NEMSES educational guidelines

August 13, 2006

Go to this site and read it. Click on all the Members link, and look

carefully at it.

http://www.nemses.org/

The NEMSES has a contract to develop an EMS curriculum to shove down our

throats in Texas. The standards that they will develop will demean what the

best

paramedic programs are doing, and they won't require a minimum level of care.

but they will institute a ceiling on skills that can be done, and thereby

ruin some of the best systems in the state.

August 14, 2006

With all respect to the NEMSES committee members (some of whom I know personally

and respect), I have two concerns:

1) Is it just me, or is this a back-door approach to institute the " National

Scope of Practice " that concerned several states such as Texas and Wisconsin?

Sure, implement the scope through this new curriculum and then NREMT ends up

basing the tests on the new educational standards. Voila, a de facto National

Scope of Practice.

2) Also, is it just me or does every EMS committee have the same " professional

committee members " on it? The circle of self-appointed EMS experts seems to be

rather self-limiting. The fact that NHTSA has asked the same ol' gang to

establish the same ol' crap through a new, quiet process is troubling to me. I

like to think I'm an informed EMS professional, and I had NEVER heard of NEMSES

prior to Gene's email.

There seems to be a startling lack of openness in much of the behind-the-scenes

activity of EMS, both in terms of the committee membership and conducting

business. These are quasi-regulatory functions that should be conducted in full

view of the affected community - US! If a government agency wants to establish

new rules or regulations, they are required to post public notice of the

regulations and accept public comments. The committees that operate behind the

scenes should have some sort of public disclosure requirement, especially as

some are operating with NHTSA's blessing and guidance. Equally importantly,

these committees should have a clearly defined mechanism to accept comments from

the public. But I digress, because a few experts, especially with RN behind

their name, know more about EMS than anyone else ever could. Is it even

possible to have an EMS committee without Gregg Margolis? ;-)

Of course, I doubt too many will care. After all, I've used French and Latin in

this post. All too many medics are more worried about American Idol than they

are the future of their profession. Or is this just a job and not a profession?

-Wes Ogilvie, MPA, JD, EMT-B

NEMSES educational guidelines

Go to this site and read it. Click on all the Members link, and look

carefully at it.

http://www.nemses.org/

The NEMSES has a contract to develop an EMS curriculum to shove down our

throats in Texas. The standards that they will develop will demean what the best

paramedic programs are doing, and they won't require a minimum level of care.

but they will institute a ceiling on skills that can be done, and thereby

ruin some of the best systems in the state.

August 14, 2006

Wes,

NHTSA has always cultivated its own crop of groveling handmaidens, whose

raison d'etre is to always submit to the will of NHTSA, at the risk of being

" uninvited " from future national committees. It's been going on since the

early 1980's.

Though remarkably under-publicized, most NHTSA meetings are open to

attendance, but generally not to outside comment until initial drafts are

prepared. NHTSA learned early on that " it's easier to ask for forgiveness

than it is to ask for permission " . This is best achieved by maintaining a

stable of lemmings who are chosen specifically for that purpose.

Bob Kellow

If you can read this message - thank a teacher.

And, because it's in English - thank a soldier.

NEMSES educational guidelines

>

> Go to this site and read it. Click on all the Members link, and look

> carefully at it.

>

> http://www.nemses.org/

>

> The NEMSES has a contract to develop an EMS curriculum to shove down our

> throats in Texas. The standards that they will develop will demean what

> the best

> paramedic programs are doing, and they won't require a minimum level of

> care.

> but they will institute a ceiling on skills that can be done, and thereby

> ruin some of the best systems in the state.

>

August 14, 2006

I don't have enough time today to read all of the materials from the

NEMSES Website. In scanning through the materials, I see the

typical federal government pattern developing: First, a committee

is assembled; next, a study is prepared; then, the study is released

with " recommendations " to comply with the study's findings and

conclusions; finally, the findings become mandates connected to the

receipt of federal funding and participation in federal programs.

