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  • #61
    Originally posted by FFmedic60 View Post
    I don't think a degree is required if you have a decent medical director who gives you good protocols to follow and trusts you enough to certify you to function as a Paramedic. If the medical directors felt more education and a degree was necessary, they would have pushed for it a few decades ago.
    This..

    Here everything hinges on your medical director.

    Update on school... We have 4 months left, Trauma, and OB and PEDS. Then review
    Get the first line into operation.

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    • #62
      in Delaware they have raised the standards for EMT-P's to must have AA. I personally think it's stupid being you are nothing more than an EMT with way more drugs. Your job is to wheel & heal. You are not a rolling Dr. Do your job, treat the symptom as it presents itself & get the patient to definitive treatment facility. That's all you are meant to do. Not diagnose the problem. Just treat the symptom & transport to a Doctor w/ 9 years of medical school & a life time of training. Also so medics should not be allowed to be medic w/o having at least 5 years of BLS under their belt....I'm a lil' anti-medic. TO many of ya think you're gods (not all). But the more of you that go thru college to be a medic tend to be WAY to cocky for your own good. Give me a medic that took the non-college course & has a life time of experience over any of these NKOTB!
      "Courage is the resistance to fear, the mastery of fear, not the lack of fear." Mark Twain
      "If you can't explain it simply, you don't understand it well enough." Uknown

      Comment


      • #63
        Originally posted by edpmedic View Post
        I agree. These agencies and companies thrive on the plentiful supply of medics. They hire new medics with little experience for the bare minimum (because they're happy just to get the work experience until they get a better job) work them to the bone, and then replace them with other new medics for the same low salary. It's even better if it's for a municipal employer. You get a lot of 1-3 year people who leave before they're vested for defined benefit. You can tell which places just want bodies to staff their rigs - they typically have just a one day orientation, maybe three ride alongs, and then you're thrown to the wolves. It costs them very little to hire and train, as opposed to companies and depts that run academies, or at least have FTO programs that may last months.
        This pretty much sums up my experience as a brand new medic in Phoenix. With the exception of Phoenix and a couple surrounding cities/reservations, all EMS is provided by two companies for the entire Phoenix metro area. If you're new, unless you've been an EMT-B with one of the companies for a few years already, you get put on General Transport rides. At the particular company I worked for, I was hired right at my interview which consisted only of a few basic questions (none being any kind of scenarios or medical questions), no background check, nothing. We had three days of orientation which consisted of just going over HIPAA stuff, charting, and going over the SOP's. Then we had to do three 12 hour shifts of precepting and then we were thrown out there to the street. Not to mention, they and the other EMS company run crews with one EMT and one medic, so right off the bat I was in charge of everything completely on my own. Even being a GT ride, the majority of my calls were all emergency transports so I hit the ground running and had to learn a lot on the fly fast. The turnover rate is really high. You don't get treated very well, management couldn't really care less about you for the most part because there are always new medics (and EMT's) looking for work they can replace you with and people already with the company willing to work OT to cover shifts that don't have permanent crews assigned to them.

        I actually thrived in the situation, truth be told. I came from a paramedic program that required 250 clinical hours and 500 vehicular/ride-along hours and I was an EMT already with ER experience on top of it. The departments we did our ride time with were very aggressive in having us run all the calls after our first few shifts to really force us to have to think and get used to what it's like out there. They monitored you very closely and were always there as a safety net, but they were very aggressive and I learned a lot fast with regard to how to run a call and developing a routine, so being thrown out there by myself with just an EMT partner I felt pretty comfortable pretty quick but it was still a bit intimidating my first shift or two. However, that's me. I know a lot of people who should not be put in that kind of situation being brand new. That's a ton of responsibility to put on someone's shoulders who has never been alone before.

        At any rate, it's not a very demanding system there with regard to standards and hiring and your post really made me think about it. Whereas here in the Chicago area when I moved back, the tests I had to take and the background stuff and everything else I had to do gain my ALS privileges in the medical systems here were almost harder and stricter than getting my paramedic cert in the first place, and I came from a pretty solid paramedic program. It's just amazing how things change from state to state and region to region in the EMS world.

