Critical Care Paramedic- has the time come?

[pushinepi2]

I hear that long time medical director and paramedic advocate Bryan Bledsoe, DO, FACEP, is authoring a critical care textbook for paramedics. Do you guys think this is a worthwhile and timely endeavor? Even though I was employed with a mainly first response fire rescue agency, we routinely were assigned to transfer vent-dependent patients to long term care facilities. When the local flight program went down, our service often stepped up to the plate to effect transfers from outlying counties. Problem is, most paramedics receive little to no training on vasoactive drug management, IV infusion maintenance, and ventilator management. For medics working for private services or planning to apply to flight programs, I think specialty training in these areas would greatly enhance an application. I went through UMBC's CCEMT-P program in 2000. It was an excellent program but it was based on a critical care nursing curriculum. The texbook was not particularly helpful and much of the enrichment material was provided by local RNs and medics. I think a paramedic-focused critical care textbook would have done well to move the course along. Any opinions? Or should critical care be left to flight teams, nurses, and respiratory therapists???

-PuSh

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[12R34Y]

I hear that long time medical director and paramedic advocate Bryan Bledsoe, DO, FACEP, is authoring a critical care textbook for paramedics. Do you guys think this is a worthwhile and timely endeavor? Even though I was employed with a mainly first response fire rescue agency, we routinely were assigned to transfer vent-dependent patients to long term care facilities. When the local flight program went down, our service often stepped up to the plate to effect transfers from outlying counties. Problem is, most paramedics receive little to no training on vasoactive drug management, IV infusion maintenance, and ventilator management. For medics working for private services or planning to apply to flight programs, I think specialty training in these areas would greatly enhance an application. I went through UMBC's CCEMT-P program in 2000. It was an excellent program but it was based on a critical care nursing curriculum. The texbook was not particularly helpful and much of the enrichment material was provided by local RNs and medics. I think a paramedic-focused critical care textbook would have done well to move the course along. Any opinions? Or should critical care be left to flight teams, nurses, and respiratory therapists???

-PuSh

I've got no problem with a critical care paramedic curriculum. the university of iowa as a great program. Several of my fellow colleagues back in the day went to that course and they brought back materials. they learned things about central lines, swanz readings, RSI, meds, etc.....i thought it looked great.

I don't think critical care belongs in the hands of an RN anymore than it does a paramedic.

I'd be interested in perusing this book when it is out.

later

 

[southerndoc]

I'm also interesting in perusing the book when it's released. However, I'm not a fan of out-of-hospital Swan-Ganz catheters or pre-hospital RSI. That's a story for another day.

I feel like the entire pre-hospital arena should be dealt with solely by paramedics. There shouldn't be such things as flight nurses. Instead, train paramedics to deal with everything. The same is true of paramedics in the hospital. I think it should be left to nurses. If you want to work in a hospital, become a nurse. If you want to work in the field, become a paramedic. (Having said that, nurse-paramedics are definitely where it's at.)

 

[12R34Y]

I'm also interesting in perusing the book when it's released. However, I'm not a fan of out-of-hospital Swan-Ganz catheters or pre-hospital RSI. That's a story for another day.

I feel like the entire pre-hospital arena should be dealt with solely by paramedics. There shouldn't be such things as flight nurses. Instead, train paramedics to deal with everything. The same is true of paramedics in the hospital. I think it should be left to nurses. If you want to work in a hospital, become a nurse. If you want to work in the field, become a paramedic. (Having said that, nurse-paramedics are definitely where it's at.)

I agree with you completely. When I said swanz, RSI etc was covered in class, I just meant that.......it was covered. I think it just adds to the knowledge base and helps to solidy some physiology points.

later

 

[Freeeedom!]

Instead of critical care paramedics, how about "driving to the hospital as fast and safely as you can" paramedics. Forget RSI, how about bagging and driving.

 

[rn29306]

Instead of critical care paramedics, how about "driving to the hospital as fast and safely as you can" paramedics. Forget RSI, how about bagging and driving.

