Re: Standards

[Guest guest]

Gene, I have to agree with you to a point. We need a standard curriculum, but

as usual we are still forgetting the rural ems folks that are not able to get

the college education because of they don't have the funds or the means of

driving long distances. Don't they need the education to.

[Guest guest]

The problems of the rural folks should be paramount in our discussions and

plans. I spent my entire life as a practicing paramedic as a rural

volunteer, so I know what you're talking about.

We're trying very hard in the community colleges to address the needs of

rural volunteer services. Almost everybody has a computer now, and internet

access is universal. We can deliver a lot of the educational requirements

over the internet. And we at TJC are actively working to develop programs

where the Labs can be done at regional hospitals, high school labs, or EMS

facilities.

We'll be able eventually, and sooner than later, to provide learning online

coupled with on-site labs done by paramedics under contract with us. This is

a feasible plan. Many are working on this, and within the next couple of

years the opportunities for online education will be expanded greatly.

There will never be a substitute for one-on-one training from experienced

paramedics. But the didactic learning can be done online, and the best

paramedics can be used as field trainers, and this will happen.

Rural volunteers will be able to gain the education and training they need

without leaving home for the most part. We are working on agreements with

some excellent EMS services to allow people to come and do intensive

rideouts. Denver EMS for example. And Las Vegas EMS. Rural/Metro and AMR

are also being contacted. We think we'll be able to offer ambulance

internships that will be extremely attractive and concentrated so that people

can take a week off and go do 24/7 internships.

Gene Gandy

[Guest guest]

Gene,

I agree with what you said about education. I have another

profession, and another degree, in Management Information Systems.

When I did that, the same situation existed then. There were those

of us with degrees that studied business, law, management, marketing,

as well as indepth systems design, analysis, programming, etc. Then

there were the quickie " institutes " that taught a programming

language in 6 months. Never mind that in a successful project only

10% or so is programming, that was the minimalist approach to say

they were a programmer. And though the internet stuff is skewing it

back toward the undereducated programmer, in most corporations the

college degreed systems developer is a requirement, and the non-

degreed person with technical only degree is much less employable.

The standard was raised, and with it the pay, professionalism, etc.

It will happen in EMS, just takes time. Physicians and attorneys

didn't used to go to college either!

=Steve , EMT-P=

> The great unknown right now is what standards are finally going to

be adopted

> by TDH for EMT and Paramedic education. The forces for mediocrity

have

> enormous power and will probably prevail.

>

> Not involved in that fight is the question of whether or not the

> EMT-Intermediate will be continued, and if so, according to the

NSC, which

> would be a sort of EMT-+ or Paramedic -, or whether we should make

some kind

> of EMT-I which could be upgraded to Paramedic, in which case we

would be out

> of sync with everybody else in the country but would have a

workable

> situation for Texas.

>

> The considerations are thus: Shall we conform with the NSC so that

EMT-Is in

> Texas will have reciprocity throughout the country or develop a

better EMT-I

> program which will serve us in Texas better?

>

> More: for the courses which will try to teach the NSC for

Paramedic with the

> minimum number of hours, how will they address the problem of

Anatomy &

> Physiology, which nowhere appears in the Paramedic Curriculum and

which

> should be taught at the college level? How are the free-standing

courses

> going to address that? Not, I'll bet, unless they're made to,

which I don't

> see happening.

>

> So us in the college programs will make em take A & P so they'll know

what's

> connected to what, and the lite programs will teach em to remember

recipes

> but not have a clue about why they're doing what. They'll get lots

of jobs

> from employers who don't give a shit (won't go there and identify

them, but

> y'all know who they are) and they'll make minimum wage. It'll

still be

> Colored Boxes. The real villains here are so-called medical

directors who

> are willing to sell out for money or who don't really care. The

mentors of

> mediocre care for money. I'll leave it to y'all to identify them

and the

> services they manage. Wouldn't it be refreshing to have some MDs

who had

> the balls to stand up for excellent care? Practically non-

existent. We've

> been let down by most of them. MD's want to rant about tort reform

but won't

> accept responsibility for the damage that they do through failure

to demand

> excellence from those they profess to control as medical

directors.