If this scenario develops, I can see adoption of the " National Scope

of Practice " being required to receive Medicare/Medicaid

reimbursement. All would be " free to opt out of the program; "

however, chosing to do so would terminate reimbursement and receipt

of federal funds; e.g., Medicare, Medicaid, HRSA Grants, DOT Grants,

etc.

If we don't get involved now and communicate our viewpoint to our

legislators, it will be too late. We probably all remember that we

had a 55 mph speeedlimit for over 20 years because compliance was

required to receive federal highway funds.

Todd, B.S., J.D., EMT-P

Amarillo, TX

>

> Go to this site and read it. Click on all the Members link, and

look

> carefully at it.

>

> http://www.nemses.org/

>

> The NEMSES has a contract to develop an EMS curriculum to shove

down our

> throats in Texas. The standards that they will develop will

demean what the best

> paramedic programs are doing, and they won't require a minimum

level of care.

> but they will institute a ceiling on skills that can be done,

and thereby

> ruin some of the best systems in the state.

>

August 14, 2006

I went out and looked at it, read the documentation the they had posted,

read the list of participants. Spent almost an hour on it actually...

There are more than a few Texans on that " members " list. Maye some of the

members are the same as before... I personally only know a couple of

them... decent people who care about their professions. As for the others,

I can't pass judgement, I don't know them.

If the curriculum that they describe is indeed the one they are going to

" shove down our throats " maybe it needs to be. It includes Arterial

catheterization, Central Venous Access, Fracture / Dislocation reduction and

hard splinting, Thoracostomy, and wound closure techniques.

They also mentioned in their core goals to have EMS be an integral part of

health care at the community level, providing on scene lab results, and

medication administration accordingly, amongst many other goals that would

greatly improve service to the community. How great would it be if the

Emergency Room were really for " emergencies " instead of being the clinic?

We have all been complaining about the limitations of EMS in it's current

incarnation since it began... Non standard practices, poor pay, bad

management, bad system organization... blah blah blah...

So, playing devil's advocate here, with a touch of sincerity... What's

wrong with people trying to honestly promote a better, more advanced way?

Is there any way to write a " first draft " of such a system that isn't

limited in some way? If *I* had to implement a system that encompassed

every system in the country, and I looked at the state of services in all

demographic areas and took an average, the standard that I would have to

come up with would bring many services up, and " limit " some in a few ways.

The needs in Iraan, Texas and Lame Deer, Montana are different from the

needs in Brooklyn, New York, and Los Angeles, California. In an ideal

world, the services that are already practicing at a " higher " level would

not be limited in their practice... Rather, I would have them model for the

rest.

On thing that I think we need to all recall is that we are all " new " at this

thing called EMS. There hasn't ever been anything quite like it in the

history of the world. " Modern " EMS has only been around a few years, and we

are still in the first generation of providers. Even the wise ones who have

been around for 25 + years are the pioneers in our field. I was talking

with a well respected Medic a few days ago, lamenting that I think I don't

know anything... I jokingly said " You've probably forgotten more than I

know. " He just shook his head and replied, " My Paramedic class was less

than half of yours, you learned more as a new Medic than I got in a few

years in the field. "

Medicine and technology are constantly evolving. If we let it outpace us,

without catching up in some serious painful leaps, then we are working in

futility.

I have the feeling that in a few years, when my rookies are " old timers "

that they will look back on these days, when we think we are doing a lot to

save lives, and laugh at OUR " ny and Roy " ways. There are things around

the corner that we lowly medics have not yet dreamed of. As an example, I

am sure many can recall when ECG in the field was merely a dream... and then

someone said " 12-Lead " ... I remember having discussions about it... that it

was too expensive, and would never be useful... I mean really, can't you

tell everything you need to know about a heart from Lead II? You know you

heard those words as well. Who knows what marvels we may be able to perform

in the not-too-distant future...