        Comment


        • #64
          Originally posted by ffscm72 View Post
          in Delaware they have raised the standards for EMT-P's to must have AA. I personally think it's stupid being you are nothing more than an EMT with way more drugs. Your job is to wheel & heal. You are not a rolling Dr.
          I think this is somewhat overly simplistic, ignorant view of what a Paramedic is able to do in comparison to an EMT.

          Do your job, treat the symptom as it presents itself & get the patient to definitive treatment facility. That's all you are meant to do. Not diagnose the problem. Just treat the symptom & transport to a Doctor w/ 9 years of medical school & a life time of training.
          Ah yes, the old "paramedics don't diagnose" statement. Well, it's pretty much a fallacy. The truth is, Paramedics do diagnose. If we give D50 to a diabetic patient with low blood sugar, then we've clearly "diagnosed" their problem as "hypoglycemia". Activating a "STEMI alert" (if your system supports such) for a patient with ST elevation in multiple leads means that you have "diagnosed" that they are having an Acute MI. The scope of a diagnosis may be limited, but it's a diagnosis nonetheless.


          Also so medics should not be allowed to be medic w/o having at least 5 years of BLS under their belt...
          I partially agree with this. There should be a minimum amount of BLS experience required before attending Paramedic training, however I know that waiting 5 years is excessive for the most part and really excessive if a person is working full-time in a busier EMS system.


          .......I'm a lil' anti-medic. TO many of ya think you're gods (not all). But the more of you that go thru college to be a medic tend to be WAY to cocky for your own good. Give me a medic that took the non-college course & has a life time of experience over any of these NKOTB!
          Yes, there are some with over-inflated egos, but really not much different than most occupations in that regards. Being a "good" Paramedic requires a degree of cockiness.

          I'd be willing to bet that (based on my experiences) there's probably at least as many EMTs that think they are just there to drive the ambulance and move the patient as there truly are Paramedics that "think they are gods".

          Comment


          • #65
            Originally posted by FireMedic049 View Post
            I think this is somewhat overly simplistic, ignorant view of what a Paramedic is able to do in comparison to an EMT.
            What does the your patch say that you get from national registry? EMT-Paramedic....like it should be...EMT before medic. Get the patient to where he/she needs to be

            Originally posted by FireMedic049 View Post
            Ah yes, the old "paramedics don't diagnose" statement. Well, it's pretty much a fallacy. The truth is, Paramedics do diagnose. If we give D50 to a diabetic patient with low blood sugar, then we've clearly "diagnosed" their problem as "hypoglycemia". Activating a "STEMI alert" (if your system supports such) for a patient with ST elevation in multiple leads means that you have "diagnosed" that they are having an Acute MI. The scope of a diagnosis may be limited, but it's a diagnosis nonetheless.
            I can see your point on this....I can't agree with it though. You may have diagnosed the symptom as it presents itself, but you have not diagnosed the problem as a whole. D-50 by itself is worthless. Without proper meal & further analysis from a physician you will continue to see that patient time & time again with the same signs & symptoms. Can the patient refuse once he is CAOx4?...of course (at least in Delaware he can). That does not mean he is cured. ST elvations...another symptom of a larger problem. Again, your treatments can only subdue the symptoms as they present themselves to you. You are a valued part of the medical setting. But you stop as soon as you drop off the patient to the RN or Dr.

            But the problem is that some medics don't just stop there...I'm waiting on the one medic that buys his own Rx pads...lol

            Originally posted by FireMedic049 View Post
            I partially agree with this. There should be a minimum amount of BLS experience required before attending Paramedic training, however I know that waiting 5 years is excessive for the most part and really excessive if a person is working full-time in a busier EMS system.
            I say five mostly as an a rounded off number...I wouldn't want to see someone jump from one right to the other. Busy or not. I think 5 years lets you appreciate what & where you have come from

