I find this forum to be odd and discriminatory or maybe this thread is just for the *****-ing without solutions.
I will restate again what I posted earlier. Some cities are more proactive. Not only by nurses but also Paramedics. I hope this does not offend the moderators to hear something like that.
In San Francisco we have Health SF which is an insurance program to help the poor and/or uninsured.
I know this forum is mostly a ***** and vent type much like the EMT forums but I would hope some would like to know about programs out there. Yes it is probably more fun to poke fun at your patients rather than get involved in solutions but at some point all the ******** gets frustrating to those who are involved in programs which are trying to make things better for at least a few including the staff in the ED. When "professionals" continue to just make jaded comments about the patients, it sometimes defeats the progress being made and it is more of a hindrance than a help.
Anyone can read what is written here since it is an open forum. All the crap about patients posted here without another view point does not make nurses or Paramedics look very professional. Also, you have to take into consideration out EMS systems and education have not advanced to the levels of those in the UK where they are considered "practitioners" (both nurses and Paramedics) so healthcare in the US is just as much to blame as the patients.
Here is a more detailed explanation of various disorders. The ABG itself is very limited in information. Therefore other labs and a thorough clinical assessment must be done and correlated.
First things first, I am a she! Been in EMS since 1998. I am a LICENSED Paramedic. I hold instructor level in ACLS, PALS, BTLS, CPR, PHTLS, and Blood Borne Pathogens HIV/AIDS. I have been teaching RNs for their continuing education hours and recerts for years. Paramedics have over 1000 hours of classroom time, mine was probably closer to 1300. We have an additional 250-300 hours of clinicals in the hospital setting (including critical care). Then we have, at the very least, 500 hours of unpaid internship on the ambulance before we can take our boards. and, don't forget that you have to be an EMT-B first so let's not forget about those hours, because they do count.
I am currently in college bridging to RN only to pursue FNP. I do not have to complete any clinicals or labs (as well as some other classes, including pharm) because I am a Paramedic and I have already had them. I am learning the same A&P and micro that I already learned before, and if it weren't for the five year rule I wouldn't even have to take them again.
As far as us managing a critical care patient during a hospital to hospital transport, well, that's what we do and we are quite proficient at it! If an RN does go with me (and believe me it's rare) he or she couldn't even touch the meds on my truck if the patient did crash. I would still be the one administering the care. The only difference would be that I would have some extra hands to assist me if needed. We don't even have respiratory techs go with us on vent transfers because we have vents on our trucks and we know how to use them. I used to fly and we carried packed RBCs on the helicopter.
As for transports, we do not refuse to transport people. That is illegal! However, if a consenting adult patient does not want to go to the ER we can't make them even if we have already given D50% in the house, or whatever the case may be. That is called kidnapping according to the law.
As for you, of course I would treat and transport you! And you would receive top notch care! What Brillo said was right on and you completely misquoted me. I once had to treat and transport a man who had just shot and killed his two children and his wife and then ran from the police and managed to jump off a bridge and survive. He had several serious injuries and I treated every one of them like he was anyone else. Similar situations have happened to me over the last 16 years in EMS and I always treat all patients the same.
All in all I really don't care how you feel about our educational needs. What made me so upset is how you talk down to us. That was uncalled for and really is unprofessional. However, I do personally apologize for the comments I left about you. But' try to lighten up on people and don't be so condescending. You can get a lot more accomplished that way because you will have more people willing to listen.
Finally for the record: I totally respect RNs and anyone else in the medical field for that matter. Just do your job and do it well no mater what title you hold and all will be good! Let's work together!
You again are still trying to make a ******* contest for RN vs Paramedic but you fail to realize you are addressing this to people IN EMS. Stop with the BS. We know what a Paramedic is. We also know that not every state requires 1000 hours of classroom. Many programs in the US barely require 1000 hours total. Some states barely made that with counting the EMT program. Texas has required only 600 total with classroom and clinical. The NREMT now still only recommends 1200 hours which includes class and clinical for the newer guidelines. The EMT for 50 years has been only about 110 - 140 hours. Now there is the AEMT which is like the old Intermediate cert but no all states have adopted it yet. This is easily looked up on the state EMS websites. It just makes you look a little foolish when you make broad statements about a profession you should know more about. Your program might be unique to your school but I bet your state does not require that many hours and I bet many Paramedics do only the minimum. Some might just want to hurry up so they can get their application in with the FD or some, like you and the nursing program with no clinicals, just want to take shortcuts.
But, nowhere in the Paramedic program included critical care ventilator management, IABP, PA catheters or much the other equipment and medications found in the ICUs. A few hours of a Paramedic clinical does not make you proficient for critical care.
BTW, what ventilator are you using for critical care transports? Do you use your own IV pumps or do you borrow from the hospital. Just how much training did you get from your company before being allowed to do this? The fact that you boast you do not need RNs and RTs makes you sound very naïve about critical care. You don't want to listen to expertise of what RTs or Critical Care RNs including those who do Flight and CCT have to tell you about critical care. Most Paramedics who have done flight utilize whatever resources they have such as these professionals to gain more knowledge rather than insulting them. I will be condescending to cocky people who believe they know it all with only the few hundred hours of training and not much for clinicals. You really have no idea how funny your posts sound when you seem to brag about your clinical hours which are not that much considering how many areas you cover to those who have seen both sides.