>

> A medical director has the power to influence EMS. But most of

them don't.

>

> My opinions are my own.

> Gene Gandy

>

> Bottom Line: EMS in Texas will not improve substantially because

we won't

> bite the bullet and demand real educational standards for

Paramedics.

>

> It won't be economically practical. A major EMS manager said to me

a few

> weeks ago, " Who'll pay these overeducated paramedics? " " How can we

pay these

> people for advanced knowledge when we've lost 12 Million Dollars in

the last

> year? "

>

> Well, ya lose 12 million here and 8 million there, and sooner or

later yore

> talkin about real money!!!

[Guest guest]

Fatboy:

Sooner or later we have to decide if we are going to allow citizens in rural

areas to suffer because their medics are allowed to meet lesser standards

than the medics in urban areas do, or if we are going to establish

meaningful standards and concentrate some of our efforts on helping these

resource-poor people meet them. The way things are now, a lot of systems can

hide behind the minimum standards, which are way too low, and can trade on

the fact that there is little chance their citizens will find out what they

are doing. In addition we truly have services that can't reasonably do

better than they are with what they have. Its hard to tell 'em apart. We

need higher minimum standards that are truly appropriate, and that apply to

every EMS service, even the folks in the frontier areas. We also need for a

great deal more of TDH resources to be devoted to helping EMS services in

these resource-poor areas meet these higher standards instead of bring the

standards down to their reach. Finally, we need a system that makes each EMS

service's quality, relative to a fixed standard, known to the citizens they

serve so EMS services that are not giving 100% can be recognized by their

communities and can be dealt with at the local level. If that were to exist

right now, there are a number of services whose chief or manager who'd have

cause to fear for his or her job. In any case, if the citizens in an area

really had a way to know their EMS service wasn't up to par, I think there

would be some positive community action. It might help some of these

organizations get the extra resources they need and, in a few cases, also

might expose some scoundrels who need a taste of tar and feathers.

Dave

Re: Standards

> Gene, I have to agree with you to a point. We need a standard curriculum,

but

> as usual we are still forgetting the rural ems folks that are not able to

get

> the college education because of they don't have the funds or the means of

> driving long distances. Don't they need the education to.

>

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[Guest guest]

DEAR DAVE,

RURAL MEDIC HERE. ARE YOU IMPLYING THAT MY STATE EXAM

WAS DIFFERENT THAN YOURS? MAYBE THAT RURAL PEOPLE

REQUIRE LESS TREATMENT WHEN INVOLVED IN A MVA? OR

MAYBE IT IS JUST EASIER TO INTUBATE A REDNECK. MY

INSTRUCTOR TRAINED ME THE SAME AS THE URBANITES IN

CLASS. MY SKILLS WERE TESTED BY THE SAME PEOPLE THAT

TEST THE GREAT URBAN MEDICS THAT YOU REFER TO IN YOU

LETTER. AND AMAZINGLY ENOUGH ALL THE URBAN SERVICES

THAT I RODE OUT WITH TO GET MY " RURAL PARAMEDIC

CERTIFICATION " CARRY FEWER ALS MEDS THAN WE DO. I FEEL

THAT THE QUALITY OF CARE IS DEPENDENT ON THE PEOPLE,

NOT THE PLACE. JUST A FEW THOUGHTS FROM A LOWLY RURAL

MEDIC.

RONNIE BROWN

EMT-P FROM B.F.E.