            Originally posted by FireMedic049 View Post
            Yes, there are some with over-inflated egos, but really not much different than most occupations in that regards. Being a "good" Paramedic requires a degree of cockiness.
            cockiness is one thing...sinful pride is another....lol


            Originally posted by FireMedic049 View Post
            I'd be willing to bet that (based on my experiences) there's probably at least as many EMTs that think they are just there to drive the ambulance and move the patient as there truly are Paramedics that "think they are gods".
            I can't argue with that statement

            Please don't get me wrong, God bless a medic...but some of them kill me with their attitudes. especially the newbies. I know you have your own protocols to follow, but I'm starting to wonder if your higher ups have missed the point of pre-hospital care. Wheel & heal is the name of the game....Not on call house doctors..& that goes double for basics(cause they are just as bad)!
            Last edited by ffscm72; 07-17-2011, 04:18 PM.
            "Courage is the resistance to fear, the mastery of fear, not the lack of fear." Mark Twain
            "If you can't explain it simply, you don't understand it well enough." Uknown

            Comment


            • #66
              Originally posted by ffscm72 View Post
              What does the your patch say that you get from national registry? EMT-Paramedic....like it should be...EMT before medic. Get the patient to where he/she needs to be
              Yes, "BLS before ALS", however you really didn't rebut my point. Both aspects are important, however there is a significant difference in the training and scope of practice between EMT and Paramedic and to say that a Paramedic is "nothing more than an EMT with way more drugs" is rife with ignorance.


              I can see your point on this....I can't agree with it though. You may have diagnosed the symptom as it presents itself, but you have not diagnosed the problem as a whole. D-50 by itself is worthless. Without proper meal & further analysis from a physician you will continue to see that patient time & time again with the same signs & symptoms. Can the patient refuse once he is CAOx4?...of course (at least in Delaware he can). That does not mean he is cured. ST elvations...another symptom of a larger problem. Again, your treatments can only subdue the symptoms as they present themselves to you. You are a valued part of the medical setting. But you stop as soon as you drop off the patient to the RN or Dr.
              You may be able to see my point, but I don't think get it though. My point was centered on your treat the symptoms, not diagnose comments and I think you're reading too far into my comments.

              In order to properly treat the symptoms, one has to identify what those symptoms are along with utilizing the available diagnostic tools to add more context to those symptoms. I'm not talking about making an equivalent diagnosis to that of a physician. It's more of a "field diagnosis" thing. Continuing with the diabetic example, the field diagnosis is not about distinguishing between Type I or II diabetes or whatever, it's simply a matter of identifying (diagnosing) "hypoglycemia" as the problem in order to know what the proper course of treatment is.

              For example, one day I had a pt with a significant altered LOC along side of the road. Nobody around him knew him, no medic alert bracelet, no obvious injury so we had nothing to go on as to what the cause was. He was partially dressed for work at a restaurant (not located in that part of town), his ID listed his address as being in another town several miles away so he appeared to be "out of place". The incident location was very close to an area in which illegal drug activity is not unusual so pretty much all signs pointed towards a drug overdose. The problem ended up being "hypoglycemia" as he was a diabetic and lived in that area now, but his ID wasn't current. Without diagnosing that (not diabetes) as the cause, the proper course of treatment would not have been known.

              Some patients we can diagnose and "cure" their immediate problem. Some patients we will be able to reach a basic diagnosis and attempt to manage until we can get to the hospital. Some patients we won't be able to diagnose the cause of their problem. Some of them will have symptoms we can treat, some won't.

              Maybe it's a semantics thing, but whatever you want to call what we do for some patients in order to treat them properly, it's still arguably a diagnosis.

              I say five mostly as an a rounded off number...I wouldn't want to see someone jump from one right to the other. Busy or not. I think 5 years lets you appreciate what & where you have come from
              I've seen and precepted students who have jumped right into Paramedic training following EMT class and as a rule, they weren't ready.

              5 years certainly will do as you stated, however that long really isn't necessary for a lot of providers to gain that insight if working on a routine basis.

