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Paramedics Providing Care?


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This is about money, plain and simple. I am currently a medic and I see there are other current and former medics here. This is about the peanuts we make and getting certain functions performed while paying the providers said peanuts. Hiring PA-Cs is not an argument that will be taken seriously because the powers that be have plenty of heartburn paying the providers $15/hr so there will be no $80-$100k providers doing this.Maybe it puts pts in danger, maybe not. It seems to me that, for the people that make the big decsisions, pt care is not the primary focus.

 

(this was recently a discussion about community health medics, around here, and a proposal was made. The budget for it was refused. Not because the city did not want it to happen, but because of the cost. Imagine how much greater the cost would be with PAs and NPs)

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This post is fascinating to me... I am a Paramedic. I have B.S. in EMS (essentially Paramedic studies). My program required the same Biology, chemistry, anatomy, physiology, sociology, psychology, nutrition, etc. that EVERY MD, PA, NP has to take in undergrad. I spent 4 years busting through school, where many PAs can go to a certificate program still and be done in 2... I know how to suture, staple, manage blood sugars, manage drunks, recognize appendicitis, gallstones, kidney stones, pneumonia. I can even somewhat read chest x-rays, CT scans, and I'm fairly good at recognizing heart attacks. I know a life-threat when I see one, and although I may occasionally leave something unrecongized, all DOCTORS do that too! THe idea that paramedics are somehow incompetent is just ridiculous! Now, that said, I spent a long time workin in an urgent care under this exact premise. I functioned as a nurse, doctor, whatever else I needed to get the job done, under direct supervision of a physician. I had an extended scope covered under that supervision and recieved specialized training to do so. Do you not think that PAs would not have existed if physicians weren't willing to train them to a specific subset of ailments? Maybe they should have said, "sorry, if you want to practice medicine, go to medical school"... Maybe I am one of a few hundred paramedics that got to experience the start of a new "education evolution" as is mentioned above - if so, how exciting I hope it continues. I agree, there are some idiot paramedics out there that should not have this responsibility, but with the education becoming more and more a BS program with extensive training beyond the certificate level, I just don't see why Paramedics shouldn't be able to do this!

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This post is fascinating to me... I am a Paramedic. I have B.S. in EMS (essentially Paramedic studies). My program required the same Biology, chemistry, anatomy, physiology, sociology, psychology, nutrition, etc. that EVERY MD, PA, NP has to take in undergrad. I spent 4 years busting through school, where many PAs can go to a certificate program still and be done in 2...

OK, simmer down now. Number one, just because you have a Bachelor's degree doesn't make you better than someone with a certificate at what they are trained to do. I gaurantee that many PAs with certificates are just as good, if not better, than many PAs with master's degrees. I mean come on, so much of a Bachelor's degree is filler material intended to make the school more money by claiming it makes one a more "well rounded" individual. I'll have 2 Bachelor's degrees (one of which is a BSN the other is in Molecular Biology) and I would still consider the certificate PA as more medically knowledgeable than myself.

THe idea that paramedics are somehow incompetent is just ridiculous! Now, that said, I spent a long time workin in an urgent care under this exact premise. I functioned as a nurse, doctor, whatever else I needed to get the job done, under direct supervision of a physician. I had an extended scope covered under that supervision and recieved specialized training to do so.

No one is saying that paramedics are incompetent. All they are saying is that they are trained to a certain level and it's questionable as to whether increasing their responsibilities is a wise decision given that training. Paramedics are good for what they are trained to do. Why can't people just be ok with being good at what they are trained to dooooo?? And just because you had an "extended scope" does not mean you are ABLE to function as a nurse or a doctor. Statements like that are borderline narcissistic.

I agree, there are some idiot paramedics out there that should not have this responsibility, but with the education becoming more and more a BS program with extensive training beyond the certificate level, I just don't see why Paramedics shouldn't be able to do this!

There are some idiots in everything out there. Again, just because you have a Bachelor's degree does not mean you are properly trained to handle all the responsibilities being proposed above.

 

And just my opinion, I think LPNs and RNs should be more "threatened" by this idea than should PAs and NPs. In my mind the "chain of command" is as follows:

paramedic/emt<LPN<RN<PA/NP<MD/DO

 

So I think that PAs and NPs are at least one degree of separation from being threatened.

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Your comments about chain of command miss a critical aspect - the area of medicine. It's the individual's knowledge and experience in that area that is key. For example, I routinely teach ACLS to RN's, PA's, NP's, MD's, DMD's, DO's, etc - as an educator on the staff of a university based teaching hospital. As a paramedic and PA student, do I know as much total medicine as a PA, NP, MD, DMD, or DO - certainly not. Do I know more about emergent management of acute cardiac problems and cardiac arrests than most of them - certainly. It's all about context: each of us has more training and experience in some areas than others.

