Thursday, January 31, 2019

EMS Inside Baseball chatter...

Two to four years for this job? Admirable idea, unlikely to work, or happen.

EMS Artifact has a thought or two on requiring paramedics to get years of training instead of the current months.

My thoughts on that:

My hazy (from 30-years ago, when I looked at it) understanding is that paramedic certification is closer to 6 months training full-time, not anything close to a 2-year Associate's degree.
Clinical rotations may almost approach a year total from start to finish, but I doubt it, at least anywhere hereabouts.
(Obviously, individual companies/agencies my have other requirements.)

You might could expand paramedic to the level of LVN training, which is a solid year.

Two years is frankly overkill, on so many levels, and a bachelor's degree, while admirable, is ridiculous to even suggest.
(I'm biased there: I was told twenty-five years ago that in 10 years, all RNs would be BA/BS degrees. Over 25 years later, and I'm still working as many shifts a week as I want with my humble associate's degree, including at the magnet hospitals that require most staff to hold a BSN, and there are only three of those out of about 40, locally. Double Bonus: they all pay less than the hospitals that accept anyone even without a BSN, even with the BSN pay bump. And they can't figure out why they're always short-handed. Hmm. I wonder...)

If you have 2 or 4 years to work for your paramedic degree, which was suddenly required, why on God's green earth wouldn't you either get a nursing degree at either ADN or BSN level, tripling your pay and expanding your work opportunities a thousand-fold, or just gut it out a few more years after a bachelor's, to become a P.A. or M.D.?

Is more training a good idea? Sure. For anyone, from EMT to board-certified neurosurgeon.
Is it necessary for paramedics? Probably not. At least not initially, for entry-level. (What you do as CE is your business, but smarter and more trained is better, certainly.)
Is it cost-effective, or sensible, to turn a 6-month (or 9-month) cert into one that takes a year, or two, or four, just to ante in? Highly unlikely, unless someone else (other than the paramedic) is paying for it, and even then, every year you're in school, you're not working to feed yourself and keep a roof over your head.

And non-governmental agencies (which is most of them outside Megopolis) will go the other way: they'd rather have cheaper, less-qualified workers, and if they have to pay more, they'll just upgrade to LVNs/ RNs/etc., and paramedic will become a dinosaur profession, except for firefighters on the civil payroll.

Exactly like live-in indentured servitude diplomate-nursing has all but disappeared.
(That will also exacerbate the perennial nursing shortage, and/or provide a new pipeline from LVN to RN, LVN being a similarly limited-end job category.)

And as a subtle hint, there's not a lot of crossover between guys who want to put out fires, and guys who'll sit still for an ADN/BSN. They are pretty fundamentally different groups, overall. I like what I do in the ER, but slinging ladders and hosepacks, and chopping cars open, wasn't the sort of thing I was into, then or now. I got my fill of heavy lifting in the Marines, thanks, and if I were in a firehouse, I'd be a captain or higher royalty by now, or retired, as my back and knees remind me daily.

FWIW, the three biggest limits on nurses now is lack of qualified instructors, lack of program seats to train more, and lack of places for them to train.
All of those things cost even more money, by the metric buttload. If you see the J.C.s and state colleges firing their Victim Studies programs to expand their faculty in nursing, EMS, and the pre-reqs for either, or anything else worthwhile, give a holler. Out here, it's hard enough to get them to even teach college-level English and math, and find students who can pass the pre-test to enter the courses, let alone successfully get a degree.

How anyone's going to leap all three of those hurdles by significantly ramping up paramedic training is probably ten more thoughts than anyone inside EMS has thought through, IMHO.


jerseygirlangie said...

The requirement for an RN to have a bachelor's degree is simply the first step in the scheme to convince them that they need a Masters degree ( so they can get into administration, and away from all of that nasty actual nursing stuff ) , or, better yet, a Ph.D. , so that they can call themselves "Doctor" , and confuse ( and potentially defraud ) the patients .

dda6ga dda6ga said...

Empire building for bureaucrats and local community colleges. More bodies, more money, more salary for me.

ADS said...

More training, and continuing education are both good things but a BS degree isn't the way to get that. A modern BS degree really certifies that the recipient has a high school level grasp of readin' ritin' and 'rithmatic and the equivalent of apprentice training in their field.

I bought a reprint of a textbook for Royal Navy engineering cadets from the late 1800s. This book, aimed at 16 year olds, started with algebra and trigonometry and ended up with steam tables and boiler design (including stress/strain calculations).
I thought about that as I sat through mandatory diversity and gen-ed courses taught at the 4th grade level, full of 22 year olds.
College is just a racket these days to keep unemployable lesbians off the streets and saddle each kid with $60,000 of undischargable debt to enrich (((the financier class))).
Zero benefits to paramedics or their patients.

Bear Claw Chris Lapp said...

I have a daughter headed into Nursing. Got her a four year related degree to enjoy the college experience. If they flood the nursing level with newbies they will just get cheaper labor as corporatism always gets thanks to gubmint. She could transition to management if necessary but PA or NACRS what ever the acronym is will pay more than I ever earned in a single year. No debt either.