Interfacility transport of ICU patients is getting increasingly difficult. Management of these pts from a pharmacological standpoint is a little more in-depth than "bag and drive".
I used to work as a critical care transport RN for a service. We also did backup 911 for our area when we were needed. The company had its own certification of what constituted a "critical care paramedic" and these guys knew their stuff about hemodynamics and drugs, along with alot of medical-based continuing education, inservices, and procedural checkoffs. Went to a call for SOB, this dude couldn't even make it to the door, he was ashen, had the deer-in-the headlights look and sat was in the toilet upon arrival. I spent 3 years in the ICU, thought this guy needed a tube emergent, had the intubation bag in my hand. Medic (who took lead on 911 calls) told me to set up for continuous breathing treatments and theophylline gtt. Guy was on nasal cannula by the time of ED arrival. Who knows what the ED did to him...Could have intubated, but didn't have to.
I think it is an excellent progression of the paramedic field for those that can hack the program.

 

[viostorm]

Instead of critical care paramedics, how about "driving to the hospital as fast and safely as you can" paramedics. Forget RSI, how about bagging and driving.

Because *critical care* is mostly for the transport environment, not 911.

I'll try that bagging and driving fast on my next 8 hour vent run ... I'll let you know how it goes.

 

[viostorm]

I hear that long time medical director and paramedic advocate Bryan Bledsoe, DO, FACEP, is authoring a critical care textbook for paramedics.-PuSh

I thought his last brady paramedic textbook was horrible and had errors throughout, I don't trust a thing in it. If his CCEMT-P book is anything like it I would steer clear.

Just off the top of my head:

* It seems he made up cardiac rhythms (eg. 'atrial tachycardia') on vol 3 page 108 which is blatantly at a rate of 60 on the strip.

* In his management of the stroke or TIA patient he recommends transporting stroke patient's supine. "Keep the patient supine or in the recovery position. If the patient has CHF, he could be maintained in a semi-upright position, if necessary" page 293 vol 3. My understanding is, consensus is suspected CVA patients should be transported 30 degree semi-fowler for ICP.

 

[tRmedic21]

I think it is an excellent idea overall. I can't comment on the author mentioned, but the idea of a Critical Care P-med class always excited me when I was in the field. I would have jumped on it in a heartbeat if I could have ever convinced my service to send em to it (or just give me the time off!).

We did a ton of long-distance inter-facility transports, mostly cardiac in origin, and I would have loved to have had the extra training and knowledge to deal with problems when they arose (as they occassionally did). We had a portable vent and IV pumps, etc., but with a 2-hour transport and no idea what most of the settings on our equipment did.... it was really of no use to us.

Good luck to the future CC-NREMPT-Ps, I say!

 

[pushinepi2]

I thought his last brady paramedic textbook was horrible and had errors throughout, I don't trust a thing in it. If his CCEMT-P book is anything like it I would steer clear.

Just off the top of my head:

* It seems he made up cardiac rhythms (eg. 'atrial tachycardia') on vol 3 page 108 which is blatantly at a rate of 60 on the strip.

* In his management of the stroke or TIA patient he recommends transporting stroke patient's supine. "Keep the patient supine or in the recovery position. If the patient has CHF, he could be maintained in a semi-upright position, if necessary" page 293 vol 3. My understanding is, consensus is suspected CVA patients should be transported 30 degree semi-fowler for ICP.

Its been great viewing all of the feedback. Just a couple of things w/respect to Bryan Bledsoe. While its true that paramedic advocacy doesn't excuse a physician from making "blatant" errors, I find it hard to believe that someone fellowed in the ACEP would describe atrial tahcycardia occuring at a rate of 60. It is safe to assume a major editing error. With regard to the transportation of suspected CVA patients, why is it necessary to transport them with elevated HOB? Should herniation occur following a CVA, the patient would present with apnea, Cheyne-Stokes respirations, and a variety of non-subtle sequelae. ICP elevation following a CVA is not a primary concern for pre-hospital providers unless there is frank herniation. Again, findings consistent with the brain stem descending through the foramen magnum would necessitate SUPINE transportation, endotracheal intubation, and judicious hyperventilation. Most CVA patients autoregulate their CPP just fine and benefit more from healthcare providers leaving them alone. I am not a 'strokeologist," and would simply like to point out the tenuous relationship between a suspected CVA and elevated ICP. The two points you mention, therefore, do little to detract from Dr. Bledsoe's credibility. He may still author a terrible textbook, but I remain unconvinced about his emergency medical ineptitude.
Finally, its interesting to see CCEMTP received with such enthusiasm. My previous service absolutely LOATHED these long distance transports and would have favored re-assigning them to local flight crews or private organizations. I think that the CCEMTP issue is an important one... if paramedics are not excited about new knowledge and expansion of practice scope, then it remains quite easy to argue against their placement in emergency rooms. Embracing critical care skills, in a manner similar to that of critical care nurses, ensures future growth and career opportunity.