              I know you have your own protocols to follow, but I'm starting to wonder if your higher ups have missed the point of pre-hospital care. Wheel & heal is the name of the game....Not on call house doctors..& that goes double for basics(cause they are just as bad)!
              What is it that has you wondering that?
              Last edited by FireMedic049; 07-17-2011, 06:53 PM.

              Comment


              • #67
                Originally posted by ffscm72 View Post
                in Delaware they have raised the standards for EMT-P's to must have AA. I personally think it's stupid being you are nothing more than an EMT with way more drugs. Your job is to wheel & heal. You are not a rolling Dr. Do your job, treat the symptom as it presents itself & get the patient to definitive treatment facility. That's all you are meant to do. Not diagnose the problem. Just treat the symptom & transport to a Doctor w/ 9 years of medical school & a life time of training. Also so medics should not be allowed to be medic w/o having at least 5 years of BLS under their belt....I'm a lil' anti-medic. TO many of ya think you're gods (not all). But the more of you that go thru college to be a medic tend to be WAY to cocky for your own good. Give me a medic that took the non-college course & has a life time of experience over any of these NKOTB!
                I'd have to agree with FireMedic049. To say paramedics do not diagnose patient's conditions is stupid. No, my diagnosis is not the final say when it comes to the patient's medical records, that would be their PCP. But what exactly do you call looking at the patient's symptoms as a whole to decide immediate treatment? If I have a patient who has a blood sugar of 20, I treat them with D50 or Glucagon. They are having a hypoglycemic incident, pretty cut and dry. Diagnosing a patient with a condition does not mean directing and providing long-term care for the condition. Or how about 3rd degree heart block? I am taught how to identify and treat this condition, not simply the signs/symptoms it causes. I'm not just treating the hypotension it causes, or the skin presentation. I am treating the root of the symptoms, the heart block itself. By identifying and diagnosing this condition, I am able to treat the condition as a whole instead of simply treating symptoms.

                No, we don't diagnose everything. There are plenty of calls I go on that I am not able to identify the root of what is going on with patients. In those instances, yes, I simply treat symptoms that I can address. But there are also plenty of medical conditions and events that I AM taught to recognize and treat the root of the incident rather than simply treating symptoms. To say that a paramedic is not able to do this, such as with a patient having an MI, demonstrates a lack of knowledge on your part on what exactly a paramedic is taught. How exactly do you think a doctor diagnoses an MI? He looks at the same 12-lead EKG we do, looks at the same signs and symptoms we do. The ER doc diagnoses the patient with the MI, but he doesn't go to the cath lab with the patient to break the clot, and he obviously doesn't give the patient follow-up afterwards. But he diagnosed the medical event in the first place. We are taught to do the same thing but with fewer conditions, the ones that will immediately present a danger to the patient's life.

                Comment


                • #68
                  I think we missing the point....why have an A.A degree for a job that only requires you to stabilize the patient...You are given NO drugs to cure the underlying issue. MI, Diabetes, & whatever else. Your job is to stabilize...nothing more.
                  E.M.T= Emergency Medical Technician. No matter your level...the job is always the same. & it isn't as deep as some of us have made it out to be. treat & street ya'll. nothing more...nothing less. I will always rely on you, the paramedic...you have the knowledge to do more for those who need you in there time of need. But can your knowledge be obtained w/o need of a college degree that not everyone can afford? Yes...I know it can. I've watched the best of the best do it & do it VERY well.
                  "Courage is the resistance to fear, the mastery of fear, not the lack of fear." Mark Twain
                  "If you can't explain it simply, you don't understand it well enough." Uknown

                  Comment


                  • #69
                    Originally posted by ffscm72 View Post
                    But can your knowledge be obtained w/o need of a college degree that not everyone can afford? Yes...I know it can. I've watched the best of the best do it & do it VERY well.
                    Yes, they are not arguing that there aren't great paramedics out there....but there are also jackasses who have gone through the easiest 7 month paramedic course they can POSSIBLY find, just to get that little "EMT-P" patch, so they can ride the big red truck. Not only would making paramedic an AA or BS course open up new doors and possibilities for the paramedic, but it would also weed out a good number of the guys who don't give a rats ***** about medicine and just want to be firefighters. And yes it would cost more, but if one does just a BIT of digging, there are TONS of scholarships and grants to be had.