__________________________________________________

[Guest guest]

,

Judging from the tone of your e-mail, you appear to have a specific service

in mind. Remember that all paramedics in the state have to meet the same

standards in testing. Rural Medics have a whole different set of obstacles

to deal with that the paramedic in the urban situation does not. Time and

distance being the two obvious ones, as well as the quality of Emergency

care in the local hospital. I worked in an area where the pop. density was

1 person per square mile. The county was 150 miles wide and 75 miles long

(11,250 sq. miles). The only hospital in the area did not have a full time

E.R. M.D. When someone came to the E.R., a doctor would come from his

office or home to the E.R. to see the pt. The nearest Level 3 hospital was

a minimum of 75 miles away and the nearest Level 2 hospital was 150 miles

away. If someone had a heart attack or major trauma at one end of the

county, the response time just to get to the individual could be as long as

1 hour. Where the urban paramedic can probably get their pt. to a level 2 or

1 Trauma Center within 15 minutes, the rural paramedic still may have

another hour to deal with a critically ill pt who may need to be healed with

steel NOW. Ever done CPR for an hour by yourself in the back of an

ambulance, or watch a pt. die from internal bleeding because the distance

was so great? Try it sometime and you may gain some respect for " your poor

country cousins. "

In New Mexico, we used to have a program where the state was divided up into

sections. The Regional Medical Program had instructors assigned to each

section and provided EMT training in week long blocks. It worked very well

in the past and would still do so, if a teaching facility could institute

such a program in this day and age of fiscal constraints.

Stay safe

Jim Easley

..

Re: Standards

>

>

> > Gene, I have to agree with you to a point. We need a standard

curriculum,

> but

> > as usual we are still forgetting the rural ems folks that are not able

to

> get

> > the college education because of they don't have the funds or the means

of

> > driving long distances. Don't they need the education to.

> >

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[Guest guest]

Actually, if I may interpret, what was meant is that in many Rural settings,

you only have one education provider, and there's no incentive to provide

more than the minimum requirements. While certain services go above and

beyond in providing additional and continuing education, there's nothing

incumbent on the initial training provider to teach more. Some do...

In traditionally urban settings, you usually have multiple training

providers, including hospitals, ems agencies, college systems and

independent agencies. This competition requires differentiation, which

implies additional training, unique clinical opportunities, or lesser

included certifications (walking away with ACLS, PALS, BTLS, etc. as well as

your patch). The competition requires that these competing institutions

train above the minimum (or in certain bad examples, train at the minimum to

attract those who want a minimum education, or want a quick-fix patch).

It's never been about rural vs. urban. In fact, you're right, rural medics

generally have longer transport times, longer enroute times, and more

patient contact, requiring deeper knowledge of pathophysiology, pharmacology

and treatment modalities than the urban medic who " only " has to keep that

patient alive 10 minutes to get them to an appropriate facility. And I say

this, working and volunteering in a very aggressive urban EMS system (7 full

time MICU's for ~300 square miles and 400,000+ people with several major

freeways, etc.). We have some pretty advanced protocols (and a medical

director that's always open to new ideas and didactic questioning of the

protocols), but still, we can work knowing that if it's as bad as it looks,

the doctor is a 10-minute ride away. Sure, most of the challenge is in that

first ten minutes, but I'll agree with you - how many medics know when their

meds start to wear off, how to re-dose and what effects it'll have?

Again, it's not rural vs. urban, it's aggressive, constantly training EMS

vs. " just enough to get by " EMS, which, unfortunately, many people

unknowingly settle for (people being served, not necessarily those in the

systems).

Mike

Re: Standards

DEAR DAVE,

RURAL MEDIC HERE. ARE YOU IMPLYING THAT MY STATE EXAM

WAS DIFFERENT THAN YOURS? MAYBE THAT RURAL PEOPLE

REQUIRE LESS TREATMENT WHEN INVOLVED IN A MVA? OR

MAYBE IT IS JUST EASIER TO INTUBATE A REDNECK. MY

INSTRUCTOR TRAINED ME THE SAME AS THE URBANITES IN

CLASS. MY SKILLS WERE TESTED BY THE SAME PEOPLE THAT

TEST THE GREAT URBAN MEDICS THAT YOU REFER TO IN YOU

LETTER. AND AMAZINGLY ENOUGH ALL THE URBAN SERVICES

THAT I RODE OUT WITH TO GET MY " RURAL PARAMEDIC

CERTIFICATION " CARRY FEWER ALS MEDS THAN WE DO. I FEEL

THAT THE QUALITY OF CARE IS DEPENDENT ON THE PEOPLE,

NOT THE PLACE. JUST A FEW THOUGHTS FROM A LOWLY RURAL

MEDIC.