 

[pushinepi2]

Because *critical care* is mostly for the transport environment, not 911.

I'll try that bagging and driving fast on my next 8 hour vent run ... I'll let you know how it goes.

Be sure to let the patient's respiratory therapist in on your patient's outcomes. Im sure you'll also have access to a blood gas machine and a ventilator to assess his airway pressues following your eight hour bag and drive run. This issue is serious in that local critical care hospitals (the long-term types) have threatened to refuse patients transported by F/R medics without proper equipment. There is no question that patients suffering from ARDS/VALI or other pathology do absolutely HORRIBLY when they're switched from custom-tailored ventilation to bagging. Plenty of data exists on the deleterious effect of airway pressures on the injured and intubated lung.
While its understood that 911 and transport medicine are two different arenas, there is plenty of skill overlap. Critical care medicine is not just infusion drips and hanging theophylline (Jesus!) on a 911 call. It embraces paralytics, surgical airway skills, CPAP, and a host of other valuable interventions. Because these skills require more paramedic oversight, they are generally limited to individuals who can document completion of an appropriate course. There's no wonder why current emergency medicine literature is replete with references to bad outcomes and paramedic emergency care... medics are so concered with "bagging and driving" or "getting to the hospital" that evidence-based/patient driven care is often de-emphasized... I can think of plenty of occasions on which my patients might have benefitted from critical care skills in the 911 setting. CPAP, dopamine infusions, resuscitation, and nasotracheal intubation all fall within the scope of critical care practice. Don't be so quick to dismiss CCM as a hospital only practice. Some things like intra-aortic balloon pumps will NEVER have mainstream paramedic utility and should not be taught in a CCEMT-P course. On the other hand, I'd find it hard to argue against an advanced airway curriculum for medics. Just my two cents. Also.. get that theophylline infusion hanging paramedic a CPAP machine. Much better outcomes with less titration and mixing.

-PuSh

 

[rn29306]

Critical care medicine is not just infusion drips and hanging theophylline (Jesus!) on a 911 call.

-PuSh

You laugh, but you were not there.

You right though, there is more to critical care transport that just what was entailed above. Check out the truck. Only one in the state of GA with our own on-board DataScope IABP. Carried every drug / fluid except blood that you would find in any ICU. ICU RN with flight or CCEMT-P certifications and critical care paramedic, often a CFP or CCEMT-P, complemented each other very well.

http://www.puckettems.com
click icon for "Programs / Services"
click icon for "Critical Care Transport Services"

 

[rn29306]

Some things like intra-aortic balloon pumps will NEVER have mainstream paramedic utility and should not be taught in a CCEMT-P course.
-PuSh

Who should be doing these things IABPs then? Granted IABP runs don't happen often and they are a pain in a regular sized unit. Our unit was spefically designed to run IABP calls and in the areas surrounding Altanta, there were labs doing caths without being located at a hospital with open heart capability..Docs put in IABP for support and called us for transport to inside Atlanta for admission to open-heart facility. Granted they aren't everyday calls and no, paramedics without training should not even attempt these calls, but who then should do them? Once word got out about our capabilities, we ran these calls about twice a week. Any why should it not be taught in CCEMT-P. CC = critical care
The alternative in Georgia was that an ICU nurse or ED nurse familiar with IABP ran the call with the ambulance, then EMS had to bring the staff nurse back to his or her hospital. Problems such as this is why our unit was created and it works quite well.

 

[viostorm]

He may still author a terrible textbook, but I remain unconvinced about his emergency medical ineptitude.

Ok, so I was pretty harsh in saying *horrible*. So I retract that statement and feel like a chump. I will say I was VERY disappointed in the text, and even more so in the slides, especially when compared with Mosby's paramedic cirriculum.

