Talk:Paramedics in the United States

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Wouldn't a better title for this article be "Paramedics in the United States of America"? First of all, "Paramedics in United States", isn't really gramatically correct. It should be "Paramedics in the United States" since that's how the country is referred to. If you live in the U.S. you wouldn't say "I live in United States", you would say "I live in the United States". And secondly, just saying "United States" is ambiguous. There are many places where states are united for one reason or another but this article is referring to the United States of America specifically. I'm just going to be bold and move the article. Dismas|(talk) 04:12, 6 March 2006 (UTC)

Contents

[edit] NPOV

Some of the more recent additions to this page seem to be very much opposed to the IAFF in particular and fire-based EMS in general. Aside from the fact that such opinions are far from universal, they are inappropriate for an encyclopedia. Comments about the pro/anti fire-based EMS are for a more political forum. --catseyes 18:22, 22 May 2007 (UTC)

I would tend to agree with you that the recent edits don't really conform to WP:NPOV, so I've tagged the article with {{POV}} so that we can all work on it. It shouldn't be so negative on the fire service, although the current tensions that are going on should indeed be mentioned. I recall seeing articles in JEMS and I think on the NAEMT's site too, have to see if I can dig them up at some point. —Elipongo (Talk|contribs) 01:59, 30 May 2007 (UTC)

Hey all, I am the one probably responsible for the recent edits in question, and would be open to discussion. Certainly the wording is open to debate, but the facts of the changes I wrote, and their impact on EMS I dont think are. For example: The statements that recent attempts to mandate degrees for US paramedics were opposed by IAFF, and IAFC (through their opposition of the National Scope of Practice Draft, and the resultant removal of the degree requirement aqnd the advance practice paramedics because of that opposition) are fact, and are pertinent to the discussion of paramedics in the US as in many other countries they are degreed. The recent opposition by the IAFC and IAFF to oppose a parallel administration similar to the NFA, as recommended by a report from George Washington University, is also fact, and pertinent to the difficulties advancing the EMS profession in the US (as is the position by the various fire service interest groups in a public letter that such an administration would deprive them of HS funding). That non-fire EMS gets less than 4% of HS monies, is also appropriate because it demonstrates the difficulties facing EMS systems, and paramedics working for these agencies. Also pertinent to the discussion, IMHO. In addition the change to reflect that the "freedom house" project was the first true ALS EMS in the nation is a fact, so therefore is also appropriate to the article even though (if my memory serves me correctly) earlier versions listed the Miami project.

Basically, the changes are pertinent to provide an accurate description of the paramedic profession, not a description that was purely biased to the fire service/IAFF view of the paramedic profession. If we are speaking of neutrality, than this page should not reflect only the fire service view, or serve the fire services propaganda efforts (which is what previous versions seemed to do, IMHO) , but must be reflective of the profession itself. So the comments are more reflective of the difficulties facing EMS in the nation today, than simply the Fire vs Non fire debate. BTW, I am a 17 year EMS professional (12 as a paramedic), teach EMS classes, and have worked for both sides of the fence. Thank you. - (croaker260)14 June 2007—Preceding unsigned comment added by Croaker260 (talk • contribs) 07:42, 14 June 2007

Hello Croaker260, thanks for writing. Part of the problem is one of balance, as a neutral encyclopedia we can't play favorites- the fire service's point of view needs to be represented too. Another problem is one of tone- the way a lot of the article is phrased right now comes off as a bit of a rant against the fire service, RNs, etc- again, not something that looks very good in an encyclopedia. The biggest issue, however, is that no sources for the information have been cited. Per the Verifiability Policy, "The threshold for inclusion in Wikipedia is verifiability, not truth."
I too find myself frustrated and annoyed by the obstacles placed in the way of EMS, however we have to keep in mind that [WP:SOAP|Wikipedia is not a soapbox]] and do our best to keep our own opinions out of the mix and try to write good, informative, neutral articles. —Elipongo (Talk contribs) 08:15, 14 June 2007 (UTC)

Wow, this article is really opinionated and slanted. It seriously needs to be edited so there is only facts represented.

[edit] Cleanup

I propose to 1) Focus on "in the United States of America" and delete information covered by the global topic Paramedics. 2) Edit word choice, tighten sentences, improve consistency.

I offer edits in small increments. Stevecalloway 12:05, 1 August 2007 (UTC)

[edit] Dubious

...exploitation of EMS by the fire service.

Are not fire service agencies part of the emergency medical services? Who or what is being exploited? Stevecalloway 19:28, 16 August 2007 (UTC)

...registered nurses and physician assistants are not permitted to provide patient care without training at the EMT-Basic level...

The sentence above should be removed. Nursing and medical doctor curriculum teach subjects and skills well beyond EMT-B. Consider this equally irrelevant example: Paramedics are not permitted to operate an ambulance without a driver's license. Stevecalloway 19:28, 16 August 2007 (UTC)

Stevecalloway, Tennessee's EMS code specifically excludes anyone but an EMT, Paramedic, RN, RT or MD from working on an ambulance. It also states that ANY ambulance transport, reguardless of the mode or team makeup, must have an EMT to be in code. Many states also adopt this model of the law. PAs, MAs, LPNs, and other healthcare providers are not allowed without express permission from Medical Control Physicians. Many state laws also state that even if someone identifies themselves as an MD to you on a scene, it's meaningless until certian steps and criteria are met, which vary from state to state. Just because someone is an MD, doesn't mean they can tell YOU what to do. 198.254.16.200 (talk) 14:59, 10 April 2008 (UTC)Chance Gearheart, EMT-IV, Lebonheur Children's Medical Center Pedi-Flite Critical Care Team

Expanding on the legal authority of paramedics would make a good section and a positive contribution to the article. The context of the disputed sentence was that EMT-B skill level is equivalent to, or above, registered nurses and physician assistants by virtue of ambulance permission. The legal authority to work an ambulance supports the skills and abilities of an EMT, (below even an EMT-P paramedic), but is a poor way to compare skills with other professions. In my opinion, the comparison of paramedics with other health professionals has given this article a negative slant. Better, we should focus on the what/how/why of paramedics rather than the what/how/why others compare less favorably. Stevecalloway (talk)

[edit] Deletions

Multiple paragraphs removed August 2007 can be found in Talk History dated before April 26, 2008.