Change is inevitable, and not always pleasant, but it's a necessary part of

growth, and improvement. Maybe someday we will be recognised as " real "

professionals... but only if we pursue to EARN that respect...

Don't get me wrong, I don't think the Scope of Practice is the only, or best

answer, but I am sure *I* don't have access to the research, statistics, and

information that the committee has gathered, and *I* can't say what *is*

best for EMS. Wes does have a sad but valid point... More and more medics

are more interested in American Idol than in their jobs... To many it is

just a " job " . That is one attitude we need to change, but many things will

have to change, in order for that to occur. I recall a recent posting which

described the educational requirements for Barbers, vs. Paramedics...

What I can do is eagerly anticipate the huge leaps that we will take in the

next few years. I will continue to learn, and grow in my clinical skill and

knowledge as much as I can, so that I can be a part of the future of EMS, as

opposed to a resistant relic...

>

> Go to this site and read it. Click on all the Members link, and look

> carefully at it.

>

> http://www.nemses.org/

>

> The NEMSES has a contract to develop an EMS curriculum to shove down our

> throats in Texas. The standards that they will develop will demean what

> the best

> paramedic programs are doing, and they won't require a minimum level of

> care.

> but they will institute a ceiling on skills that can be done, and thereby

> ruin some of the best systems in the state.

>

August 14, 2006

What??? Gene, you been out in the sun too long? You mean re-writing the

National Standard Curriculum (some of which the Great State of Texas still

hasn't adopted the last version of...EMT-I '88)...to match it up against the

Scope of Practice document that is also moving to final approval...

I read over the entire website, noticed that Texas is VERY well represented ( I

recognized 3 of the 24 names on the list of particpants as being from

Texas...)...will be interesting to see what they come up with...but seems they

are still argueing about format of the NSC...

Dudley

NEMSES educational guidelines

Go to this site and read it. Click on all the Members link, and look

carefully at it.

http://www.nemses.org/

The NEMSES has a contract to develop an EMS curriculum to shove down our

throats in Texas. The standards that they will develop will demean what the best

paramedic programs are doing, and they won't require a minimum level of care.

but they will institute a ceiling on skills that can be done, and thereby

ruin some of the best systems in the state.

August 14, 2006

I didn't say that any of the committee members were not decent people. They

all are. And they are all dedicated to improving EMS.

My whole gripe is about process.

The SOP was developed without the sort of input that it should have had.

Hence, it caused a firestorm when it was released because it would have created

ceilings on care rather than minimum standards.

I don't want the new curriculum to suffer that fate.

Todd put it quite well. This has the earmarks of becoming a federal

mandate. I expect that it will become a federal mandate. So if we don't

watch out, we'll be mandated to do things that are not good for EMS in Texas.

I don't care about EMS in Rhode Island. I do care about EMS in rural Texas,

and I want a system that is allowed the flexibility to change as the times

change. Once we are under federal rules, EMS will be like every other

bureaucracy--impossible to govern--impossible to improve. If you think the

Homeland

Security Agency or FEMA are models for government, then you're likely to love

the federalization of EMS.

Lest anyone think I'm for dumbing down the curriculum, I invite you to look

at what the programs I'm involved with teach. We have always taught above the

level of the national standard curriculum both in the college and in the

private educational sphere.

I would dearly love for the time to come when every Paramedic would have a BS

degree and four years of education and training. That is not going to

happen anytime soon.

In the meantime, we must function in the best way possible.

All I want is for the process to be open and receptive to ideas and

criticism. I don't want this to become another national registry model--a

dogmatic,

closed organization that won't tell you how they do things.

When I used the terms " shoved down our throats " I meant waking up one morning

and finding a mandate to adopt something that none of us want and that will

be unworkable for us.

This is far too important to do it the " good ole boy " way. It is far too

important to let personalities and personal relationships govern what's done.