From Mosby: "If the patient's condition permits, the patient should be kept supine with head elevated 15 degrees to facilitate venous drainage." p.909

I have yet to find another cirriculum that recommends patient be transported either flat or in the recovery position. I'm pretty sure UMBC CCEMT-P we were told to transport 15-30 degrees semi-fowler, I will see if I can find a reference for this.

http://pedsccm.wustl.edu/All-Net/english/neurpage/protect/icp-tx-3.htm

I don't have a "peer reviewed" reference for this but I can tell you I heard it is a concern with the stop and go of the ambulance that spikes in ICP will occur due to the "g-forces" associated with transport. Even more critical for fixed wing aeromedical transport.

In the end it probably doesn't make a bit of difference.

And certainly I do not suggest errors in a textbook make someone an incompetent emergency physician. However if my name was being sold on a book (probably the most popular paramedic cirriculum) that would be published to and sold to thousands, if not hundreds of thousands of students I would hope I would review it more closely.

 

[viostorm]

I'll try that bagging and driving fast on my next 8 hour vent run ... I'll let you know how it goes.

Ok, so I was being sarcastic (I'll leave the poor patient on the vent) but I felt like freedom was talking smack about paramedics and it ruffled my feathers. EMS is complicated and paramedics are much more then EMT's. I agree there is little outcome based evidence that shows paramedics do anything positive for patients. I think it is important to remember the profession is only 40-50 years old and we might not know what training et cetera is necessary to achieve good outcomes.

Also in my experience paramedic competency varies GREATLY regionally and around the country.

I felt the UMBC CCEMT-P cirriculum was great. And PNCCT even better. If nothing else, it enables you to have reasonable conversations with nurses and physicians and understand what they want you to do to ultimately provide better care. It definitely improves communication.

By saying *most* of the CCEMT-P is not for 911, I mean there is a great emphasis on lab values (which outside the i-stat are unavailable), a section on EMTALA law, IABP's, and a myriad of other that you will never have prehospitally.

Everyone in CCEMT-P usually already knows how to be a good 911 medic. In my opinion, 911 is easy compared to critical care transport.

I personally believe so strongly in the cirriculum that if I were king I would require any critical care transport tech to have CCEMT-P. The flight service around here is staffed with 911 medics that migrated to the CC transport environment with no formal education.

There are several skills that will obviously benefit the 911 patient, like as Push suggested advanced airway, 12-lead interpretaion, et cetera. But for 911 those patients are few and far between.

 

[southerndoc]

I have forwarded a link to this discussion to Bryan. Perhaps he can add some insights to this.

 

[viostorm]

Forget RSI, how about bagging and driving.

Just to weigh in on RSI ...

1) Certainly the evidence suggests worse outcomes with paramedic RSI (san diego study).

Although, RSI has not been studied in rural EMS, where patients would likely get the most benefit from early intubation and RSI is most necessary. Paramedic corps are smaller and have the potential for more supervision.

2) There is no data that compares paramedic RSI outcomes versus rural ER physician outcomes.

3) There is no data that suggests patients have better outcomes with emergency physician intubation over calling anesthesia for every intubation.

 

[viostorm]

I have forwarded a link to this discussion to Bryan. Perhaps he can add some insights to this.

GGGRREEEAAATTT. So now one of the most prominent EP's in the country will think I'm a chump. Don't you love the net? Viostorm, think before you type ... think before you type.

From my girlfriend: "open mouth ... insert foot"

she also said "you could edit your post before he reads it ... but that would make you a big p*ssy"

 

[southerndoc]

GGGRREEEAAATTT. So now one of the most prominent EP's in the country will think I'm a chump. Don't you love the net? Viostorm, think before you type ... think before you type.

From my girlfriend: "open mouth ... insert foot"

she also said "you could edit your post before he reads it ... but that would make you a big p*ssy"

Dr. Bledsoe asked that the following reply be posted:

I appreciate the comment although one must understand that a 5-volume book
with nearly 3,000 pages will have an error or two (I could show you quite a
few--although must are fixed each time the book is reprinted--not
revised--but reprinted). The item in question was a compositors error where
wandering atrial pacemaker was labelled atrial tachycardia. It was corrected
in reprints and in later editions. In terms of book choices, that is an
individual preference. The treatment for stroke was correct when that
chapter was written (by a neurologist). Treatments change and textbooks are
revised.