 

As a firefighter/medic, I've done a number of home health interventions: trach suctioning, dressing changes, wound monitoring, ostomy changes, etc. I believe that is the intent of this approach: routine monitoring and home health interventions. With proper training, a medic can certainly do this sort of work well. Whether it will work in a particular system depends heavily on the characteristics of the individual system: call volume, paramedic training, patient needs, etc.

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OK, so because one person thinks they are themselves qualified, then all paramedics should be given more responsibilities?

 

"It's all about context: each of us has more training and experience in some areas than others."

 

So are we going to have to review each paramedic's personal abilities and determine whether they, as individuals, are capable of performing these actions. There's a reason that medicine is standardized. It's so that we can have an easy and convenient way of ensuring that HCPs are able to provide a specific level of care. I did a summer internship in the ER where I helped reduce dislocated joints (don't tell anyone...). Does that mean everyone should now be allowed to do this?

 

What I was saying is that providing paramedics with more training will put them more on par with LPNs and RNs.

 

"With proper training, a medic can certainly do this sort of work well."

 

With proper training, anyone can do anything! Take someone and train them as a doctor (i.e. medical school) then they can do what a doctor does! Isn't it wonderful!?

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... [your last reply]...

 

Excellent...!!!

 

The notion that "With proper training, a medic can certainly do this sort of work well."

Is as true as:

 

"With proper training, a CNA can certainly do the work of a Medic well."

"With proper training, a Medic can certainly do the work of a Nurse well."

"With proper training, a Nurse can certainly do the work of a NP/PA well."

:wink:

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In my mind the "chain of command" is as follows:

paramedic/emt<LPN<RN<PA/NP<MD/DO

 

.

 

lpn's are below paramedics. an lpn is a medical assistant who can start IV's. at many places they are not allowed to push any IV meds, etc. paramedics provide most of the emergent care provided by physicians in emergency depts including emergency airway, surgical crichs, central lines(in many places), etc. the standard for paramedic is rapidly becoming a 2 yr a.s. degree(some states now require it) just like entry level rn's. lpn is 9 mo right out of high school.

md/do>AA/CRNA/pa/np>rn/emt-p/rt>lpn>emt-b/ma>cna

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dude, lpn is 9 mo right out of high school. right out of lpn school they need to take an extra cert course just to start Iv's. I know and work with some wonderful lpn's but day 1 out of lpn school a brand new paramedic(who by definition was previously a basic for a min of 6 mo) runs circles around them. name a skill a brand new lpn has that a brand new medic does not. I could give you many the other way around. rapid sequence intubation, cardioversion, needle decompression of pneumo, IO's, etc, etc

senior lpn's can have great responsibility but that is something earned with time and experience.

don't know why you are always against the medics. it's a lot of responsibility with very little backup.

we are not going to agree on this one as we have been round and round about it before.

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this is the description and prereqs for lpn at a local program:

Licensed Practical Nurse

 

The Licensed Practical Nursing Program is a 10 month- 1376 hour program consisting of Classroom and Clinical Experience - which is attained at local hospitals or long-term care facilities. Coursework includes general and specialized nursing subjects.

Approximately 40% of the program is spent providing nursing care in health care institutions throughout the region.

This course includes Nursing Principles and Skills, Body Structure and Function, Medical and Surgical Nursing, Nursing Issues, Pharmacology, Normal Nutrition, Normal Growth and Development, Maternity Nursing, Nursing of Children, and Pre-employment Skills.

Upon Completion of Coursework the student is awarded a certificate- career passport and becomes eligible to sit for the State Board Exam.

Admission Policy

 

  • You must be 18 years of age or older.
  • Graduate from a State Department of Education approved high school or have GED equivalency certificate.
  • Pass required standards on pre-entrance and assessment tests which evaluate math and reading skills.
  • Interview with the director.
  • Provide personal and employer references.
  • Submit health information.
  • Must be able to transfer clients safely, read charts and collect objective data, such as auscultation of body sounds. Immunizations are required.

 

in comparison to the above the local emt-p program is 107 quarter units done over 2 yrs after an emt-b course and a min of 6 mo employment in that capacity. this leads to an a.s. in paramedicine(the min. credential allowed to practice in this state).

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Where I live the nearest paramedic program is 152 hours for EMT-B and 644 hours for EMT-P. The LPN program is 52 weeks. So the paramedic would have to go to class, what, 15 hours a week to get it done in 52 weeks. And also where I live the nurse practice act states that LPNs may administer IV medication except for antineoplastic agents, titrated meds and IV push meds other than heparin flush. May not administer hemodialysis. But sure, they have to have a cert. to start an IV. I'll give you that. So would it be better if I said emt-b < emt-p/lpn < rn < pa/np < md/do?