Back to the topic since we now have "education" established.
What exactly do you feel could be done differently in EMS? Please don't just say the "authority" to refuse. Unless more education and experience are provided for EMS providers on chronic illnesses, addictions and alternative programs, that SHOULD NOT happen. But there are other ways to be proactive rather than "reactive" especially in the emotional context.
Hey guys, back to the topic at hand. Please discuss the RN versus paramedic topic in a new thread. Thanks very much!
There is no RN vs Paramedic topic going on by akluhawk or myself. If cowboymedic and medic2514 would read what is written they would find they are discussing this with people who are also involved or have been involved directly in EMS. All of our posts have been directly about the relevancy of Paramedic training to "treat and street" or just deny treatment. There has not been any discussion as to whether an RN or Paramedic would be better for the job by either of us. But, any comparison which has been made in education has been to show college level work which should be required of Paramedics in order to bring EMS up to a higher level as a recognized profession as all other health care professions. This is nothing new but in the United States it has been a hindrance to adopting protocols for such things as "treat and street" or refusal of care. You also can not just refuse to transport a patient who may have no other alternative to getting care due to all the economic changes in health care.
The article I presented was tossed out as BS in several discussions because of the closure of several clinics. But to offset this SF has an insurance program call "Health SF" which helps. We also have other means of providing care but NOT if the patient is left on the streets. We do have to document a need and must get the person accepted into the programs if they are willing. If they are ****** out by the people who first see them, this makes the job of the SW and CM more difficult. We used to have a service for homeless alcoholics started by a former Paramedic who got a Bachelors and probably Masters in SW but I believe that is no longer because of a lack of support which also included conflicts with EMS protocols.
This isn't even remotely close to what medic2514 stated! Can you even read? What was said is:
This means that medic2514 isn't saying they'd refuse service -- just that they doubt whether you'd even bother to call 911 given that you have so little respect for the training and expertise of EMTs.
I hope for your patients' sakes that your assessment skills are a heck of a lot better than your reading comprehension skills!
Are you medic2514? How do you know what he is thinking? On the EMS forums some Paramedics get into a tantrum mode as soon as the education word is mentioned. I bet he has said the same "I am quitting this forum if you don't stop talking about education" on the EMS forums also. This is no different than some of the ADN vs BSN discussions on this forum. The only difference is for the Parmedics we are talking about raising the certificate of a few hundred hours to a mere Associates degree. Or, at least have college level prerequisites such as A&P, pharmacology and pathophysiology rather than just a tech school overview. Is that really too much to ask before they make judgments about whether a patient needs to be refused transport or to manage a critical ICU to ICU transfer? We can not even touch on all the levels of addiction and mental illness involved by some who are chronic 911 callers. There are reasons why some with chronic illnesses and elderly are put on mood stabilizers but that is something we can not even touch on because a couple of Paramedics have gotten their feelings hurt when "more education" is mentioned. There are bigger issues which must be taken into consideration before just telling someone they can not ride in your ambulance.
The fact is EMS education in the US is way too low and has remained that way for 50 years. Because some feel they have a few cool "life saving" skills they should be given the "authority" to determine who needs treatment and who doesn't. You can sling all the personal insults you want and make the "I hope you don't call 911" threats but the fact still remains in the US about EMS education. This is a national issue which has been under review for decades but has met opposition by those who refuse to acknowledge 1000 hours of training is not enough especially if you are doing CCT with lots of drips and a ventilator. Each state and every EMS agency have their own agendas which keeps EMS fragmented. But, if you feel that is more than enough to be a competent Critical Care provider, then Paramedics should be replacing RNs in the ICU. There is no shortage of them and they will gladly work for what an RN makes. I guess I wasted a lot of time getting a different degree so I could work in the ICUs. I should have just been an advocate for Paramedics with a few months of training to be in the ICUs.
I imagine that since it is likely that the RNs who make policy at the ANA and AACN had to take on student loan debt they will want everyone else to as well. Hardly fair that some people have to spend $60K for a BSN at a university and some people only have to spend $10K and both have the same job and get paid the same.
Hasn't anybody taken advantage of the tuition assistance of their employer PLUS their state's RN loan forgiveness or repayment?
I used to really enjoy this site, but after reading all of the unprofessional posts made by "TraumaSurfer" I most definitely will not be returning allnurses.
TraumaSurfer...... you may want to look into a hobby to release all of that miserable energy you have inside (besides this site). The word "bully" actually came to mind while reading your comments. I bet you don't have a lot of friends.
CowboyMedic....... KEEP SAVING LIVES !! What you do is important and I know that people are walking around today who would have been dead if not for your interventions. Maybe, since TraumaSurfer hates EMS so much, he won't call 911 when his life is on the line......but then again, I bet he will. His tune will change if that day ever comes.
Amazing how everytime someone mentions the education for Paramedics should be raised it is seen as a hate post. Thus EMS remains a certificate technician and those who might love EMS but must move on to nursing or some other health profession if they want to advance their education.