I can tell you this, based on the last stats I saw (in January) the Brady
paramedic series (or an earlier version of the same book) was used as the
primary course text by about 90% of the paramedic programs in the
English-speaking world. It has been translated into Spanish, Korean (and
Canadian). The Mosby book historically has had more errors. Why do you think
the cover reads "Mosby's Paramedic Textbook, Second Edition (Revised)?
Revisions are rare in the publishing business. Mosby's Intermediate book
(Shade, et al) was recalled by the publisher for lethal drug
errors--something that ultimately cost the editor her job.

The book "Critical Care Paramedic" will be out in the fall, 37 chapters,
1,000 pages, heavily illustrated. Persons mastering that text should be
successful in the CCT, FP-C, and CCRN exams. The reviews have been excellent
and we all already getting orders. Perhaps VIOSTORM needs an intensive month
of emergency medicine!

Bryan E. Bledsoe, DO, FACEP
Adjunct Professor of Emergency Medicine
The George Washington University Medical Center

 

[pushinepi2]

Just to weigh in on RSI ...

1) Certainly the evidence suggests worse outcomes with paramedic RSI (san diego study).

Although, RSI has not been studied in rural EMS, where patients would likely get the most benefit from early intubation and RSI is most necessary. Paramedic corps are smaller and have the potential for more supervision.

2) There is no data that compares paramedic RSI outcomes versus rural ER physician outcomes.

3) There is no data that suggests patients have better outcomes with emergency physician intubation over calling anesthesia for every intubation.

Quite a few things to address here. Perhaps I'll leave some of them to Dr. Bledsoe. Great exchange, huh? Its no wonder that EM lives up to its name as a, "close knit" community. Anyway, the paramedic RSI discussion is definitely one that evokes loads of controversy. I tried and failed to write an RSI protocol for my service. Like Viostorm's post suggests, there's little in the way of EBM to support its use. There are valid points on either side of the RSI debate. I think most clinicians will agree that it is imperative to have a difficult airway rescue plan. RSI is necessary for many things including trismus, increased ICP, intractable seizures, and other pathologies. What is important to remember is the difference between the field and the emergency department. The San Diego study is often quoted when referring to paramedic outcome and ability. Success rates between ER physicians and medics are comparable despite the statistically significant differences in outcome. What the San Diego paramedics did not have at their disposal was an extra respiratory therapist, ER nurse, and critical care technician. This deficiency rears its ugly head in the most recent study discussed in Annals of Emergency Medicine. I don't have the reference at hand, but the article compared the outcomes of patients undergoing RSI (by medics and MDs/DOs) who suffered from TBI. Predictably, outcomes of those patients intubated in the field were poorer than those patients intubated in the ED. Patients in the field arm of the study also endured prolonged periods of desaturation. This finding speaks to the very heart of the debate. If paramedics are to maintain and practice this RSI skill, they must certainly achieve parity with their physician counterparts. In order for them to practice excellent medicine, they should be equipped with contant-waveform end tidal CO2 technology and the personnel necessary to monitor the paralyzed patient. I can recall many field intubations that were, "crash" in nature... I remember several instances of inadequate pre-procedural hypooxygenation. Since our service ran with an EMT and paramedic in rural areas, it was technically difficult to appropriately monitor intubated patients while hooking them up to the cardiac monitor, manually ventilating them, and securing the tube on the way to the hospital. These differences are key to understanding the challenging pre-hospital environment. Studies that demonstrate poor outcomes inspire paramedics to adapt new and innovative strategies for bringing exciting and potentially life saving emergency medical care into the often chaotic out-of-hospital realm. Obviously, a critical care paramedic curriculum would be incomplete without mention of RSI, new end tidal CO2 monitors, and these important studies. Keep on discussing,

-Push

 

[pushinepi2]

From my girlfriend: "open mouth ... insert foot"

she also said "you could edit your post before he reads it ... but that would make you a big p*ssy"

Don't you hate this convenient and easily accessible quoting feature ?
Seriously, though... these forums are all about discussion. Its not a bad thing to put forward impassioned opinions on your topic of choice. I think this forum would be exceedingly dull if everything was peer-reviewed and screened prior to posting... Keep up the inspired work! Anyway, back to those "terrible" textbooks.....