 

So, back to what I was saying earlier, everyone is qualified to do everything? Because with just a little more training I can do more stuff! Why don't we just make RN the basic requirement into healthcare? Why don't we just make PA the basic requirement to work in healthcare? Why don't we just abolish all current designations in healthcare and create a system where you can customize your educational experience to achieve the exact level of specificity you desire? We'll take it class by class and after each class you'll have a different set of letters after your name and you can do a certain amount of things. Sounds easy to me.

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Whoa whoa whoa. I am not against medics at all. I'm just saying that with the creep that is occurring in healthcare, everyone might as well just become a PA or MD. There is such a big push to have everyone in healthcare start doing more than what they do now. I know the RNs are joked a lot on here for all their certs and all the letters after their names, but that's what this sounds like to me. Take a emt-b --> more classes --> emt-p --> more classes --> emt-PA --> more classes --> emt-MD.

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Not against the medics.... as has been said, been one.

Not against the LPNs... as has been said, been one.

 

I sat through the training of BOTH those careers and obtained licensure/certification in both before going on to RN school.

 

Your spiel about how long the training is... is BS and again, you really don't know what you are talking about. Even if you used your number of 9 months for LPN training, You know as well as I do that there as 6 month Medic courses out there and you also know that 6 months as a EMT-B really means little if you were doing SNF and ALF transports all day. Try again.

 

I attended a LPN program AFTER Medic school and while it was a "breeze"... cakewalk due to my training and experience as a medic, there were quite a few things covered that wasn't in my medic program. Medics are the kings of "pre-hospital" care and packaging. This is where they excel and this is where they should be utilized.

 

Soooo.... if it has already been recognized and acceptable that a ADN-RN can take a week long class to get a Medic Cert and sit for the NTEMT-P... but a NREMT-P needs to sit in class for a yr+ to get a ADN-RN... and that a simple fact is that the only difference between a ADN-RN and a good LPN is IV medications and a psych nursing course. As you already stated, a simple week long class rectifies the IV medication part.

 

Then it would stand to reason that while the LPNs you seem to have known were duds... LPNs are closer to RNs than EMT-Ps.

But then again... last time we had this discussion... it was RNs that YOU were asserting were less trained and/or qualified than Medics.

 

A keyed in LPN with ACLS and PALS certs will have a depth and broad base of knowlege that would allow them to run circles around a typical medic in a non-prehospital setting.

 

But as you stated...

We won't agree on this because as a former medic, you think you know what was covered in a LPN program and how long the training was, and as a former medic and former LPN/RN, I KNOW what was covered and sat through the training... and as is expected... when you don't know... you will simple write it off as fluffy, touchy, feely nursing classes with no real value.

 

Sometimes, I wonder why I even bother...

 

YMMV

 

Contrarian

 

P.S... picking one course near YOU that agrees with your perspective isn't what's know as research...

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let's agree to disagree on this one.

I think we can both agree that there are great lpn's and medics out there with varying levels of training and experience.

some medics I wouldn't let touch a dog and some lpn's do bed baths all day long and hand out meds. some medics(like the seattle guys) give tpa and start central lines in the field and do perimortem c-sections and some lpn's run depts every bit as well or better than an rn.

I wouldn't trade any of my senior night shift lpn's for rn's.

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I dunno... hard to argue with someone who has done both...

 

The EMT-P program I attended at Fayettville Tech Comunity college in 1989 in Fayetteville North Carolina (was stationed at Ft. Bragg as a Airborne Combat Medic) was 6 months long.

Later, the nursing school I attended had both LPN and RN classes.

ALL RN students in my program had to complete the LPN portion yr 1 then advance to the RN portion yr 2.

You could sit for the LPN boards and stop there after yr 1 or be invited to go on to complete your RN.

If your grades weren't up to par... you would not be invited to complete your RN.

 

I was working in a ED as a PCT-III (EMT-P) during that 1st 12 months in nursing school.

Somewhere near month 17 (during the RN portion)... I transferred to the ICU.

When I graduated my nursing program, I was then a EMT-P/RN new grad CCU intern for 6 months.

I got my CCRN later.

 

I did this for a few yrs then attended a dual FNP/PA-C program.

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Admission Policy

  • You must be 18 years of age or older.
  • Graduate from a State Department of Education approved high school or have GED equivalency certificate.
  • Pass required standards on pre-entrance and assessment tests which evaluate math and reading skills.
  • Interview with the director.
  • Provide personal and employer references.
  • Submit health information.
  • Must be able to transfer clients safely, read charts and collect objective data, such as auscultation of body sounds. Immunizations are required.

