TraumaSurfer

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.

Hasn't anybody taken advantage of the tuition assistance of their employer PLUS their state's RN loan forgiveness or repayment? 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

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.

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? 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. 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. 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. 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. 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.

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. 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. Here is a presentation, including some of the stats you want. http://gatheringofeagles.us/2010/Presentations/Eckstein - Mandatory 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. 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. 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.

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.

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.

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?

What has EMS done to improve things? There is no way Paramedics in the US are prepared to run at the same level as those in other countries which have a Masters degree. Six to eight months of training do not make you a mid level practitioner. Most of the "treat and release" by Paramedics in the US are done by convenience for the Paramedics and with the benefit of the patient in mind. Usually there is some "emotional" motive which determines who the Paramedic wants to transport and who they don't. Just ask any of the EMTs for BLS ambulance which does most of the transports because the ALS truck has something better to do like get back to the station. If Paramedics are allowed to treat and release or refuse to transport the patient, they still get the patient to sign an RMA or AMA form rather than taking responsibility themselves for chosing not to transport. Here is an article which is an embarrassment and didn't get many comments because it sent the wrong message. People That ‘Fly’ Frequently Behave Badly « KRON4 Three trucks to one call and then for these Paramedics to complain about a patient not being an emergency even though they gave narcan. Unfortunately this an example of EMS in the US for many major cities. Why do you need 3 trucks and 4 - 6 Paramedics for every call and then complain about not having enough trucks for "emergencies"? I also wonder what would happen to the EMT and Paramedic classes if the students were told on the first day that 98% of the calls they will do will be routine and all that emergency hero life saving stuff is mostly in the movies to sell tickets? It is too bad the training for Paramedics is not done a little differently to better prepare them for reality. Then maybe a different set of professionals could actually see things clearer and come up with a better way.

In the American language a question can also indicate sarcasm. Where did you get the "2 semesters" from for a bridge program for Paramedics. YOU mentioned it. If know of a 2 semester bridge program, please provide a link. I am sure there are several Paramedics looking for a shortcut for becoming an RN. Otherwise, why would you just make up a statement with those numbers? (That is a guestion.)

You need to start providing links to back up your statements. I have provided them when I need to make a point. I could also link back to your own posts when you question what I have written concerning your statements. Very few Paramedic programs in the United States have the same prerequisites of nursing schools. In fact, many Paramedic programs are taught at private tech schools, fire departments and ambulance services. It may takes at least two semesters to take the prerequisites. I don't believe there are many colleges with will allow you to take A&P 1 with A&P 2 in the same semester. So, please provide a link to a college nursing program which allows a Paramedic to complete the nursing program in just 2 semesters. But, for those who do make the prerequisites to enter the Excelsior program, some have bragged on completing it in less than 6 months. California does not recognize Excelsior so I really don't care but some Paramedics have completed the program to cross a stateline to work especially if the state has no minimum clinical hours requirement.

Paramedics can also take the program right after receiving their cert. This is a very easy way for a Paramedic to get to RN. It is definitely shorter than any "bridge" program.

In one post you want people to spend big money for the MSN. Now you are saying it is not worth it. In your MSN post you take about taking the shortest possible route to get an end result yet you complain about autonomy declining. Since there are over 3 million RNs in the US and only 55% have higher degrees, that leaves 45%, which is a large number, to argue that education is not worth it and the ADN is good enough. You stated ALL of your new grads are employed. I believe that is alot better than some in the US. I bet they also have insurance. I also bet they are making much more than other entry level workers who require only an Associates degree. Tell me how many other jobs have flexible hours or days of work, decent pay, benefits and an opportunity to work almost anywhere in the US including travel assignments. All of this can be done with an Associates degree. Why change if you can get all that for a mere Associates? Right now the RN is probably the only patient care profession which will grant an Associates degree with no nursing clinicals in some states. You are losing autonomy and compensation because you have become complacent and have stood back while others have started making a move. Others are also willing to work for less just to get a piece of what nurses have. When you are wanting more than you are willing to put forth to keep up, you get left behind. When you fragment your educational system with shortcuts and inadequate programs, your profession suffers. You reap what you sow and your autonomy will suffer.