There’s a saying in the Special Operations Forces (SOF) community.
“When you can do what I do you may go where I go.”
Think about that. I’ll give you a minute...
That’s a pretty powerful saying I think. When we look at a profession, a job title, a promotion, etc. we should recall that it takes a certain amount of effort to attain that position. We aren’t owed the privileges or responsibilities bestowed upon that position if we haven’t paid the price of entry.
I think in EMS we forget this sometimes. I am personally one of the loudest voices for opened scope of practice, greater autonomy, and greater self governance at the state and federal level but I am just as vocal about our need for higher barriers to entry and better education (both initial and ongoing). Not surprisingly, there is much descent on both of the ideas I am championing.
If I had a dime for every time someone screamed, “we don’t need no college degree to take ‘em to the hospital,” or “if you make medics get a degree we will have an even worse shortage!” I’d be rich. EMTs as they are do not need a degree... Yes, I concede that, but they do need more than 120hrs of training. They need something far closer to 600hrs for their CURRENT scope. If you look toward the national standard AEMT level (or similar, some of the distinctions are inexplicable in their scope) an associates degree would be appropriate. The resistance I see comes from two things; some have a legitimate feeling of inferiority at the idea that to perform their job they may have required formal education as apposed to their academy style education and others are intimidated by the financial costs associated with collegiate learning (this can be worked around).
Other persons in this discussion are resistant to trust paramedics with treatments based on arbitrary or inappropriately framed reasons. Advanced airway management encapsulates this perfectly (but is far from the biggest issue). Opponents of an expanded scope often say things like, “If you take their respiratory drive in the wrong situation they could very well die.” Or, “It might be better to just scoop-and-run to the hospital.” Neither are wholly incorrect statements but both are built on several fallacies:
1. Paramedics aren’t trained well enough to perform or understand the procedure and it’s indications/ contraindications.
Malarkey. Physicians, YOU are who is supposed to provide the clinical education and ensure proper vetting of the personnel under your license. Until such a time as paramedics are truly independently licensed (not dependently licensed) physicians are SOLELY responsible for the paramedics allowed to practice with sub-par education under their licenses. Take an interest and share your knowledge. Many of us are as up on this topic as you are but for our colleagues that are not, do not use their ineptitude as an excuse to deny patients a fighting chance a life, a mercy from excruciating pain, or prevention of an airway disaster. Cut. The. Fat.
Nationally, some areas produce incredibly well trained paramedics. Several long-standing accredited universities produce well rounded bachelors degreed paramedics. These aren’t the norm, but they are becoming so. With this shift you will see providers more focused, better educated, and more ready to manage complex cases with complex responses instead of canned treatments of old.
2. Scoop-and-run should be the treatment for impending airway failures, not treating the patient in the field.
Like it or not, that paramedic in the field with an impending or unacceptably compromised airway actually has the best opportunity to rescue that airway. That’s true whether he’s 10 minutes out or an hour. The key here is that they must be expertly trained and educated (see above) and they must be given the confidence that when they make that hard choice to take another person’s airway that you will back them when they’re right and re-educate them when they aren’t. Residents foul this up at an alarming rate but nobody thinks we need to hobble them in treating their patients, instead it is constant refinement of their education and exposure that makes their treatment safer and ultimately produces a safe and effective provider. That doesn’t change just because the patient is on a stretcher in an ambulance and not in a bed in a bay.
To be honest, I’m not sure this rant makes much sense. I would actually appreciate feedback on the structure despite this being spur of the moment writing. Bottom line, know that if you want to improve things for your patients and improve what you can offer them improve yourself. That’s it. Be worthy of that improvement and don’t demand it like a child.