Doesn't anyone see the connection between education and the ability to treat and release? If you don't want to get past a certicate, don't expect medical directors to just hand you the power to leave people on the street. The post made by cowboy medic is a great example of a system which fails those who just need a little assistance. No way would a community Paramedic program be of any use in a system like that until attitudes and education changes. Right now EMS is as much the problem which over plays the potential of being part of the solution. So, until the Paramedics who are so against more education even when it comes to CCT, don't expect much change in transport policies. At some point you should stop bitchin and start looking at solutions or at least realizing that cutbacks in medical funding for outpatient services/clinics affect us all.
And medic2514, it is extremely unprofessional to even suggest about not providing 911 service to anyone who disagrees with you. This is just another example where a few bad apples in EMS treat patients by emotions and ego rather than by physical assessment.
TramaSurfer, my comment on ACLS/PALS was referring to our new grad NURSES that are hired into the ER not PARAMEDICS. Every Paramedic that is hired into our ER already has ACLS/PALS. .
I see you still want a medic vs nurse discussion even though those commenting at you are experienced in EMS.
RNs get what they need to know about codes in their orientation which is a lot longer than the ACLS cert or recert. Nursing also other certs to gain information. An examples are ENPC, TNCC and PNCCT. Hospitals may also do their own inhouse training instead of or in addition to ACLS or PALS. A couple of hospital systems have "ACLS" designed specifically for their facility and patient population. ACLS and PALS do not teach about heart transplants, LVADs or congenital anomalies. RNs participating on Rapid Response and code teams definitely will training and experience which by far exceeds the minimum to get an ACLS card.
Most paramedics that are coming onto the street now are at the college associate degree level. Even thought I graduated from a Tech school for my paramedic I believe I have the same knowledge as them, I just don't have a degree. .
Most? Really? Who are you trying to kid?
The statistics are still at only about 20% and most of those degrees held by current Paramedic license holders are in Fire Science, Nursing or some other health profession. The volunteers may have a degree in accounting, business or some other non-health care degree. The state of Texas has a licensed Paramedic patch for those holding an Associates (which can also includes nursing) and only 50% hold that credential. I would bet some of those are RNs who got the cert for Flight. Even EMS instructors do not need degrees (not even an Associates) at most votechs and they may be exempt at some community colleges which have the cert program rather than the degree.
Fire Departments and Ambulance companies may have their own Paramedic training. Memphis FD and AMR are two big examples. For FFs, the Paramedic cert is just another hoop to getting hiring or extra money in the paycheck although some are very good at EMS for what they are required to do.
Your statement itself is exactly the why many in EMS do argue against raising the education level and most have not wanted to get a degree.
Have you not heard about the recent controversy in EMS where the NREMT is requiring COAEMSP accreditation for Paramedic programs? If you had you would not be making such assumptions and comments which were covered when the many votech schools and EMTs complained. I again will tell you it is important you stay current in what is happening in your profession. EMS is trying to change but will those (like yourself) who say there is no difference between a tech school cert and a college degree, EMS will still be stagnated in the area of education.
But I am currently bridging to RN. And let me tell you that the ADVANCED CLASSES for Pharm and A&P that you went on about, I'm currently taking A&P and Pharm, are the same exact materials that I've already covered in my paramedic course. .
Most bridge programs have advanced their education requirements to include college level A&P and pharmacology prerequisites. You also stated your whole didactic was only 700 hours. Just how much time did you spend on Pharmacology, A&P, pathophysiology and EMS procedures? You contradict yourself or don't realize you might still get more pharmacology in your other classes. You may not realize what your still don't know. The nursing modules build upon each other and you will have more pharmacology in clinicals.
If there is anyone being HIGH AND MIGHTY that is you. You are saying that paramedics should not be out there because the tech shcools are easy. No they are not, we had a 50% attrition rate (due to grades, if you couldn't handle it you were gone) at our school which is probably higher than any nursing school in the country. .
One reason for a large attrition rate in Paramedic schools is the lack of prerequisites. By the time a nursing student gets accepted into a program, they have probably already had a year of college doing the prerequisites. Nursing schools should be selective in their candidates and by the time a student finishes the prerequisites they should have a better idea about college and if they want to continue. It is a very sad statement for your nursing program which has allowed you shortcuts and I will use this in other discussions about raising the standards in nursing education.
Please provide a link to your bridge program. But I think I know which one you are in. Have you actually been accepted in the program? If you are just now starting the prerequisites you still have a long way to go.
This class is an introduction.
NURS 1431 Introduction to Pharmacology and Dosage Calculations
There are still two other classes which you probably have not taken.
NURS 2303 Pharmacology
NURS 2403 Dosage Calculations for Nurses
The other reason is a lack of professional educators in EMS. Most votechs do not require their instructors to have even an Associates degree and they are trying to teach pharmacology and A&P as well as EMS procedures. Yes here I will use the word most since the requirements to be a Paramedic instructor are easily found on your EMS website along with some of the other information I am typing. I suggest you look at your state's EMS website as well as the NREMT to see what is happening in EMS. This does not look good when some in EMS don't stay current but yet try to bash other professions. I am not bashing EMS. I am directing my comments at your responses.
I am very much pro advancement of EMS and increasing the education standard in the US.