RONNIE BROWN

EMT-P FROM B.F.E.

__________________________________________________

[Guest guest]

I have to agree with you it isn't about rual vs urban, BUT here is alot of

vol. EMS that have the way of thinking " we are vol. what can they do to us.

We can do what we want and get away with it. " Now not all are like that but

I personaly know alot that do.

Re: Standards

>

>

>

> DEAR DAVE,

>

> RURAL MEDIC HERE. ARE YOU IMPLYING THAT MY STATE EXAM

> WAS DIFFERENT THAN YOURS? MAYBE THAT RURAL PEOPLE

> REQUIRE LESS TREATMENT WHEN INVOLVED IN A MVA? OR

> MAYBE IT IS JUST EASIER TO INTUBATE A REDNECK. MY

> INSTRUCTOR TRAINED ME THE SAME AS THE URBANITES IN

> CLASS. MY SKILLS WERE TESTED BY THE SAME PEOPLE THAT

> TEST THE GREAT URBAN MEDICS THAT YOU REFER TO IN YOU

> LETTER. AND AMAZINGLY ENOUGH ALL THE URBAN SERVICES

> THAT I RODE OUT WITH TO GET MY " RURAL PARAMEDIC

> CERTIFICATION " CARRY FEWER ALS MEDS THAN WE DO. I FEEL

> THAT THE QUALITY OF CARE IS DEPENDENT ON THE PEOPLE,

> NOT THE PLACE. JUST A FEW THOUGHTS FROM A LOWLY RURAL

> MEDIC.

>

> RONNIE BROWN

> EMT-P FROM B.F.E.

>

>

>

> __________________________________________________

>

[Guest guest]

Amen from another rural redneck Paramedic

Fred Baker EMTP

Re: Standards

DEAR DAVE,

RURAL MEDIC HERE. ARE YOU IMPLYING THAT MY STATE EXAM

WAS DIFFERENT THAN YOURS? MAYBE THAT RURAL PEOPLE

REQUIRE LESS TREATMENT WHEN INVOLVED IN A MVA? OR

MAYBE IT IS JUST EASIER TO INTUBATE A REDNECK. MY

INSTRUCTOR TRAINED ME THE SAME AS THE URBANITES IN

CLASS. MY SKILLS WERE TESTED BY THE SAME PEOPLE THAT

TEST THE GREAT URBAN MEDICS THAT YOU REFER TO IN YOU

LETTER. AND AMAZINGLY ENOUGH ALL THE URBAN SERVICES

THAT I RODE OUT WITH TO GET MY " RURAL PARAMEDIC

CERTIFICATION " CARRY FEWER ALS MEDS THAN WE DO. I FEEL

THAT THE QUALITY OF CARE IS DEPENDENT ON THE PEOPLE,

NOT THE PLACE. JUST A FEW THOUGHTS FROM A LOWLY RURAL

MEDIC.

RONNIE BROWN

EMT-P FROM B.F.E.

__________________________________________________

[Guest guest]

Rural:

Answers below. I think you misinterpreted what I was saying.

Re: Standards

>

> DEAR DAVE,

>

> RURAL MEDIC HERE. ARE YOU IMPLYING THAT MY STATE EXAM

> WAS DIFFERENT THAN YOURS? MAYBE THAT RURAL PEOPLE

> REQUIRE LESS TREATMENT WHEN INVOLVED IN A MVA?

Not at all, rural. The exam is the same but it tests to a low common

denominator that is TOO low, given what we are expected to be able to do.

