"Is the Time Really Now ?"

[jim.kendrick@att.net]

All,

A few thoughts... forgive the disjointing of ideas... on shift today.

First, AirWolfMedic I used your subject line, not disrepectfully, but to 
provoke further discussion or at least reflection by the appropiate readers of 
this thread.

I dreaded reading once again the RN vs Medic bash that I anticipated that would 
come from this thread. From my surprise it didn't appear to be the SOS but 
rather an excellent articulation of ideas. Mr. Brosius, reno316, Ms. Stover-
Wall among others have posted excellent or thought provoking ideas. Enough on 
that point. All of which to a very large extent I subscribe to.

To the idea of 150 years of tradition, I'm sorry to say that exists everywhere 
within EMS and Fire/EMS in different degrees. There is a body of resistance to 
positive changes in EMS / CCT in alot of the areas of the country. The new DOT 
Paramedic curriculum has met with comments of adversion from those who don't 
see the need for "ambulance drivers" to get the education that most likely is 
best done in the junior college environs to do the Paramedic's job in the 21st 
century. A hospital or training center based paramedic education is less costly 
on time and money to those localities who require paramedics and must also 
provide their training per at least one fire chief who spoke to me on the 
subject. How many paramedic have read EMS in 2010?

By de facto I consider paramedicine as a profession but one of the requirements 
of a profession is there is an accepted body of knowledge by those who practice 
that profession. EMT - * are not there yet. Can we be, sure, three to five 
years at best if it was mandated by law today. Another troublesome point is the 
fact that how can we "police" members of our profession? Less than optimal care 
is found in all areas of medicine but sometimes the purveyors of such care lose 
the ability to practice as regulated by their state boards of professional 
practice. To fund a state board of paramedicine would require licensing fees - 
would you be willing to part with $ 40.00 - $ 100.00 every two or so years to 
support those activities. As an example lets consider and contrast the practice 
of the AAS(ADN) Nurse to a Paramedic. ( Paramedics with a degree - if that's a 
requirement for your cert in your state - let me know privately - overlook my 
example)

ADN requires a two year degree from a approved school (most all cases a junior 
college at least.)by the regulatory board of nursing of that state. Well, for 
the paramedic, to sit for the "final test" that simply varies greatly depending 
upon the state in question. Once the appropiate requirements have been met and 
fees paid, the ADN sits for the NCLEX-RN (a national test) and if the testee's 
grades met the state boards standards a license to practice is granted. For the 
paramedic there is a ray of hope here - the National Registry test. Does your 
area require this ? maybe, maybe not. The point here is that your state 
government controls whatever practice you have. That one place to start. I 
don't really mean your EMS regulatory agency alone. They really have no mandate 
to make a radical change. Now maybe your elected officials are the place to go 
for change. I would not without some solid knowledge and reasons. Having EMS on 
board would be better still. One may also gain some insight here if they where 
to read the trials and tribulations of the first 100 years of nursing - in the 
form of a history of the nursing profession - I know I saw some parallels when 
I was forced as part of my nursing program to read it.

As it has been said by other authors to this thread, the difference between 
Paramedicine and Nursing is apples and oranges. It is period. But they do 
overlap. To those who believe that they end at the airdoors of the ED, your 
wrong. It is a continuum of care that begins with the onset of illness and 
injury to it's logical endpoint such as cure or rehab. All in a collabrative 
team. Those in each of their chosen medical professions who profess this and 
leave their other collegues on the wayside should be reminded, educated or 
dismissed if the two forementioned items are unsuccessful. You know there are 
those in all endeavours who refuse to learn from atop their ivory towers of 
isolation with, in their minds, their advanced education and or advanced 
experience. "Ah, changes is never good, long live the status quo".

Simple economic fact: So long as the supply exceeds demand cost are low. For 
Paramedics, so long as EMT-A, EMT-I or other paramedics at a lower salary level 
can provide the "same" service(care) at a lower cost then salary's will remain 
where they are. This is true in ambulance services or ERs where you are 
employed as techs. I mean this in the context another skill level can 
substitute.

The reason nurses are commanding the salary, is the health care system beyond 
the streets is totally dependent upon them. Let no nurses ( or can not recuit 
enought to staff) a unit not come to work for several days and watch how fast a 
medical center scrambles. Laws, standards of care, JCAHO and Medicare get 
involved here. Don't forget John Q Public has a overall positive mental image 
of Nurses. This is strong moxie for the Nurses to get greater pay. 

Lets focus for a moment on a common ground that Paramedics know. ED Nurses - 
Those big bucks, sign on bonuses, etc. come with reasons for those benefits. 
Usually difficult working conditions, huge workloads, low appreciation from 
hospital / unit administration to name a few reasons. I am aware that those 
sign on bonuses are in proportion to the degree of undesireability of 
employment in each case. Paramedics who do ambulance runs for a whole shift 
back to back, no nature or food breaks and complete your charting after your 
shift ends know what I'm talking about and are brothers and sisters in the same 
trench as these nurses. Moving on, a huge difference that drives pay is also 
the power of the ANA, ENA and JCAHO. Alike power base or demand for paramedics 
just doesn't exist.(as of yet)  

In the email that stated in Maryland you can attend a course to become a CNA 
after some further education that's simply a slap in the face. I suspect a 
local "expert" who had little current education or understanding of EMS is the 
center of this. There are several states where a paramedic can attend a local 
one year program and sit for the NCLEX-RNin order to learn the difference of 
knowledge the beginning RN requires.(The same standard should apply to RNs also 
and does in many states but no all). Those localities show a bit more 
intelligence and or understanding of the Nurse and Paramedic professions than 
that exhibited by aforementioned post.   

The time for change might be now but a consensus between leaders and leadership 
organizations of EMS with the support of the other medical professions is 
tantamount. Are we as group (profession) ready to do the work, endure the 
hardships and cheerfully do the other difficult and or other unsavory tasks 
that will needed and expected along this path?

If you are count me in. Otherwise, stop with the bellyaching and put your 
talents in educating our peers outside this forum.

Jim Kendrick RN, NREMT-P, FP-C





            

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