I never said Paramedics should not do what they are trained for in prehospital emergency medicine. I did state that Paramedic programs DO NOT prepare them for high acuity CCT. Please refer to the post by alkulahawk.
My last comment on this is going to be. The level of training that I got, the number of hours that I spent in clinicals, and the different areas that I spent in clinicals prepared me to be ready from day one when I stepped on the truck. And I don't have just 4 years experience, I will have 6 in July but apparently unless you have 30 years like you everyone else is stupid according to you.
Your arguments lose validity when you get emotional and start name calling or trying to say others called Paramedic stupid. You are trying to defend your tech cert and have clearly stated there is no difference between a degree and the cert Paramedics in knowledge. I will continue to argue for higher education standards.
I don't believe JenniferG intended to call Paramedics with less than 30 years of experience stupid. Please refer to my reply to her about education, experience and street smarts.
Transfer those credits to a BSN or one of the few entry MSN programs.
Nursing will not care about your other degrees. The BSN is what will matter.
You also should search the legislative plans for the BSN in your state. Your state and most of the NE have been committed to raising the education standard.
There is actually no reason for the nurses with 20+ years of experience to act like this is a big surprise. ADN vs BSN is definitely not new. Back in the 1980s the BSN legislation was a big deal. But, the nursing shortage helped get some of the Bills defeated or overturned. But, it should have planted the seed for these nurses that the day might come when the BSN was a reality. When the debates in legislation were happening in the 1980s many were just starting out or still looking for a nursing program.
As for a comment about no policy makers care, I do differ with that also. If you look at just about any BON website you will see pieces of legislation happening in your state and at the Federal level. Not all might be about initial education but many do have some impact in an area of nursing which could affect you or your patients. Maybe Home Health, School and Public Health RNs are most aware of what is going on since they have had some changes which has impacted their specialty and patients.
But do you believe someone just out of school is better than your 30+ years of training and experience because they hold a higher certificate?
Your comment makes not sense. If it takes 30 years of "street smarts" to be compared with a new grad with a college degree than I think my point has been made.
Let's make a more realistic comparison here. If your Paramedic who graduates from a certificate program with just the minimum "hours of training" which does not have full college level A&P courses with labs, pharmacology or pathophysiology is compared with one who has a solid Associates degree, where do you think both will be in 5 years. Both will have "street smarts" but the one with a solid education will also have the ability to discount some of the "street smarts" because of the "that's have we've always done it.
You were putting down "most " paramedics by 'hear say per conferences and talking to others and reading magazines yet I you dont give any specific referenced non biased statistics regarding such instances of transfers being refused or lack of care d /t that medics opinions of them.
Stating Paramedics need to raise their education beyond a tech cert in order to get "advanced skills and protocols or guidelines" is not putting them down.
Hearsay? These conferences have medical directors (doctors) of real EMS agencies, experiences Paramedics and regional/state leaders for EMS. This is not bar room or anonymous forum gossip. We also have some of the headlines makers of serious screw-ups but there are others which don't all make the news because of privacy policies. Exactly how many patients are denied transport is easily skewed because of what I mentioned earlier with the RMA or AMA forms. Usually it is not until a death is involved that we find out a big bad issue with an agency such as with Washington DC. If you don't know about the problems there which have been heavily scrutinized then you probably don't know too much about EMS.
If you are really serious about learning more for knowledge and not just to start a "picking on poor EMS" emotional mess, I would be happy to provide more data.
And if your such a believer of another countries policies for training maybe you should practice there.
Everyone has an opinion and I was simply asking for clarification of yours to try and understand it better- you don't teach someone or try to make a difference by putting that person down and accusing them of living under a rock .and for the record anyone that does a procedure or gives a med and doesn't understand the 'why' behind it- has no business in the medical profession.
Enough with the emotional mud slinging. Higher education for the advancement of any profession is on the table. CMS looks at this when it comes to patient outcomes and reimbursement.
Many in the US would like to move to another country to work in EMS because of their higher education and autonomy. But, work visas and regulation of outsiders entering the work force in another country make this difficult. It is no different with nurses.
You are not my student. I am not trying to teach you anything. But, I am trying to give you more insight to the problems faced today by EMS. It is way more fragmented than nursing and it is probably less than 1/10th the size of nursing.
I believe my course was around 1100-1200 hours. So around 700 in classroom, learning what we needed for the field with everything from A&P, Pharm, Cardiology, Respiratory, Assessment skills, etc. Along with ACLS and PALS before we could test for our National Registry. Our new grads that are hired into the ER don't even have ACLS. If you want to talk about scary, it's that. Your working codes without certifications..
Your new grad Paramedics in the ER are not running the codes. Paramedics working in the ER do not run code except for maybe some very tiny ER but then there is a doctor nearby to sign the chart. But, even Paramedics will argue that these weekend certs are pretty meaningless. If you only have 4 years of experience then you probably have no clue about when ACLS actually was a cert to be proud of. Now it is just a card and I would not trust anyone based purely on being a cardholder to be proficient at ACLS. This includes some Paramedics. Then NREMT requires ACLS because they test for 46 states which all may have differing education requirements for Paramedics which can be anywhere from 600 hours of training up to an Associates degree in only one state.