                    Comment


                    • #70
                      Originally posted by ATFDFF View Post
                      Yes, they are not arguing that there aren't great paramedics out there....but there are also jackasses who have gone through the easiest 7 month paramedic course they can POSSIBLY find, just to get that little "EMT-P" patch, so they can ride the big red truck. Not only would making paramedic an AA or BS course open up new doors and possibilities for the paramedic, but it would also weed out a good number of the guys who don't give a rats ***** about medicine and just want to be firefighters. And yes it would cost more, but if one does just a BIT of digging, there are TONS of scholarships and grants to be had.
                      AA/BS degrees doesn't guarantee good medics nor assure that most people won't just get thru it to ride the big red truck.

                      If you take out all the "junk" in college courses & maybe add a course in "common sense" then I'd be more into it. Unfortunately it's all about the dollar.
                      "Courage is the resistance to fear, the mastery of fear, not the lack of fear." Mark Twain
                      "If you can't explain it simply, you don't understand it well enough." Uknown

                      Comment


                      • #71
                        Originally posted by ffscm72 View Post
                        AA/BS degrees doesn't guarantee good medics nor assure that most people won't just get thru it to ride the big red truck.

                        If you take out all the "junk" in college courses & maybe add a course in "common sense" then I'd be more into it. Unfortunately it's all about the dollar.
                        Clearly nothing will be able to completely eliminate people who are "just doing it." BUT there is a huge difference between someone committing to a (usually) part-time 7 month program where more than 50% of your time is in the field, as opposed to a 2 or 4 year program, learning TRUE A&P, more indepth studies of your drugs, etc.

                        Comment


                        • #72
                          Originally posted by ffscm72 View Post
                          I think we missing the point....why have an A.A degree for a job that only requires you to stabilize the patient...You are given NO drugs to cure the underlying issue. MI, Diabetes, & whatever else. Your job is to stabilize...nothing more.

                          It's certainly true that a degree is not essential to being able to competently provide Paramedic level care. It's equally true that a degree will not guarantee a "better" pre-hospital provider. There's valid points on both sides of the debate and moving towards a degree based certification/licensure for Paramedics could help move the profession to a more even standing in the medical field, thus resulting in better compensation and new opportunities.

                          E.M.T= Emergency Medical Technician. No matter your level...the job is always the same. & it isn't as deep as some of us have made it out to be. treat & street ya'll. nothing more...nothing less. I will always rely on you, the paramedic...you have the knowledge to do more for those who need you in there time of need. But can your knowledge be obtained w/o need of a college degree that not everyone can afford? Yes...I know it can. I've watched the best of the best do it & do it VERY well.
                          Yes, this job isn't necessarily as "deep" as some make it out to be, however it's also no where near as "shallow" as you make it out to be.

                          Do you realize that "treat & street" is not an EMS term? It is an ER term referring to quickly addressing a patient's complaint (the "treat") and discharging them from the ER (the "street") rather than having them linger in the ER unnecessarily.

                          Comment


                          • #73
                            Originally posted by FireMedic049 View Post
                            It's certainly true that a degree is not essential to being able to competently provide Paramedic level care. It's equally true that a degree will not guarantee a "better" pre-hospital provider. There's valid points on both sides of the debate and moving towards a degree based certification/licensure for Paramedics could help move the profession to a more even standing in the medical field, thus resulting in better compensation and new opportunities.
                            Exactly my point....for the most part (there are certainly exceptions to this) EMTs/Medics tend to be looked down upon by the rest of the medical field. I'm certainly not saying we need the same standing as a physician or even a BSN RN, but if we start to show more schooling requirements/more requirements in general, it would make a pretty clear case for project medical directors to give us more rights and responsibilities. And, in turn, this improves our leverage to get more from our employers, etc.

