and colloid solutions, when all they have on a rig is saline and maybe ringers?) How many states have medic to nurse programs? Why would requirements for paramedic be any lesser? If you can start an IV and administer meds, what more do you need to know? Does a paralegal exempt out of law school classes?

If you are certified by the military to the EMT-B level it seems to me that you have met the requirement to enroll in paramedic school. The same requirement everyone else had to meet. Otherwise what stops the infantryman taught IV skills from getting exempted from that part of paramedic class? Would you exempt a med tech or phlebatomist? (sure he can stick the needle in the vein, but there is more to IV therapy than that)

I love politicians. They are great. Always thinking things through before they spend money on it.

PS. If a military person got a waiver to enlist for a criminal conviction, becomes a military medic and transfers to civilian medic what is the employability of this medic in the civilian world?

ALS142
05-20-2008, 01:46 PM
I'm a retired Navy corpsman (Hospitalman Chief Warrant Officer) and presently a field paramedic. While the education given to medics in the military is excellent, the training is usually not equivalent to being a paramedic. Medics are trained as lab techs, surgical techs, floor nurses, X-ray techs, etc. Those that are trained as Combat Medics do have exceptional abilities dealing with traumatic injuries. Special Forces and Independant Duty medics function nearly as doctors but they are usually working on a healthy, physically fit person generally between the ages of 18-40.

In EMS, the majority of our calls involve a generally older, and occasionally younger, population with diffuse medical complaints and cardiac/respiratory problems. Most of these military medics would be hard pressed to properly interpret cardiac rhythms and prescribe the proper treatment. When I would work in the ED department at whatever base hospital I was assigned, generally the other medics on staff, and occasionally the doctors too, would ask me to interpret a non-sinus rhythm and recommend a course of action. This wasn't a slam on their abilities, they just did not commonly encounter patients with these complaints.