Your right I didn't spend massive amounts of time in one area, that is because we have to be able to handle anything that comes up in the field. But there were two areas that were the majority of our clinicals hours and that was ER and EMS ride alongs. During the EMS ride alongs we had to have so many calls were we where running the calls with the paramedic assisting us and only stepping in if we messed up or something was over our heads at the time.
You might have missed how I had spent clinicals hours in the ICU, or were you too lazy to read that? I live in Oklahoma and we have two major trauma centers. One in Oklahoma City and one in Tulsa. The major hospitals are in OKC and Tulsa. Sometimes you have two to fours hour transfers if you were coming from a small level four hospital that needed to get someone to a level I or level II and medievac was not flying that day to bad weather.
Ok now your starting to tick me off by saying that my transports were EMTALA violations. You think that we are not properly trained. You are DEAD WRONG. We are signed off on everything we do by our medical directors which are the same MD's and DO's that are giving you your orders in the ER. They trust us to use our ASSESSMENT SKILLS and DECISION MAKING to determine what needs to be done on our calls. But I don't want to this to be an EMS vs Nursing battle. I'm just defending my brothers and sisters who you are basically calling stupid monkeys who can barely think for themselves.
And by the way, I WAS NOT BRAGGING about anything. I was stating what kind of calls that paramedics are doing every single day. Also you mention that an RN or RT could ride along. I don't know many hospitals that would spare an RN or RT for a transfer. The only time that I have had an RN or RT with me was during NICU transfers where we went to get the pt from an outlying facility and transported them back to Tulsa.
You are trying to justify that your 500 hours of clinicals were enough. For most prehospital protocols and procedures, it might be. You stated several areas you did clinicals in. Do you not see have little training you got in any area? A few hours here and there does not necessarily make you qualified to critical care transports such as the example you gave. I hope you at least understand why an RN and/or RT should be with you during a NICU transfer. This type of transfer should be done by a qualified NICU team consisting of RN/RN or RN/RT. The same for Pediatrics. This is not about patting your EGO so we don't hurt your feelings but about the safety of the patient. Having a qualified team to transport a patient is what EMTALA is all about. Not whether you and your brothers and sisters get offended. Unless you have been properly educated and trained, you should not be doing high acuity transports. Paramedic programs do not provide that type training in just 1000 hours. This is not an EMS vs nursing issue. You would not see a nurse who works in an Adult ICU hopping on a NICU transport or a med-surg RN trying to tell an ICU RN how to manage their IABPs. They have enough education and training to know their limitations. That might be the message you need to take from this on your next CCT.
Please refrain from calling Paramedics "stupid monkeys". If you are really this naïve about the situation in the US with Paramedic education, you should make some attempt to get more involved with the broader picture for EMS rather than making personal attacks on those who just restate what has been stated many times by those who are trying to change things in EMS to advance it as a profession.
Six to eight months of training for a paramedic? I spent two years training to be a paramedic. The same amount of time most nurses spend for their ADN (not counting pre-reqs). I spent about 4-6 months getting my EMT-B, then another 18 months getting my EMT-P. I had over 500 hrs of clinicals (for paramedic) between Lab for iv sticks and blood draw, OR for intubations, ICU for cardiac and pharm, OB for L&D, ER for just about everything else, psych, dialysis, then my ems clinicals on the truck.
I can not speak for a system that has both BLS and ALS trucks, because I have always worked for an ALS system. We never responded to a call that BLS was sent out on then called for backup, it was always our calls. There were so many times that I wanted to say, "hey you don't need to go to the hospital for this, because this is complete bs." But guess what, we still had to transport. I knew when I was getting into ems that not every call would be a code or trauma. I also spent my first year or two busting my butt in a transfer station. Yes I have had some very sick patients. Multiple patients on vents, on propofol drips, on cardizem drips, blood hanging. You name it and I have probably transported it. And i'm not talking about short 15-20 minute trips, even though I've had those. I'm talking about two to four hour transfers where your the only one keeping those patients alive to get to a higher level of care than the previous hospital.
Two years tell us very little. Many programs are stretch out the same numbers of "hours of trainig" over a long period of time. EMT is also only about 110 to 150 hours which could be done in 3 weeks. 500 hours of clinicals is not much when compared to nurses or other allied health professionals which require an Associates degree and 800 to 1200 hours of clinicals. The fact that your clinicals were only 500 hours means you did not spend much time in any one area very long. The fact that you seem to brag about high acuity transports but did not mention any ICU experience could be an indication you don't know what you don't know about critcal care patients. Scary to say the least that these transports are still common in EMS even with all the adverse events which have been documented. You could easily have told the hospital you did not want to be the only one keeping the patient alive and they would have been obligated to send RNs and/or RTs with you. Don't let your ego get you in over your head and do harm or kill the patient on this long CCTs. The sending hospital should also be held accountable. If the transfer originated in the ED, this is an EMTALA violation if you were not properly educated and trained for these transports or you were by yourself with these patients.
I'm curious where your information comes from pertaining to most paramedics transport for convenience and using their emotions to dictate transfer? You say "most" can you define that more?