We can debate civilly, and that's what the process needs. Openness, a civil

debate, and complete access for input.

I've worked with folks on the committee before, and they're all bright, good

people. However, sometimes people think that when you disagree with them,

it's personal. This is not personal. This is about developing the very best

model possible, and that should be done in the glare of bright sunlight.

I hope the committee members will keep that in mind as they do their work and

report progress often and loudly.

Gene Gandy, JD, LP

>

> I went out and looked at it, read the documentation the they had posted,

> read the list of participants. Spent almost an hour on it actually...

> There are more than a few Texans on that " members " list. Maye some of the

> members are the same as before... I personally only know a couple of

> them... decent people who care about their professions. As for the others,

> I can't pass judgment, I don't know them.

>

> If the curriculum that they describe is indeed the one they are going to

> " shove down our throats " maybe it needs to be. It includes Arterial

> catheterization, Central Venous Access, Fracture / Dislocation reduction and

> hard splinting, Thoracostomy, and wound closure techniques.

>

> They also mentioned in their core goals to have EMS be an integral part of

> health care at the community level, providing on scene lab results, and

> medication administration accordingly, amongst many other goals that would

> greatly improve service to the community. How great would it be if the

> Emergency Room were really for " emergencies " instead of being the clinic?

>

> We have all been complaining about the limitations of EMS in it's current

> incarnation since it began... Non standard practices, poor pay, bad

> management, bad system organization. management, bad sys

>

> So, playing devil's advocate here, with a touch of sincerity... What's

> wrong with people trying to honestly promote a better, more advanced way?

> Is there any way to write a " first draft " of such a system that isn't

> limited in some way? If *I* had to implement a system that encompassed

> every system in the country, and I looked at the state of services in all

> demographic areas and took an average, the standard that I would have to

> come up with would bring many services up, and " limit " some in a few ways.

> The needs in Iraan, Texas and Lame Deer, Montana are different from the

> needs in Brooklyn, New York, and Los Angeles, California. In an ideal

> world, the services that are already practicing at a " higher " level would

> not be limited in their practice... Rather, I would have them model for the

> rest.

>

> On thing that I think we need to all recall is that we are all " new " at this

> thing called EMS. There hasn't ever been anything quite like it in the

> history of the world. " Modern " EMS has only been around a few years, and we

> are still in the first generation of providers. Even the wise ones who have

> been around for 25 + years are the pioneers in our field. I was talking

> with a well respected Medic a few days ago, lamenting that I think I don't

> know anything... I jokingly said " You've probably forgotten more than I

> know. " He just shook his head and replied, " My Paramedic class was less

> than half of yours, you learned more as a new Medic than I got in a few

> years in the field. "

>

> Medicine and technology are constantly evolving. If we let it outpace us,

> without catching up in some serious painful leaps, then we are working in

> futility.

>

> I have the feeling that in a few years, when my rookies are " old timers "

> that they will look back on these days, when we think we are doing a lot to

> save lives, and laugh at OUR " ny and Roy " ways. There are things around

> the corner that we lowly medics have not yet dreamed of. As an example, I

> am sure many can recall when ECG in the field was merely a dream... and then

> someone said " 12-Lead " ... I remember having discussions about it... that it

> was too expensive, and would never be useful... I mean really, can't you

> tell everything you need to know about a heart from Lead II? You know you

> heard those words as well. Who knows what marvels we may be able to perform

> in the not-too-distant future...

>

> Change is inevitable, and not always pleasant, but it's a necessary part of

> growth, and improvement. Maybe someday we will be recognised as " real "

> professionals. professionals.<wbr>.. but only if we pursue to

>

> Don't get me wrong, I don't think the Scope of Practice is the only, or best

> answer, but I am sure *I* don't have access to the research, statistics, and

> information that the committee has gathered, and *I* can't say what *is*

> best for EMS. Wes does have a sad but valid point... More and more medics

> are more interested in American Idol than in their jobs... To many it is

> just a " job " . That is one attitude we need to change, but many things will

> have to change, in order for that to occur. I recall a recent posting which

> described the educational requirements for Barbers, vs. Paramedics..

