Praetorian said:
Actually I liked the approach our former medical director took in protocol development- he had other physicians from other specialties chiming in on various protocols. Anesthesiology for pain control and airway management; cardiology for cardiac protocols; granted the final oversight and ultimate responsibility lay with our BC EM physician medical director (who was also a paramedic).
But personally I think the biggest problem that exists in EMS is a lack of proper education before entering the field. But that's just my opinion.....
As likely the only person in known history (or at least on this thread) dumb enough to throw away two perfectly good professions to seek another and become a physician, I'll comment. First of all, if we made paramedic training as rigorous as PA training we would have very few paramedics. Has anyone ever tried to live on a paramedic salary when the job wasn't attached to a fire department? Its not the most attractive profession in terms of salary, and if you suddenly require masters degrees from all the good old boy medics in places like Orange County Virginia, Prince George's county Maryland, and Johnson County Iowa, it won't work. I still remember in 1992 when I started medic school at Northern Virginia Community College. You always knew it was an EMS school night because of all the light racks on the old rusty trucks in the parking lot. I loved these guys and loved working with them, but lets not fool ourselves into believing that the average medic is intelligent enough to be anything near a PA. And unless you have completed medic, PA, and medical school, then my comments are as close to evidence as you are going to get on this topic.
In medic school, there were people like Jeff, FoughtFyre, Southerndoc, and myself who read every square centimeter of text out of Brady's Paramedic Emergency Care by Bledsoe, Porter, and Shade. But there were also a large majority that only cared about coming to class because their volunteer squad back home in the hills had paid their way to come. They spent most of the time trying to suck their gut in over their Rhonco pocket defibrillators and 5 Minitor pagers so that they could make themselves more attractive to the 4 toothed EMS chick in the tightest 9 pocket jump pants. I think there were more smoke breaks than lectures most nights. I remember not understanding why it took like 8 weeks for these guys to be able to determine a heart rate other than by just counting the number of QRS's in a 6 second strip and multiplying by 10. That whole 300, 150, 100, 75, 60...stuff went right over their heads.
And it wasn't because these guys were bad people. They just weren't Jeffs, and Foughtfyre's, or Southerndocs. So we can't expect to develop a standard that we would have like to have held ourselves to and apply it to a population of people that probably couldn't ever pass bio 1 or chem 1. And without those types of sciences you are not going to teach anyone physiology or pharmacology at a very deep level.
I still remember when I came back from the incredible EMS system we had in Northern Virginia and moved to Texas in 94 after leaving the military. I found a small town...Trinity, Texas about 20 miles from where I was going to school in Huntsville, Tx. I went up there and started volunteering, sporting my gold patch when Texas was a red patch state...and these old backwoods medics really thought I must have written the EMS text. But as it turned out, these guys could spot a crumping patient way better than I could and could put an IV in your granny's spider vein. I learned a lot from these guys, and eventually realized that they were plenty good for where they were serving. I also learned that it was important to untie the Basset Hound from the rear bumper before going on a call
But these guys could never have made it through a PA curriculum or anything similar. In fact they would never make it through the current medic curriculum. And if we are going to somehow expect more from them, we are going to have to pay them a fair wage for God's sake.
As for having a non-EM boarded doc on the NREMT, I find that completely unacceptable. Its still okay to have rural FP's as medical directors for their local EMS because otherwise there would be no one. And more time than not in situations like this the most intelligent medic in the system is just shoving papers in front of the doc to sign to send to the state EMS agency for approval and such. But the NREMT is a huge organization that represents nearly every EMT and paramedic in the country. They run a very tight ship, give an incredibly good exam, and should only be made up of EM physicians at this juncture in time. Otherwise we risk inappropriate influence on the policies that dictate future training, and I don't want some expert in SI joint injections trying to determine what a medic needs to be tested on for instance.
Wheeeewwww......taking a breath and giving my fingers some much needed rest.