Also in the video- the patient was not an emergency AFTER they gave the narcan- he was alert- talking and aware of his medications all three if those lead me to believe he was stable. If a basic Emt were to show up to that scene they would of scooped and gone no meds could b given- that patient could of been in respiratory distress,cardiac distress or already dead before arriving to the hospital. I don't believe a paramedic can claim they are a mid level practitioner they are trained to quickly assess life threatening injuries- treat appropriately and transport. A paramedic is a paramedic their scope of practice is the same in the US.
-Y do they need so many to show up? Because not all situation are for one to two paramedics. You have to take into account- lifting the patient- starting an iv- ekgs- airway support and sometimes dealing w family, the police can not always b on scene for that. I for one would feel better knowing I had to many on scene than not enough and wait for extra hands that may delay care. I'm not saying the EMS system is perfect and I'm sure there are many flaws however just like in the ED we can not just refuse caring for a patient because they r frequent flyers.I'm also curious what does a masters degree help with? You still are under the direction of a medical director and can only do so much before arriving at the hospital. A masters degree may give you more knowledge as to disease processes that you read in a book- hands on experience is sometimes more valuable. I guess I have never worked w a crew that felt they were 'to good' or 'overqualified' to go on a call.
Where do I get my info from? Thirty years of working in EMS and EDs along with attending state and national conferences as well as state and regional meetings listening to all the problems which plague EMS. Talking to Paramedics everyday and reading some of the EMS forums will also give you a better idea about what i happening in EMS.You would have to be living under a rock to not know of the current EMS situation across the US. Even picking up some fluff mag like JEMS can give you more insight on the issues being discussed in EMS about a
I see you are also one of the street smarts person who doesn't believe book learning is of much value. You obviously have no idea about the EMS systems in other countries. Did you know they will include over 2000 hours of clinicals in their Masters degree? They actually learn why and when they should do a particular skill or give a med. This would include the administration of narcan. An ASSESSMENT should be done. You don't just write off this person as being a waste of time because you dislike being bothered by people who have addictions. Until these addicts have an alternative for care, this will continue. If there are no alternative resources the Paramedic needs to consider that rather than ******** about having to go on a call.
Some EMTs can give narcan along with a few other meds. But, what I was referring to is the complaints from EMTs who get dumped on by Paramedis to transpot a patient who could benefit from some ALS intervention.
The gist of the news article is having to respond to the drug addict. Paramedics know they have to transport per protocol.
No need to take offense, I was just putting my personal experience/plan on the table. I have already been promised a job by the clinical manager in the ED in which I work (don't start the program until May) and I have a BAS already so I will have no issue. I understand, however, that not everyone is in this situation.
I suppose you want to stay at that one hospital in the same job until you retire. No transfers or promotions? Same pay grade?What happens if you friend is no longer the manager when you finish? Even with your friend as the manager HR will have the first say about employment ev en if you are an employee. It is not uncommon for an RN to be under employed today. What happens if the hospital is sold and you must apply again for your job and the BSN is now preferred?
I find this forum to be odd and discriminatory or maybe this thread is just for the *****-ing without solutions.
I will restate again what I posted earlier. Some cities are more proactive. Not only by nurses but also Paramedics. I hope this does not offend the moderators to hear something like that.
In San Francisco we have Health SF which is an insurance program to help the poor and/or uninsured.
Healthy San Francisco - Our Health Access Program
We also had a program started by a Paramedic who also has a degree in Social Work. (I know this is a nursing forum but I believe this is relevant).
Nevius: S.F. paramedic says homeless people burden hospitals - SFGate
We also had the McMillian project.
http://www.sfdph.org/dph/files/repor...6MonIntRpt.pdf
Mobile Assistance Program
http://sfhomeless.wikia.com/wiki/Com...ce_Patrol_(MAP)
A more detailed cost analysis of these projects:
http://www.sfcontroller.org/Modules/...documentid=920
I know this forum is mostly a ***** and vent type much like the EMT forums but I would hope some would like to know about programs out there. Yes it is probably more fun to poke fun at your patients rather than get involved in solutions but at some point all the ******** gets frustrating to those who are involved in programs which are trying to make things better for at least a few including the staff in the ED. When "professionals" continue to just make jaded comments about the patients, it sometimes defeats the progress being made and it is more of a hindrance than a help.
Anyone can read what is written here since it is an open forum. All the crap about patients posted here without another view point does not make nurses or Paramedics look very professional. Also, you have to take into consideration out EMS systems and education have not advanced to the levels of those in the UK where they are considered "practitioners" (both nurses and Paramedics) so healthcare in the US is just as much to blame as the patients.
Here is a more detailed explanation of various disorders. The ABG itself is very limited in information. Therefore other labs and a thorough clinical assessment must be done and correlated.
Interpretation of Arterial Blood Gases (ABGs)
Here is the link to Heathy SF.
Healthy San Francisco | San Francisco Health Plan
The program started by Niels Tangherlini Paramedic/Social Worker
Nevius: S.F. paramedic says homeless people burden hospitals - SFGate
Mobile Assistance Program
Program: MOBLE ASSISTANCE PROGRAM (MAP)
McMillan Stabilization unit.
http://www.sfdph.org/dph/files/repor...an/6MonAtt.pdf
But, nowhere in the Paramedic program included critical care ventilator management, IABP, PA catheters or much the other equipment and medications found in the ICUs. A few hours of a Paramedic clinical does not make you proficient for critical care.