>

> What I can do is eagerly anticipate the huge leaps that we will take in the

> next few years. I will continue to learn, and grow in my clinical skill and

> knowledge as much as I can, so that I can be a part of the future of EMS, as

> opposed to a resistant relic...

>

> On 8/14/06, wegandy1938@wegandy < wegandy1938@wegandy> wrote:

> >

> > Go to this site and read it. Click on all the Members link, and look

> > carefully at it.

> >

> > http://www.nemses.http

> >

> > The NEMSES has a contract to develop an EMS curriculum to shove down our

> > throats in Texas. The standards that they will develop will demean what

> > the best

> > paramedic programs are doing, and they won't require a minimum level of

> > care.

> > but they will institute a ceiling on skills that can be done, and thereby

> > ruin some of the best systems in the state.

> >

August 14, 2006

I think there are at least 5 from Texas. Ed Racht, Kenny Navarro, Debra

Cason, ine Van Meuers, and Hatch. There may be more.

But there's nobody there with a rural interest. They're all big city, big

program educators. Nothing wrong with that, but we rural hicks would like to

have a piece of the pie too. What happens will most likely have the most

adverse effects on us.

Notice I am presuming adverse effects. I suppose I naturally adopt that

stance for the same reasons that I am skeptical when a guy from the IRS knocks

on

my door and says, " I'm from the IRS and I'm here to help you. "

This is on the pathway to becoming a federal mandate. No EMS Curriculum, no

federal highway funds.

If I seem always to be the one opposing these things, it's just my natural

lawyer's training that makes me that way. I like the adversarial system.

That's the way truth is determined.

I bear no ill will to the folks on the committee; in fact, I commend them for

spending the time to do this. I just wish there were a wider representation

of the whole EMS community on there and not so many of the same old folks who

are always on these committees.

Bob Waddell says that NEMSES asked for people to become topic writers, but if

they did, they must have whispered it in the dark of night, because I don't

recall ever seeing such a thing.

Now we must be vigilant. Let's not become complacent. Let's have our

voices heard NOW, before it's too late.

Maybe we all want the same things. Maybe not. Let the dialog begin.

Gene G.

>

> What??? Gene, you been out in the sun too long? You mean re-writing the

> National Standard Curriculum (some of which the Great State of Texas still

hasn't

> adopted the last version of...EMT-I '88)...to match it up against the Scope

> of Practice document that is also moving to final approval...

>

> I read over the entire website, noticed that Texas is VERY well represented

> ( I recognized 3 of the 24 names on the list of particpants as being from

> Texas...)... I read over the entire website, noticed that Texas is VERY well

> represented ( I recognized 3 of the 24 names on

>

> Dudley

>

> NEMSES educational guidelines

>

> Go to this site and read it. Click on all the Members link, and look

> carefully at it.

>

> http://www.nemses.http

>

> The NEMSES has a contract to develop an EMS curriculum to shove down our

> throats in Texas. The standards that they will develop will demean what the

> best

> paramedic programs are doing, and they won't require a minimum level of

> care.

> but they will institute a ceiling on skills that can be done, and thereby

> ruin some of the best systems in the state.

>

August 14, 2006

The nine most terrifying words in the English language are, 'I'm from the

government and I'm here to help.'

Reagan

NEMSES educational guidelines

>

> Go to this site and read it. Click on all the Members link, and look

> carefully at it.

>

> http://www.nemses.http

>

> The NEMSES has a contract to develop an EMS curriculum to shove down our

> throats in Texas. The standards that they will develop will demean what the

> best

> paramedic programs are doing, and they won't require a minimum level of

> care.

> but they will institute a ceiling on skills that can be done, and thereby

> ruin some of the best systems in the state.