One reason the test (and many of our standards) are low is because rural and

frontier EMS services have resource troubles (and they make that plain every

time these issues come up) that make it hard for them to get the kind of

initial and continuing training and the support they need to operate at a

higher level. Its not that the rural EMS services are bad, its that they

need more resources. Actually, rural people in an MVA, in a heart attack, or

in any kind of a medical emergency need MORE and BETTER EMS treatment than

their counterparts in the urban areas because they will be in EMS care far

longer in many cases. What the EMS professionals do or don't do, can or

can't do, know or don't know will make a much greater difference in these

patients' outcome for that reason at least. In otherwords, the EMS people

who need to be the best and most knowledgable ARE the rural and frontier EMS

folks

> MAYBE IT IS JUST EASIER TO INTUBATE A REDNECK. MY

> INSTRUCTOR TRAINED ME THE SAME AS THE URBANITES IN

> CLASS. MY SKILLS WERE TESTED BY THE SAME PEOPLE THAT

> TEST THE GREAT URBAN MEDICS THAT YOU REFER TO IN YOU

> LETTER.

Most of the necks I've intubated were blue, or kinda pasty-colored, but I

imagine a redneck intubates about the same. As to your training, I'm very

glad you were well prepared and had the surgical clinicals and advanced

training mannikins available that many of the urban and suburban schools do.

I've seen what a lot of rural schools have to work with and its not what it

should be and needs to be. Its also not that way through any fault of

their's. They just don't have the resources to provide all the training

experiences their people need. Considering what many of them have to work

with, they are performing miracles out there. I just think the playing field

should be made uniformly tougher and that the steps needed to make that

tougher playing field level should be a major focus of TDH.

AND AMAZINGLY ENOUGH ALL THE URBAN SERVICES

> THAT I RODE OUT WITH TO GET MY " RURAL PARAMEDIC

> CERTIFICATION " CARRY FEWER ALS MEDS THAN WE DO. I FEEL

> THAT THE QUALITY OF CARE IS DEPENDENT ON THE PEOPLE,

> NOT THE PLACE. JUST A FEW THOUGHTS FROM A LOWLY RURAL

> MEDIC.

I'm not amazed. As I've already said, the rural medics and rural EMS

services carry a bigger part of the burden of patient outcomes than do their

urban counterparts. Longer transport times alone make having additional

treatment modalities available important. However, with that greater

opportunity to influence patient outcome and with the additional skills

needed to do that comes a need for a greater base of knowledge and critical

reasoning skill. Some of the rural schools I've had a chance to observe just

can't provide the training for that with their available resources. I agree

that the quality of the care a patient receives is partially dependent on

the people who provide it. It is also very much depended on the quality of

the training they receive and the support structures within which they

operate. You have to have all the pieces of the puzzle in place for the

system to work to its best effect. All I was proposing was for TDH to stop

worrying about whether proposed rules were going to make life too hard for

rural and frontier EMS services. Guidelines and rules should be universal

and should be based on the needs of the citizens, not on the preferences of

EMS services. The approach is to consider rules and guidelines on that basis

and then to find ways to help all EMS services meet those guidelines. Doing

things that way would be very much to the advantage of rural EMS services

whose members really do want to be all they can be and would be the bane of

all EMS services that like to put up a shiny image to mask a crummy EMS

organization.

>

> RONNIE BROWN

> EMT-P FROM B.F.E.

B.F.E.? Isn't that near Cairo?

Dave

[Guest guest]

Mike:

Your reply to our rural colleague made the point I was trying to make much

more elegantly than I was able to. Direct hit!

The only thing I'd suggest is that many of those rural educators would like

to do more but lack of resources resistance from various quarters prevents

it.

Dave

Re: Standards

>

>

>

> DEAR DAVE,

>

> RURAL MEDIC HERE. ARE YOU IMPLYING THAT MY STATE EXAM

> WAS DIFFERENT THAN YOURS? MAYBE THAT RURAL PEOPLE

> REQUIRE LESS TREATMENT WHEN INVOLVED IN A MVA? OR

> MAYBE IT IS JUST EASIER TO INTUBATE A REDNECK. MY

> INSTRUCTOR TRAINED ME THE SAME AS THE URBANITES IN

> CLASS. MY SKILLS WERE TESTED BY THE SAME PEOPLE THAT

> TEST THE GREAT URBAN MEDICS THAT YOU REFER TO IN YOU

> LETTER. AND AMAZINGLY ENOUGH ALL THE URBAN SERVICES

> THAT I RODE OUT WITH TO GET MY " RURAL PARAMEDIC

> CERTIFICATION " CARRY FEWER ALS MEDS THAN WE DO. I FEEL

> THAT THE QUALITY OF CARE IS DEPENDENT ON THE PEOPLE,

> NOT THE PLACE. JUST A FEW THOUGHTS FROM A LOWLY RURAL

> MEDIC.