RandyGC said...

My observation from the outside is that around here, EMS/PM is what a lot of folks go into because they don't want to/can't afford to go to school right now.

Some are earning money and/or taking classes part time towards a degree, others just want to work and aren't interested (at least for now) in moving up the food chain to management.

A lot of those folks are certified because they want to be firefighters and a majority of the local full time departments don't have separate EMS tracks ya gotta have both to be hired. (and then there's the community that has a combined FD/PD, everyone has to be certified as a firefighter/EMS/police officer).

As stated before, just another example of creeping credentialism, fostered by folks that probably haven't worked out in the field for years, if ever.

Reltney McFee said...

ADS said...
"More training, and continuing education are both good things but a BS degree isn't the way to get that. A modern BS degree really certifies that the recipient has a high school level grasp of readin' ritin' and 'rithmatic and the equivalent of apprentice training in their field."

As our friends in The Diversity might say, Word!.

I started out as a basic EMT, worked for Da City EMS to pay for ADN Nursing school. That worked out very well: I came out with no debt (even if it WAS nigh onto 40 years ago...)

Similarly, worked full time, got my BSN: the local university had a "weekend college", and I could play Lets Make A Deal, so that my weekends of class could be free.

In my BSN program, I cannot think of a single thing that made me a better nurse. Payoff for me" Without a bachelor's, no grad school for you! I first tried Nurse Anesthetist, but, it seems, if you do not hide your conservative cred (long story, epic fail of terrain analysis on my part), the academics are uninterested in you.

I eventually went to PA school, and managed to wise up enough to not broadcast my non-liberal perspectives. Again, the only payoff of my BSN was 25 cents an hour premium, and eligibility for grad school. Oh, yes, and an interesting divorce story, when HER attorney wanted alimony so The Plaintiff could get her BSN "to support her children better". Tee Hee.

Jonathan H said...

The other interesting thing that requiring even an Associates (let alone a BSN) would do is effectively get rid of part time/ volunteer EMS; when you have trouble getting people to do the job, the WORST thing you can do is increase the time and money it takes to qualify for the job.
And of course, degree requirements would also ensure that no firefighter considered becoming dual certified, ensuring even more of a shortage and higher expenses for small rural departments that are already being hamstrung by higher costs for equipment and training.
A local volunteer firefighter told me that every call his department does is multi departmental because no department can afford to be equipped for a range of calls and so local departments specialize, e.g rescue, brush fire, high reach... He also said that every call also involves EMS and police - effectively tripling the number of people (and therefore costs) required to respond to anything.

Pat H. said...

I received a BSN because it made sense for me to do that. I already had a BA degree, so only needed 13 hours of Anatomy, physiology, and microbiology to get ready for the two years of nursing school. Incuding two summers, I had the degree. I don't know how unique that is, maybe it's not at all. When I started at a hospital my BSN garnered $4,000.00 more per year than an associate's degree. Now I'm retired and not missing it much at all.

Tenringzen said...

In my AO the state uses my taxes to pay two years'tuition for every high school graduate at a community college or trade school. When I became an EMT the program was 8 months long. Guess how long it is now. That's right. Two years. The community college systemy wants ALL of that money diverted to them. Paramedic is another two years.

EMT is minimum wage around here. PM is about $15 an hour. The new most popular program is PM to RN. One year to better hours and better pay.

FWIW,I live in an area where 30 minute transport times are the norm, and the trauma center is 2.5 hours away if the helos aren't flying. We can't afford the current barriers to entry in EMS, nor can we afford the loss of competent paramedics to RN-dom.

None of this bodes well for society in the long term.

why said...

I went through a 2-year degree program for Paramedic.......graduated in 1984. But I did it in 1 yr (I was already an EMT-SS). 1st - the AAS (Associate of Applied Science) curriculum is based off someone coming in with nothing. So, the first semester is spent doing EMT-B(asic) (plus classes to meet state requirements for the degree itself). The next semester is spent on EMT-SS (Special Skills, now known as Intermediate). The 3rd semester plus summer was spent on EMT-P(aramedic) (back then it was called Paramedic completion). And the final semester was spent completing state requirements for the degree. Actually wasn't a bad gig, though no one has ever really asked me about it.

I was the only one in the class to continue through the program (single at the time). All of the other students were from the local FDs and just needed the cert.

Anonymous said...

Interesting that Cleveland Clinic has instituted it's own nursing school possibly not that pleased with the training and competency of the nurses they were hiring.

North of Flyover country said...

FWIW EMT should be based on the master apprentice beyond the basics. Very little that an be learned in the classroom that really applies in the field. CE training would cover the updates/upgrades for both.

Anonymous said...

Hey Aesop,

the Nevada Hospital association has released their "not an AAR" for the Vegas shooting.

It's harrowing.


joemedic said...

I spent 20+ years as a paramedic--leaving after being a Critical Care Paramedic for 10+ years. When I started, we were writing paper charts as an example.