>

August 14, 2006

Gene, et al,

It seems that a group the size of this list should be able to

organize and pull support from our respective regions to support the

continued administration at the State level. I will gladly offer

my research and writing skills, as well knocking on our area

lawmakers'doors to give Texas EMS providers the voice we need.

What should we do to make sure all on the same page and present a

united front? I believe that the Texas Legislature conveins its

next session in January of 2007. I think we could have something

rolling by then. Maybe you Austin folk could help with some

lobbying efforts. We will also need need to get with our U.S.

Senators and Congressmen.

I am quite sure that my employer would support my participation in

this effort.

Let me know what you think.

Todd, B.S., J.D., EMT-P

> > >

> > > Go to this site and read it. Click on all the Members link,

and look

> > > carefully at it.

> > >

> > > http://www.nemses.http

> > >

> > > The NEMSES has a contract to develop an EMS curriculum to

shove down our

> > > throats in Texas. The standards that they will develop will

demean what

> > > the best

> > > paramedic programs are doing, and they won't require a minimum

level of

> > > care.

> > > but they will institute a ceiling on skills that can be done,

and thereby

> > > ruin some of the best systems in the state.

> > >

August 14, 2006

Gene,

I agree with you for the most part. There does most definitely need to be

more involvement from the trenches. The circular problem, which Wes so

nicely pointed out, is that there are so many in EMS now that are only in it

as a stepping stone or just a " job " . BUT, in order to raise the dedication

and heartfelt interest in the profession, we have to have professionals to

do so. That requires more education... and we can't rally for more

education, without educated people to do so... It's a difficult problem, and

one that won't be solved easily.

I was recently talking with someone who has worked with those on the Scope

of Practice committee. He was saying that the SOP was posted out for

discussion years ago, and that only a tiny handful of responses were

received. Something well less than one percent of all potentially affected

personnel actually responded. I remember seeing them posted out as well.

Not having had the time to research it as thoroughly as I'd have liked, I

did not respond either.

I do seem to recall a massive debate on this list, as well as others, about

it... If those people had felt so strongly about it as to spew verbiage on

the list, then they should have written responses to the actual document,

and made the trip to attend the meetings when they were held in Texas.

Perhaps also, the same few people are sitting on these committees because

they are highly educated professionals. But, might it also be because the

word of the day is Apathy? Nobody else wants to tackle the problem because

" someone else " will take care of it. Sure, people will scream and holler

when it actually does affect them, but until then, it is business as

usual... out of sight out of mind...

So the million dollar question is...

What can we do, outside of this list, to really and truly raise awareness of

this looming legislation?

--

-Meris NREMT-P

FTO MetroCare Services EMS

Austin, TX

August 15, 2006

Actually, Meris, there WERE written responses from Texas - plenty of them. In

fact, I was told that Texas was one of the states with the LARGEST numbers of

responses against portions of the Scope of Practice. SOME of the revisions in

the current document were based on those written responses. However, there were

some of the things that Texans didn't like that DIDN'T get changed or changed

much either. (Instead of changing some of those things, they watered down the

verbage about whether or not a state has to accept the SOP.) So, apathy for the

most part was not the issue because this has been a hot topic in Texas for at

least a year at GETAC and the subcommittee meetings as well as other places. I

know that even GETAC itself sent a document to the Scope of Practice Committee

incorporating all the comments that they received on it. Texas also had a

couple of folks who went and spoke directly to the SOP Committee, but I do not

know for sure what was said.

Anyway, I think the real issue at this point is that the comments seem to have

been only partially listened to and even though they watered down the

" acceptance " part of the SOP, it appears that the Committee and others are

trying to find other ways to FORCE compliance by all states. The watered down

wording appears to have been a bone thrown to the masses who resisted because

" there is more than one way to skin a cat. "

Jane Hill

-------------- Original message from " Meris " :

--------------