PuSh

 

[southerndoc]

No frets. Dr. B is pretty cool. Anyone who subscribes to EMS-L or is a member of the NAEMSP sees his frequent posts come across the lists.

 

[viostorm]

No frets. Dr. B is pretty cool. Anyone who subscribes to EMS-L or is a member of the NAEMSP sees his frequent posts come across the lists.

Well great, thanks for the discussion from everyone.

What I learned:

1) All textbooks have errors and you have to be tolerant of them

2) Emergency medicine is a small community.

-viostorm

Oh, and Dr. Bledsoe will you sign my CCEMT-P book when it comes out?

 

[trauma_junky]

I hear that long time medical director and paramedic advocate Bryan Bledsoe, DO, FACEP, is authoring a critical care textbook for paramedics. Do you guys think this is a worthwhile and timely endeavor? Even though I was employed with a mainly first response fire rescue agency, we routinely were assigned to transfer vent-dependent patients to long term care facilities. When the local flight program went down, our service often stepped up to the plate to effect transfers from outlying counties. Problem is, most paramedics receive little to no training on vasoactive drug management, IV infusion maintenance, and ventilator management. For medics working for private services or planning to apply to flight programs, I think specialty training in these areas would greatly enhance an application. I went through UMBC's CCEMT-P program in 2000. It was an excellent program but it was based on a critical care nursing curriculum. The texbook was not particularly helpful and much of the enrichment material was provided by local RNs and medics. I think a paramedic-focused critical care textbook would have done well to move the course along. Any opinions? Or should critical care be left to flight teams, nurses, and respiratory therapists???

-PuSh

I think EMS needs a complete work over. It needs to be a BS degree program with a year of intership rotations in and out of the hospital. No more basics, only paramedic level. They need to be practioners as well. Another damn card coarse doen't change a thing. All it does is allows some billy bob to add another set of letters behind his already long name. The Eagles really need to quit pissing over scope of practice and force the complete issue more.

Oh ya by the way, don't get hurt in LA. Talk about prehistoric EMS.

 

[pushinepi2]

..I think EMS needs a complete work over. It needs to be a BS degree program with a year of intership rotations in and out of the hospital. No more basics, only paramedic level....

I'm sure passive agencies like the Florida Fire Chiefs Association would just LOVE to transition to a BS. We can't even step up to the plate and require associates level degrees for graduating medics. Your point is well taken, though... the addition of another merit badge does little to increase prestige and opportunity. No respect will be gained from RNs or other allied health professionals until paramedics as a whole agree to similar pre-requisites. I can't imagine fire departments requiring a four year degree for their medics. There might be some merit to the argument that advanced practice medics should hold at least a BS. Today's current economic and political climate, however, will not support the creation of a bachelor's level EMS professional.

 

[leviathan]

I'm sure passive agencies like the Florida Fire Chiefs Association would just LOVE to transition to a BS. We can't even step up to the plate and require associates level degrees for graduating medics. Your point is well taken, though... the addition of another merit badge does little to increase prestige and opportunity. No respect will be gained from RNs or other allied health professionals until paramedics as a whole agree to similar pre-requisites. I can't imagine fire departments requiring a four year degree for their medics. There might be some merit to the argument that advanced practice medics should hold at least a BS. Today's current economic and political climate, however, will not support the creation of a bachelor's level EMS professional.

Ontario (Canada) has an Honours BSc program that leads to a joint Paramedicine/Health Science degree in the standard 4 years. Normally, the paramedic certificate takes 2 years to complete, which is just for the level 1 paramedic (something similar to the American EMT-B, but I believe they have a little more responsibility).

 

[khoehi]

I am an EMS educator and I would like to toss my hat in the game if thats ok. First, I couldn't agree more with the B.S. paramedic curriculum, but considering the already alarming shortage of paramedics, how do we fill the gaps. Second, RN's are not required to have a B.S. to work, so you are taking medics, who typically make 10/hr less than R.N.'s and requiring more education. What I would request you future doc's get started on is better insurance reimbursement or we are all going to be ascribing to Hillary's "Free Healthcare for all" plan which is going to make your student loans a real pain to repay. Good luck to all of you and if any of you have suggestions for EMS education, keep my ID handy. I am a program director and am always looking for good advice.