In most services of the three I worked in, in order to go up into management you needed a four year degree of some sort.

Now, apparently the emphasis is to get the EMT-B students into paramedic school as quickly as possible. Which meant that I had paramedic students who couldn't write a proper chart, couldn't do a decent patient assessment or even give a radio report.

When I was working as an FTO in the old days, I would always give homework--"When you see me again, tell me why this med was hung and what for." Or after tossing them a patient med, "Tell me what it is used for, indications, contraindications."

Before I left EMS I was just happy not to have my students not kill a patient.

Follow the money--more can be made from milking someone out of the credit hours to get a degree rather than a certification...


why said...

When TX first started down the road, there were ECAs (Emergency Care Attendants) and EMTs - the primary difference being clinicals (ECAs didn't). There was a 2-year requirement of being EMT-B before going on to EMT-Specials Skills (IVs, intubations), then another 2 years SS before going on to Paramedic completion (drugs, of which there were only 12...., and cardiac monitoring and defibrillation)....we used old MRLs (think the cardiac monitor/defibrillator that Johnny and Roy used).....I'm not real sure when the leap from Basic to Paramedic could be accomplished in 1 step.....The program I went through was one of the first that by-passed the 2-year requirement between steps (at least that's what they told us, IIRC)....

Bingo321 said...

In Kansas approximately 25 years ago when I went through Paramedic school including pre-reqs and post-reqs a certificate took a full 4 semesters and an Associates degree another full semester.This included EMT-Basic, Anatomy and Physiology which were pre-reqs. The third semester of MICT school were 56 hour weeks working 24 hour shifts for the entire semester. During the second semester of MICT we worked many 12 ER shifts. After MICT school in order to get an associates degree the general education requirements had to be obtained. I'd say that qualifies for a full Associates degree which is what I received.

Stealth Spaniel said...

All of this useless "degree" upgrading has more to do with money into the education system than any sort of quality control. The same thing happened with Administration Associates. In the old days, a legal secretary was on the job training. Then legal secretary was upgraded to either "paralegal" for the attorney crowd or administration assistant for the non legal answer phones and type. HR cat ladies started getting unindated with resumes by 1994, so to cut down on their work, they added degree requirements. Now you see Admin Assist jobs requiring a BS-BA/MS-MA with XX years of experience. All bullpucky: your 18 year old granddaughter is better off working, and she does not need any degree to answer "Mr. Throckmorton's office. How may I direct your call?" as she types up the company's new diversity policy.

Adam said...

It's a BS degree in Australia - 3 years if my memory serves me correctly. Pretty soon you're going to need a degree to wipe your own bottom.

kiggman said...

What a shit planet this is.

Aesop said...

Read it and weep.
The highlight is on page 18.

Boys and girls, I don't care how your agency gilded the lily, the NHTSA program guidelines make Paramedic a 1000-1200 hour program, (plus EMT-Basic (110 hours) plus A&P).

For Common Core grads, doing 8 hour days, 1000 hrs is six months.
The EMT and A&P would be, at most, one almost full-time semester load at the JC, and hardly what anyone would call challenging. You could even do the courses serially, and you'd be talking 3 months, at 1 mo. apiece.
At most, combined, that's a short year.
Average would be closer to 9 months.
And let's get serious, there's little in the EMT program that couldn't be covered by the average Advanced First Aid Red Cross class from circa 1980 (before the dumbing down because retards with h.s. diplomas) in about 40 hours or less.
That's called a week, not a semester slow-milked for the convenience of lazy faculty and their bi-annual paychecks.

If you managed to cram 9 months of actual training into 2 years or more [sarc], I feel your pain, but that doesn't argue for a better program, just someone else milking the cow on all four teats, for the educational $$.

My sincere condolences.

Had it been an option, I could have completed my entire RN program in 12 months, and hand to heaven, I could teach the same to anyone who wanted to pass it, 10-15 at a time, from start to finish, and dollars to donuts I'd have a higher certification/licensure pass rate than the best schools in the state for the ADN or BSN programs, as well as make better nurses once they hit the hospital wards. But the Nursing Academic Mafia would have to work for a living, and would never even permit that as a trial program, because it would shatter their rice bowls.

But I also wouldn't be handicapped by massaging the egos of the diversity admittees.
Either you'd meet the requirements and pass, or you'd be shitcanned without pity. Your patient's heart attack doesn't GAF what color you are, what you're screwing in your bedroom, or as which one of 57 genders you identify.

Nota bene there are also no multiple choice exams tattooed on patients' chests in the field. Either you know your stuff, or people die.

What I'm getting from a lot of you is how fornicated the whole process has become.

In the county that invented paramedics, when I started out in EMS, barely after Johnnie and Roy were still on first-run TV, the in-house training program was...wait for it...6 months. Period.
In, out, done.

Anonymous said...

It's not just on the training side, from the Las Vegas report cited above, is this little observation--

"“Patients who needed orthopedic surgery and would
generally be a full trauma activation were able to
be handled as outpatients

emphasis added.

yes, special circumstances, but proof they could do it.