                            Comment


                            • #74
                              It is as shallow as I make it. Our treatments are limited & so our or skills....& for proper reason. Why? cause we do not have the proper medical analysis tools required nor proper facilities. Why? cause we are only meant to stabilize & get them to that facility. To think you do more than that is only fooling yourself into believing you are part of the end solution. You stabilize...I stabilize. That's it...nothing more, nothing less. Know your role in the bigger scheme & you'll become better member of what you are meant to do. If you want more, go get it & move on. (e.g. LPN, RN, DR) what ever floats your boat. If you want better pay from an employer? go be a nurse or DR. This is EMS, it's run by the Department of Transportation...the same people that make the lil' yellow lines crooked as all get up & get paid WAY to much for it...lol

                              & yes I'm aware of where the saying "treat & street" come from. But the same can hold true for EMS....Get them to the hospital in a timely manner instead of pretending to diagnose the pt. in the back of a bumpy ambulance & not having them linger in the back of an ambulance so some self inflated provider can pretend to be more than he/she is.

                              *side note: please be aware (cause I haven't mention this & it VERY wrong to point the blame @ one group) that I don't just hold these opinions to just medics....EMT-Basic's are VERY MUCH as guilty of this. We all aspire to be more, but in the process forget to be the best @ what initially trained for.
                              "Courage is the resistance to fear, the mastery of fear, not the lack of fear." Mark Twain
                              "If you can't explain it simply, you don't understand it well enough." Uknown

                              Comment


                              • #75
                                Originally posted by ffscm72 View Post
                                It is as shallow as I make it. Our treatments are limited & so our or skills....& for proper reason. Why? cause we do not have the proper medical analysis tools required nor proper facilities. Why? cause we are only meant to stabilize & get them to that facility.
                                I kind of disagree with your analysis. Yes, our skill set and treatments do not reflect the entirety of what is available in the medical field. However, your consistent portrayal of what EMS and specifically Paramedics can do paints more of a picture of the old "load & go" days of early EMS rather than reflect the reality that the modern ALS ambulance can provide a significant amount of what would be a patient's initial ER care in their home or wherever they are at.

                                Yes, our education and tools have limits, however we seem to be getting more stuff added on a somewhat regular basis.

                                In the 15 years that I have been an ALS provider, EMS (at least where I've worked) has added the following off the top of my head to our scope of practice, skill set, or diagnostic equipment:
                                * 12-lead EKGs with telemetry
                                * Alternate airway adjuncts (Combi-tube, King-LT, etc.)
                                * C-PAP
                                * Adult IO access
                                * Capnography
                                * CO monitoring equipment
                                * Lactate meters
                                * Numerous medications, including additional narcotic options and nitrous oxide.
                                * Numerous revisions and expansions of treatment protocols allowing paramedics to use their own discretion regarding treatment when in the past a Medical Command Physician would have needed to be contacted prior to treatment.


                                Some systems have expanded even more allowing the use of things like pre-hospital thrombolytics, portable ultrasound & interactive assessment/diagnostics (video conferencing with MDs).

                                Who knows what the future will hold, but our limitations will be influenced by multiple factors including the ability or inability to squeeze even more equipment into our tiny ER on wheels and the feasibility to do so and not simply because "we aren't doctors" or because "we are only meant to stabilize & get them to that (hospital)".


                                To think you do more than that is only fooling yourself into believing you are part of the end solution. You stabilize...I stabilize. That's it...nothing more, nothing less. Know your role in the bigger scheme & you'll become better member of what you are meant to do.
                                The vast majority of providers that I've known over my now 18+ year career do understand their role and do not think they are more than what they are in their role.

                                & yes I'm aware of where the saying "treat & street" come from. But the same can hold true for EMS....Get them to the hospital in a timely manner instead of pretending to diagnose the pt. in the back of a bumpy ambulance & not having them linger in the back of an ambulance so some self inflated provider can pretend to be more than he/she is.
                                Well, if you know what the origin of "treat & street" is, then using it in the fashion that you are (linking it to EMS) is only making you look more foolish in this discussion.
                                Last edited by FireMedic049; 07-19-2011, 03:05 PM.

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