 

Those sure look like the admission pre-reqs to a few PA programs and DE-NP programs now-a-days...

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That is sweeeeeet. So do you practice as a PA-C or an FNP? Does it really matter where you claim residency? I would love to graduate in a year and go right into some sort of icu (high hopes) and then go on to Acute Care NP or CRNA (probably CRNA).

 

As a PA-C...

Never got the MSN needed to practice as a NP outside of California.

Since I am considering doing a doctorate degree... I have been doing some light, cursory research on the DNP.

 

Lots of hospitals now have in-house "Nurse-Intern" programs to get new-grads and newer grads into ICU/CCU/GI/Surg nursing.

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Ah, the DNP. The school where I am doing my ABSN has already switched to the DNP as entry for NPs. Pretty soon all NPs will be doctors and so will PAs... and paramedics...

 

Where I live there is a superabundance of nursing programs (same for PA programs). So new grad nurses get the shaft for employment in general let alone the highly coveted icu positions. I would definitely do an intern program if I could. However, I still have a year to go so I'll worry about that later.

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Those sure look like the admission pre-reqs to a few PA programs and DE-NP programs now-a-days...

 

don't remind me. not a fan of direct entry pa or np.

as an aside I think the time of the 6 mo emt-p program is coming to a close. there is a large push within the ems community for standardization and I think that will happen at the a.s. level. a few states(mine included) have made a.s. the min. entry level criteria so folks from out of state, even with an nremt-p cert still need to get the a.s. to practice. funny thing is the WA medics are better clinically(that's more about the medical directors than anything else).

even 20 yrs ago when I did a certificate level program it was a yr long and we all were making fun of the grads from shorter programs. at the time in ca any emt-p could get reciprocity for lpn.( I think this option no longer exists) I know a few guys who did so they could augment their medic salary with some nursing home work on their off days.

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as an aside I think the time of the 6 mo emt-p program is coming to a close. there is a large push within the ems community for standardization and I think that will happen at the a.s. level.

 

Very true. As of 12/31/12, anyone sitting for the national registry paramedic exam will have to have graduated from a coAEMSP accredited program. We have been going through preparation for our accreditation site visit, and it has been a ton of work for the last year. Most of the "medic mill" programs in the state will be shutting down; in order to meet the requirements most programs will have to have a minimum of ~1300 hours of education. There are also pre-req/co-req requirements for courses like english, math, and A&P; our paramedic program includes a human cadaver lab as a component of the anatomy requirement. With the focus on competency-based education and minimum numbers of patient contacts, most of our graduates are taking 18 months- 2 years to complete the entire program. The days of the 6 month program are over.

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This post is fascinating to me... I am a Paramedic. I have B.S. in EMS (essentially Paramedic studies). My program required the same Biology, chemistry, anatomy, physiology, sociology, psychology, nutrition, etc. that EVERY MD, PA, NP has to take in undergrad. I spent 4 years busting through school, where many PAs can go to a certificate program still and be done in 2... I know how to suture, staple, manage blood sugars, manage drunks, recognize appendicitis, gallstones, kidney stones, pneumonia. I can even somewhat read chest x-rays, CT scans, and I'm fairly good at recognizing heart attacks. I know a life-threat when I see one, and although I may occasionally leave something unrecongized, all DOCTORS do that too!

 

I functioned as a nurse, doctor, whatever else I needed to get the job done, under direct supervision of a physician. I had an extended scope covered under that supervision and recieved specialized training to do so.

 

Hmmm...

 

So... since you already have the knowledge and perform/practice to the level of PAs and RNs and MDs... what's the point in applying to a PA program...???

Acording to what you wrote above... you already know it all and can do it all.

Hell... you should save your money, and not waste your time since you already found a job that exceeds the scope of practice of medics, and RNs.

 

Be sure to tell them at your PA school interview that you already basically work as a PA/MD... they may as in the past, simply hand you a diploma at the interview.

 

Or maybe you should just skip the program interview and just show up at NCCPA headquarters and demand reciprocity.

 

If you go to NCCPA... ask for "Mike Hunt" and tell them Rusty D. Bedsprings sent you....

 

:heheh:

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Hmmm...

 

 

Or maybe you should just skip the program interview and just show up a NCCPA headquarters and demand reciprocity.

 

If you go to NCCPA... ask for "Mike Hunt" and tell them Rusty D. Bedsprings sent you....

 

:heheh:

 

I thought ben dover was in charge of pa reciprocity now.

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