I read an article this morning from my hometown newspaper, about the future of nursing.

It's a quick read.  Anything in there that is applicable to EMS?

http://www.buffalonews.com/life/health-parenting/health/article7344...

What do you think?

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Removing the requirement for NPs to not "collaborate" (read "supervision") with a physician? Good luck with your medical malpractice insurance.

As far as anything applicable to EMS, I guess only if you think the community health care aspect of advanced practice paramedics is solely in the domain of EMS. Personally, locally I'd rather see paramedics take over the government administration positions in EMS. The local County EMS Authority (i.e. regional EMS office) currently has an opening for a facilities coordinator. Preferred candidate? An RN.

Isn't that ridiculous?  I'd bet a paramedic with 6 years service and an MPA (or something similar) could perform much better.

Actually, that "no physician supervisor" model for nurse practitioners is alive, well, and insured in something like 14 states.

Chew on this for a minute - in Australia, physicians have very little oversight in the EMS arena.  They may sit on a state-level board or something, but EMS is run by EMSers.

Can we also compare the education requirements for Australian paramedics to US paramedics?

Personally, I think physician involvement at a closer level is beneficial provided that the physician isn't simply a paycheck and signature on a line at the bottom of protocols. I think a perfect example was the 2010 food poisoning MCI in Wake County. How many more patients would you have had to transport if it wasn't for the ability to have a physician respond to the scene?

I think both paths are good ones to have available.  

The community paramedic, or other expanded role, is great for people who want to further their education and responsibilities but have an interest in clinical care and not administration.

I also think that "EMSers" should hold more administrative roles at all levels.  It drives me crazy that Colorado's new state level EMS board is made up of more physicians and nurses than paramedics.  I won't even get into the fact that they are appointed by the governor who wouldn't know an ambulance from a delivery truck.

I think that right now close, local physician involvement is important and beneficial.  I would, however, like to see us more self governing as out education level increases.

Regardless of the path an individual paramedic chooses having more of us involved can only improve the industry.

Looking at that scenario from inside the "American EMS box" that physician involvement was essential - because without a doc, we can't alter practice protocols, etc.

From the Australian box - well, I don't have any experience from there, but I wonder that New South Wales Ambulance couldn't have done just the same thing?  Maybe some of our forum mates over there can chime in?

Joe Paczkowski said:

Can we also compare the education requirements for Australian paramedics to US paramedics?

Personally, I think physician involvement at a closer level is beneficial provided that the physician isn't simply a paycheck and signature on a line at the bottom of protocols. I think a perfect example was the 2010 food poisoning MCI in Wake County. How many more patients would you have had to transport if it wasn't for the ability to have a physician respond to the scene?

Indeed!  By comparison, how many paramedics sit on the board of nursing?

If there is even one, named by statute, I'll buy you dinner!

Timothy Rossette said:

I think both paths are good ones to have available.  

The community paramedic, or other expanded role, is great for people who want to further their education and responsibilities but have an interest in clinical care and not administration.

I also think that "EMSers" should hold more administrative roles at all levels.  It drives me crazy that Colorado's new state level EMS board is made up of more physicians and nurses than paramedics.  I won't even get into the fact that they are appointed by the governor who wouldn't know an ambulance from a delivery truck.

I think that right now close, local physician involvement is important and beneficial.  I would, however, like to see us more self governing as out education level increases.

Regardless of the path an individual paramedic chooses having more of us involved can only improve the industry.

You were pretty safe with the Board of Nursing.  Just for fun I checked the state level EMS committees and found that one is required to have 0 EMTs out of 32 members and the other only 3 EMTs out of 8 members.

This is disappointing.   


Skip Kirkwood said:

Indeed!  By comparison, how many paramedics sit on the board of nursing?

If there is even one, named by statute, I'll buy you dinner!

Timothy Rossette said:

I think both paths are good ones to have available.  

The community paramedic, or other expanded role, is great for people who want to further their education and responsibilities but have an interest in clinical care and not administration.

I also think that "EMSers" should hold more administrative roles at all levels.  It drives me crazy that Colorado's new state level EMS board is made up of more physicians and nurses than paramedics.  I won't even get into the fact that they are appointed by the governor who wouldn't know an ambulance from a delivery truck.

I think that right now close, local physician involvement is important and beneficial.  I would, however, like to see us more self governing as out education level increases.

Regardless of the path an individual paramedic chooses having more of us involved can only improve the industry.

Take away for EMS? WE (EMS providers) need more education and to set the bar higher. Forgive me Skip, I have the greatest admiration for what you and your service has down to implement the APP program, as well as promoting EMS and EMS education in general. However, before we start taking the "take away message" down the road of advancing the paramedic practice across the board, we really should look at how nursing and other professions have advanced themselves. By promoting higher educational standards first, then moving in a direction that serves the patient. Similarly, I believe that much of our approach to the volunteer EMS staffing issue is flawed. Instead of lowering the standards to get more volunteers to apply (the old "it takes too long to become a ...." choose your level), we should be raising the requirements. My rationale is that quality potential volunteers will be drawn to a quality organization. I was able to demonstrate an increase in volunteerism in an organiztion by increasing training and educational requirements amongst the members, as well as incentivising education. EMS has a long history of wanting the quick way out (Looking for fast track paramedic program, need a medic to RN bridge, etc). Go through the steps and gain a bachelors or advanced degree, that is the take away message in my humble opinion

Warren - you got it!  Thanks.  And "organize"!!!

  I could not agree with you more.  However, the ice-breaker is getting that attitude bred into the new medics so it is propagated to those that come afterward.  The last two paramedic classes I've dealt with come in with the attitude that "education is nice, but the important thing I'm here for is to know how to do skills." 


Warren E. Shaulis said:

Take away for EMS? WE (EMS providers) need more education and to set the bar higher. 

It sounds like the onus is on the pre-service educators to overcome that notion - to insist on critical thinking and knowledge in addition to skills and procedures.

Where else can a change in the thoughts of the new generation occur?

Chris Azevedo said:

  I could not agree with you more.  However, the ice-breaker is getting that attitude bred into the new medics so it is propagated to those that come afterward.  The last two paramedic classes I've dealt with come in with the attitude that "education is nice, but the important thing I'm here for is to know how to do skills." 


Skip Kirkwood said:

Where else can a change in the thoughts of the new generation occur?


It needs to come from every level. Our instructors need to tell students they're going to need education, our thought leaders need to tell us (thanks to most of the people on this board for doing their part), our administrative/EMS board types need to talk about it, our employers need to expect it (which might be the hardest step, since that could translate into more expensive employees).

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