>

> RONNIE BROWN

> EMT-P FROM B.F.E.

>

>

>

> __________________________________________________

>

[Guest guest]

Right. As a rural medic for several years, and as a teacher of rural

medics for several more (I was the guy that went to BFE as Rural

says, teaching mostly night classes) for Texas Tech Health Sciences

Center in Lubbock. In our entire school, the main emphasis was on

rural medicine. I agree the requirements for rural medicine, if

anything, are more stringent than for more urban services. We had to

do more, and for longer, because of the distances, and the

capabilities of the local hospitals. So rural medics needed to be

trained to the same standards. And we ALL need to learn more, be

trained to higher standards. I'd say that fact is hard to dispute.

But, the problem of funding and cost can't be underestimated. I well

remember the dire predictions of gloom when the rules changed in the

early 80's to require at least 1 ECA per ambulance, instead of the

First Aid card that was then required. There was genuine concern

that these services, who are overwhelmingly volunteer, would cease to

exist, and that would decrease rather than increase the quality of

care in those communities, for whom the nearest paid service was 30

or more miles away.

This still exists to some extent. Raising standards is necessary.

It's a natural part of things (as I've said before, Physicians didn't

have degrees at one time either, but professions evolve and mature,

and upgrade.

The answer, as we know, is that we must raise the funding level of

EMS systems as a whole. This will happen slowly, but we have to make

sure we're viewed as necessary to the community. Funding on par with

the Fire and Police services is a minimum. And I'm not sure where the

private providers fit in (why are there private EMS services, but not

private fire or police services? Or do EMS systems do the

Police/Security Guard dichotomy, where the official emergency

responders are all public, and the secondary ones are private?

Another discussion).

Like many things, rural areas just can't afford things urban areas,

with their larger and industrialized tax bases, can. We just have to

keep trying!

=Steve , EMT-P=

> Mike:

>

> Your reply to our rural colleague made the point I was trying to

make much

> more elegantly than I was able to. Direct hit!

> The only thing I'd suggest is that many of those rural educators

would like

> to do more but lack of resources resistance from various quarters

prevents

> it.

>

> Dave

> Re: Standards

> >

> >

> >

> > DEAR DAVE,

> >

> > RURAL MEDIC HERE. ARE YOU IMPLYING THAT MY STATE EXAM

> > WAS DIFFERENT THAN YOURS? MAYBE THAT RURAL PEOPLE

> > REQUIRE LESS TREATMENT WHEN INVOLVED IN A MVA? OR

> > MAYBE IT IS JUST EASIER TO INTUBATE A REDNECK. MY

> > INSTRUCTOR TRAINED ME THE SAME AS THE URBANITES IN

> > CLASS. MY SKILLS WERE TESTED BY THE SAME PEOPLE THAT

> > TEST THE GREAT URBAN MEDICS THAT YOU REFER TO IN YOU

> > LETTER. AND AMAZINGLY ENOUGH ALL THE URBAN SERVICES

> > THAT I RODE OUT WITH TO GET MY " RURAL PARAMEDIC

> > CERTIFICATION " CARRY FEWER ALS MEDS THAN WE DO. I FEEL

> > THAT THE QUALITY OF CARE IS DEPENDENT ON THE PEOPLE,

> > NOT THE PLACE. JUST A FEW THOUGHTS FROM A LOWLY RURAL

> > MEDIC.

> >

> > RONNIE BROWN

> > EMT-P FROM B.F.E.

> >

> >

> >

> > __________________________________________________

> >