Monday, April 7, 2008

Dr. Bledsoe on NREMT Changes

First a bit of back story, there's an article written by Dr. Brian Bledsoe on about a proposed change to NREMT policy regarding who may and may not sit for the paramedic exam, many comments were left on the article web page and rather than list mine with everyone else's I've decided to post my comments to my blog.

Dr. Brian Bledsoe always manages to stir the pot and piss people off and as usual a discussion on the advancement of EMS stating that we need to raise the bar is bound to be offend someone. And as per usual the discussion devolves into a an argument of urban vs. rural and paid vs. volunteer. Now, as for my experience, I am a graduate of an accredited paramedic education program and I have taught and mentored students from non-accredited programs. Is there a difference in the education one can obtain? Absolutely. If we are ever to become a profession then we need to take a lesson from the history of nursing education and push towards degree-based programs for paramedics. Regional/local paramedic education programs cannot match the education received in an academic setting, there is no arguing this point. Now, I'm not saying that non-accredited programs do not produce good paramedics, I've known several great paramedics that are the product of non-accredited programs and they are excellent practitioners, but we also must ask, what if those providers had access to everything that an academic setting had to offer- could they be something more than what they are now? I received my paramedic education in a university level program, now I realize that this option is not available to a lot of people, but there are plenty of really great community college based paramedic programs out there that are available to the masses and there is no reason why people can't get themselves to them. I have a colleague back in Maine who despite having several "local" medic programs available to him drove 120 miles one way to obtain his paramedic education from a community college. We need to start making EMS as a degree program, there is no getting around it, we need grassroots involvement in EMS organizations so we can gain the lobbying power needed to bring about change. We need people to get off their collective asses and give a damn rather than continue to sit around and bitch and whine about how we aren't respected.

Now, while I’m on my rant of respect we as EMS providers need to understand how other allied health care professionals work. How many times have we walked in to a nursing home only to treat the staff like they don't know anything? You *know* you're guilty of it, what many EMS folk don't understand is that they do not operate in the same manner that we do. Standing orders in a nursing home have nothing to do with emergency medicine. Even something as simple as oxygen administration often times requires an order. How many times have you gone in to the ER and rolled your eyes at something that an ER nurse does? How many times have your actions caused us all to lose respect in the eyes of that veteran ER nurse who has forgotten more than you'll ever know about emergency medicine? The fact of the matter is we are not a respected part of the health care team. We as EMS providers know what we are and what we are capable of, but we are not professionals, we are tradesmen, and for us to become professionals we need to enact change and I believe this shift in policy on the part of the NREMT is a step in the right direction


Cheating Death said...

I agree completely. I am finishing up my Accredited program and I do see a difference between my education and many of my peers at non-accredited schools. Why not take it one step further and make it a DEGREE!

It makes the rest of the world think of us as more than some half-tech school program.

Ironically in my area many of the community college programs are the non-accredited programs and at 2 years long, their education is still lacking as they can't keep good instructors.

Sevesteen said...

Devil's advocate here, from the point of view of a patient rather than an EMT--If you raise educational requirements, make it a profession you'll have to pay EMT's more. Do you think you will have the same number of EMT's, all making more money, or will you have the same budget for salary, just spread among fewer people? Which is the best use of resources?

MedicMatthew said...

Well, Sevesteen, that is another topic entirely. The next, or rather a future step in the advancement of EMS to a profession will have to be to restructure the way that we, as a whole, provide ambulance services. It just simply does not make sense to have multiple small ambulance services spread out across the countryside when through regionalization services can be merged into a larger entity with reduced overhead. Now, I know that comment is sure to stir up a shit storm, but this is exactly what my former employer did back in Maine and it worked despite much internal opposition from the local folk who had been with the ambulance services for years. Through regionalization and restructuring we can streamline the whole system.

Ellie said...

This is possibly the one and only thing that I (as much as it pains me to say) agree with Bledsoe on.
It's time professionalism came to the forefront of EMS.

Anonymous said...

As a Paramedic I disagree with you, EMS is not health care; It is public safety.

MedicMatthew said...

First and foremost we are healthcare providers. That is what we are trained to be; that is the role we fill. That being said, we do also fall in to the role of public safety. However, licensed/registered EMS providers also work in a variety of other settings all within the realm of healthcare that have nothing to do with ambulances or fire apparatus.