BTW, what ventilator are you using for critical care transports? Do you use your own IV pumps or do you borrow from the hospital. Just how much training did you get from your company before being allowed to do this? The fact that you boast you do not need RNs and RTs makes you sound very naïve about critical care. You don't want to listen to expertise of what RTs or Critical Care RNs including those who do Flight and CCT have to tell you about critical care. Most Paramedics who have done flight utilize whatever resources they have such as these professionals to gain more knowledge rather than insulting them. I will be condescending to cocky people who believe they know it all with only the few hundred hours of training and not much for clinicals. You really have no idea how funny your posts sound when you seem to brag about your clinical hours which are not that much considering how many areas you cover to those who have seen both sides.
Back to the topic since we now have "education" established.
What exactly do you feel could be done differently in EMS? Please don't just say the "authority" to refuse. Unless more education and experience are provided for EMS providers on chronic illnesses, addictions and alternative programs, that SHOULD NOT happen. But there are other ways to be proactive rather than "reactive" especially in the emotional context.
The article I presented was tossed out as BS in several discussions because of the closure of several clinics. But to offset this SF has an insurance program call "Health SF" which helps. We also have other means of providing care but NOT if the patient is left on the streets. We do have to document a need and must get the person accepted into the programs if they are willing. If they are ****** out by the people who first see them, this makes the job of the SW and CM more difficult. We used to have a service for homeless alcoholics started by a former Paramedic who got a Bachelors and probably Masters in SW but I believe that is no longer because of a lack of support which also included conflicts with EMS protocols.
The fact is EMS education in the US is way too low and has remained that way for 50 years. Because some feel they have a few cool "life saving" skills they should be given the "authority" to determine who needs treatment and who doesn't. You can sling all the personal insults you want and make the "I hope you don't call 911" threats but the fact still remains in the US about EMS education. This is a national issue which has been under review for decades but has met opposition by those who refuse to acknowledge 1000 hours of training is not enough especially if you are doing CCT with lots of drips and a ventilator. Each state and every EMS agency have their own agendas which keeps EMS fragmented. But, if you feel that is more than enough to be a competent Critical Care provider, then Paramedics should be replacing RNs in the ICU. There is no shortage of them and they will gladly work for what an RN makes. I guess I wasted a lot of time getting a different degree so I could work in the ICUs. I should have just been an advocate for Paramedics with a few months of training to be in the ICUs.
Examples:
http://www.benefits.gov/benefits/benefit-details/449
California
OSHPD - Foundation - Bachelor of Science Nursing Loan Repayment Program
Several states offer the loan repayment or forgiveness for at least some of the expense.
A extensive listing of scholarship and repayment programs.
American Association of Colleges of Nursing | Financial Aid
Doesn't anyone see the connection between education and the ability to treat and release? If you don't want to get past a certicate, don't expect medical directors to just hand you the power to leave people on the street. The post made by cowboy medic is a great example of a system which fails those who just need a little assistance. No way would a community Paramedic program be of any use in a system like that until attitudes and education changes. Right now EMS is as much the problem which over plays the potential of being part of the solution. So, until the Paramedics who are so against more education even when it comes to CCT, don't expect much change in transport policies. At some point you should stop bitchin and start looking at solutions or at least realizing that cutbacks in medical funding for outpatient services/clinics affect us all.
And medic2514, it is extremely unprofessional to even suggest about not providing 911 service to anyone who disagrees with you. This is just another example where a few bad apples in EMS treat patients by emotions and ego rather than by physical assessment.
RNs get what they need to know about codes in their orientation which is a lot longer than the ACLS cert or recert. Nursing also other certs to gain information. An examples are ENPC, TNCC and PNCCT. Hospitals may also do their own inhouse training instead of or in addition to ACLS or PALS. A couple of hospital systems have "ACLS" designed specifically for their facility and patient population. ACLS and PALS do not teach about heart transplants, LVADs or congenital anomalies. RNs participating on Rapid Response and code teams definitely will training and experience which by far exceeds the minimum to get an ACLS card.
The statistics are still at only about 20% and most of those degrees held by current Paramedic license holders are in Fire Science, Nursing or some other health profession. The volunteers may have a degree in accounting, business or some other non-health care degree. The state of Texas has a licensed Paramedic patch for those holding an Associates (which can also includes nursing) and only 50% hold that credential. I would bet some of those are RNs who got the cert for Flight. Even EMS instructors do not need degrees (not even an Associates) at most votechs and they may be exempt at some community colleges which have the cert program rather than the degree.
Fire Departments and Ambulance companies may have their own Paramedic training. Memphis FD and AMR are two big examples. For FFs, the Paramedic cert is just another hoop to getting hiring or extra money in the paycheck although some are very good at EMS for what they are required to do.
Your statement itself is exactly the why many in EMS do argue against raising the education level and most have not wanted to get a degree.
Have you not heard about the recent controversy in EMS where the NREMT is requiring COAEMSP accreditation for Paramedic programs? If you had you would not be making such assumptions and comments which were covered when the many votech schools and EMTs complained. I again will tell you it is important you stay current in what is happening in your profession. EMS is trying to change but will those (like yourself) who say there is no difference between a tech school cert and a college degree, EMS will still be stagnated in the area of education.