 

[deleted6669]

I agree that a bs for medics is overkill. some states now require an a.s. and this seems more reasonable. back in the day I did a 1 yr certificate medic program but already had a prior bs.
the a.s. degree for medics allows them to do a 1 yr medic to rn bridge or a 2 yr pa program, both good options for a medic who grows tired of lifting and bls transfers.

 

[146233]

I agree that a bs for medics is overkill. some states now require an a.s. and this seems more reasonable. back in the day I did a 1 yr certificate medic program but already had a prior bs.
the a.s. degree for medics allows them to do a 1 yr medic to rn bridge or a 2 yr pa program, both good options for a medic who grows tired of lifting and bls transfers.

 

[leviathan]

Dr. Bledsoe asked that the following reply be posted:
the Brady
paramedic series (or an earlier version of the same book) was used as the
primary course text by about 90% of the paramedic programs in the
English-speaking world. It has been translated into Spanish, Korean (and
Canadian).

Ahh, yes, I'm using Bledsoe's Canadian version of the book up here too eh???

I think his book is OK, but I have nothing to compare it to. I just think the level of the book is a bit too simplistic in regards to the anatomy, physiology, and pathology. Of course, Dr. Bledsoe is probably writing it at the level which the higher-ups have deemed is appropriate for prehospital providers.

 

[ParamedicMan]

While I am a big fan on Bledsoe, I used Air and Surface Patient Transport Principles and Practice by Mosby for CCEMT-P. It's the text for the FP-C (Flight Paramedic) exam, which is the mack-daddy of all CC tests, and also the only nationally accepted test. It is dry as the Sahara, but the information cannot be beat. It is older than the Bledsoe book (2002 vs 2005 ish) Having said that, I haven't spent as much time with the Bledsoe book as I have with the Mosby, so that might have something to do with it.
As for the BS vs AS debate, I am an AS medic getting my 4-year degree. Maybe it is just a quirk, but I would rather have the folks in my AS class care for me instead of the BS one. Proof positive that one really cannot judge by the certificate, but by the competence of the medic, be it BS, AS or certificate. I also make less than half of the AS trained RNs at my hospital, so why I go out of my way to get extra training I will never know...(waiting VERY patiently on acceptance to med school)

 

[MacGyver]

I think we should just move to a mandatory doctoral program for all paramedics. Then we can all be DOCTORS!

Yay, go DOCTORS!!!!

 

[Unlimited415]

Instead of critical care paramedics, how about "driving to the hospital as fast and safely as you can" paramedics. Forget RSI, how about bagging and driving.

Hope you're being facetious, as that's the number one thing young unconfident EMTs resort to...which is probably why there are an incredible number of ambulance crashes in some areas...seriously some local companies have crashes at least once a week (raging from major to minor scratches from turning too fast or side swiping the box).

As far as Bledsoe's books...I really wish they were more in-depth and yes a LOT fewer mistakes and ambiguities. There are a LOT of sections that just aren't clear and too much time is spent trying to figure it out.

As for BS degrees for paramedics...why not, I see bachelor's as the basic degree to be a professional.

 

[howelljolly]

Ditto on the BS degree for Medics. A lot of hospitals near where I worked require a BSN for nurses, and almost all require them for charge nurses and supervisors.

I think its self defeating to say that Im not going to get a BS because I'll still be making less than a BSN.

We are not going to make any more money until EMS is viewed as a profession in itself. And until we reverse the trend of making EMS just a required work detail on fire departments, and (unfortunately) not have it as a volunteer activity and hobby for high school students, that's not going to happen.

Yes, requiring a BS for medics will probably reduce the numbers (I DONT believe that there is any shortage) temporarily. Once the programs start cranking out medics that don't need to supplement their income, or feel the need to leave EMS to pursue academics, and actually have terminal degrees within EMS, I think we'll be in better shape.

As Ive said before, we medics are not even qualified to be top dog in our own field. When the going gets tough, protocol says you need a nurse. With some agencies, when the going gets really tough, you need a nurse, and a respiratory therapist, and you need to leave the medic home. I agree that with the way the system is now, that nurses have more "experience" (read "number of patients seen") than most medics over the same time frame.... but it doesnt have to be that way....
anyway....