Please provide a link to your bridge program. But I think I know which one you are in. Have you actually been accepted in the program? If you are just now starting the prerequisites you still have a long way to go.
This class is an introduction.
NURS 1431 Introduction to Pharmacology and Dosage Calculations
There are still two other classes which you probably have not taken.
NURS 2303 Pharmacology
NURS 2403 Dosage Calculations for Nurses
The other reason is a lack of professional educators in EMS. Most votechs do not require their instructors to have even an Associates degree and they are trying to teach pharmacology and A&P as well as EMS procedures. Yes here I will use the word most since the requirements to be a Paramedic instructor are easily found on your EMS website along with some of the other information I am typing. I suggest you look at your state's EMS website as well as the NREMT to see what is happening in EMS. This does not look good when some in EMS don't stay current but yet try to bash other professions. I am not bashing EMS. I am directing my comments at your responses.
I am very much pro advancement of EMS and increasing the education standard in the US.
I never said Paramedics should not do what they are trained for in prehospital emergency medicine. I did state that Paramedic programs DO NOT prepare them for high acuity CCT. Please refer to the post by alkulahawk.
I don't believe JenniferG intended to call Paramedics with less than 30 years of experience stupid. Please refer to my reply to her about education, experience and street smarts.
Okay so you have worked in EMS 4+ years or going on 6. What happened to 5+?
Do not go backwards in degrees.
Transfer those credits to a BSN or one of the few entry MSN programs.
Nursing will not care about your other degrees. The BSN is what will matter.
You also should search the legislative plans for the BSN in your state. Your state and most of the NE have been committed to raising the education standard.
There is actually no reason for the nurses with 20+ years of experience to act like this is a big surprise. ADN vs BSN is definitely not new. Back in the 1980s the BSN legislation was a big deal. But, the nursing shortage helped get some of the Bills defeated or overturned. But, it should have planted the seed for these nurses that the day might come when the BSN was a reality. When the debates in legislation were happening in the 1980s many were just starting out or still looking for a nursing program.
A Policy Perspective on the Entry into Practice Issue
As for a comment about no policy makers care, I do differ with that also. If you look at just about any BON website you will see pieces of legislation happening in your state and at the Federal level. Not all might be about initial education but many do have some impact in an area of nursing which could affect you or your patients. Maybe Home Health, School and Public Health RNs are most aware of what is going on since they have had some changes which has impacted their specialty and patients.
Let's make a more realistic comparison here. If your Paramedic who graduates from a certificate program with just the minimum "hours of training" which does not have full college level A&P courses with labs, pharmacology or pathophysiology is compared with one who has a solid Associates degree, where do you think both will be in 5 years. Both will have "street smarts" but the one with a solid education will also have the ability to discount some of the "street smarts" because of the "that's have we've always done it.
Hearsay? These conferences have medical directors (doctors) of real EMS agencies, experiences Paramedics and regional/state leaders for EMS. This is not bar room or anonymous forum gossip. We also have some of the headlines makers of serious screw-ups but there are others which don't all make the news because of privacy policies. Exactly how many patients are denied transport is easily skewed because of what I mentioned earlier with the RMA or AMA forms. Usually it is not until a death is involved that we find out a big bad issue with an agency such as with Washington DC. If you don't know about the problems there which have been heavily scrutinized then you probably don't know too much about EMS.
Here is a presentation, including some of the stats you want.
http://gatheringofeagles.us/2010/Pre... Transport.pdf
If you are really serious about learning more for knowledge and not just to start a "picking on poor EMS" emotional mess, I would be happy to provide more data.
Enough with the emotional mud slinging. Higher education for the advancement of any profession is on the table. CMS looks at this when it comes to patient outcomes and reimbursement.
Many in the US would like to move to another country to work in EMS because of their higher education and autonomy. But, work visas and regulation of outsiders entering the work force in another country make this difficult. It is no different with nurses.
You are not my student. I am not trying to teach you anything. But, I am trying to give you more insight to the problems faced today by EMS. It is way more fragmented than nursing and it is probably less than 1/10th the size of nursing.
Please refrain from calling Paramedics "stupid monkeys". If you are really this naïve about the situation in the US with Paramedic education, you should make some attempt to get more involved with the broader picture for EMS rather than making personal attacks on those who just restate what has been stated many times by those who are trying to change things in EMS to advance it as a profession.
I see you are also one of the street smarts person who doesn't believe book learning is of much value. You obviously have no idea about the EMS systems in other countries. Did you know they will include over 2000 hours of clinicals in their Masters degree? They actually learn why and when they should do a particular skill or give a med. This would include the administration of narcan. An ASSESSMENT should be done. You don't just write off this person as being a waste of time because you dislike being bothered by people who have addictions. Until these addicts have an alternative for care, this will continue. If there are no alternative resources the Paramedic needs to consider that rather than ******** about having to go on a call.
Some EMTs can give narcan along with a few other meds. But, what I was referring to is the complaints from EMTs who get dumped on by Paramedis to transpot a patient who could benefit from some ALS intervention.
The gist of the news article is having to respond to the drug addict. Paramedics know they have to transport per protocol.