Source added to IAFC fighting against degrees with minor rewrite to reflect their current stance.

JPINFV (talk) 04:59, 4 March 2008 (UTC)

[edit] EMT-Paramedic vs "Paramedic" and the patch caption

I feel that the caption to the patch is misleading. Numerous states (California and Texas, for example. Albeit Texas also has a "Licensed Paramedic" level for college educated medics (2 year EMS degree or any 4 year degree)), as well as the National Registry, officially recognize the level as EMT-Paramedic. As well, numerous state patches reflect this designation. State and/or agency patches differ between them as to design, including the designation of the levels (EMT-Paramedic vs Paramedic or EMT vs EMT-Basic). As this is supposed to be more of a national article, I feel that the current wording and caption are out of place in the article. JPINFV (talk) 05:16, 4 March 2008 (UTC)

Please suggest an alternative wording for the caption. The issue is confusing to the public primarily because, contrary to the legal designations, paramedics are not called EMTs in the field. Example, if a BLS crew is calling for ALS, they might say "send me a paramedic" but not "send me an EMT" (though technically, paramedics are EMTs of the highest order). The point is to emphasize in this article that there is an ostensible difference between EMTs and Paramedics in the field. In NYC, the paramedic is officially an AEMTP, but they are simply called paramedics. Nurses can be either ASN, BSN, MSN, CCRN, CEN, etc., but they are still nurses in the public eye. There needs to be some simple standard for differentiating between ALS and BLS, especially now (as you pointed out) that there are even 4-year paramedic degrees in some areas. Forget the public, there are doctors who couldn't tell you the difference between "paramedic" and "EMT" (basic) to save their lives, and this is more than a mere pretention in the highly structured ranking system of medical care. The patch was put forth to simply show that paramedics have their own unique patches to designate their level of care, it was not meant to say that all patches say "EMS Paramedic, City of New York" -- although I see your point. Alexfox29 (talk) 01:23, 6 March 2008 (UTC)
My problem with the patch is that the caption is boarder-line factually wrong from a national prospective because there are plenty of patches that retain the EMT-Paramedic designation. Given that it's a national article, I'm not opposed to a blurb about different nomenclature in standard practice, but the caption seems to be worded as 'paramedic patches exclude EMT to avoid confusion.' I'm not going to argue that paramedics are generally called "paramedics" while Basics are generally called "EMTs." Of course this doesn't even address the fact that each state has their own intermediate/alternative designations (EMT-CC, EMT-IV, EMT-I [roman numeral 1, not intermediate], EMT-II [2. roman numeral examples are the legislative name for Basic and Intermediates in California]), EMT-I85, EMT-I99, etc). As such, I think that the NHTSA/NREMT (yes, two separate entities, but more providers are familiar with NREMT than NHTSA and the NREMT's guidelines stems from the NHTSA) levels are more appropriate for articles with a national scope. I've got an exam tomorrow morning and I'll see what I can put together as an alternative sometime soon (I'm looking at expanding the "skills" section and am tempted to seek renaming it to "procedures"). I do think, given proper support (i.e. not stubs), that there is more than enough difference and material for a state by state page on EMS. Looking at the edit, I can't speak to what intermediates are called (are they called "EMTs" or by their designation?) since the area I worked in didn't/couldn't [California EMT-Intermediates=limited ALS" which required an express reason and approval from state EMSA for a county to certify them] utilize them.JPINFV (talk) 04:16, 6 March 2008 (UTC)
Your reasoning is understood. This is a gray area that is even more gray between regions, and it's difficult to nail down. Paramedics are EMTs, yet they're not called EMTs in practive. A common phrase heard in the field is, "Are you an EMT or a Paramedic?" Many people, and many physicians and nurses, don't know the difference. Intermediates were called "IV-techs" in one of the regions I worked in; there are "Critical Care Techs" in another region. New York City EMS and FDNY only use the EMT and Paramedic designations. I've put my two cents in from my region, so I will leave it to you to shape it the way you see fit as someone who represents a new set of eyes and a distant region, and maybe we can thow a little NHTSA/NREMT in there to create a more nationwide perspective. Alexfox29 (talk) 07:50, 6 March 2008 (UTC)
I removed the reference to EMTs in the patch caption and tried to soften the EMT versus Paramedic statements to leave room for the ambiguity between official level of care designations and typical field jargon. Feel free to adjust further. Your points on this were well made. Alexfox29 (talk) 15:07, 6 March 2008 (UTC)

[edit] Paramedic vs RN?

In the following excerpt:

Paramedics in the United States, working independently and under the direction of emergency medical control physicians, generally provide the most advanced level of emergency medical care available to the general public outside of a hospital setting (flight crews utilizing registered nurses, mid-level providers (PA, NP) or physicians being the primary exception).

I'm not sure that it is universally agreed that registered nurses constitute a higher level of care than paramedics. With due respect to nurses and paramedics alike, I'd like to remove "registered nurses" from the example of when a higher level of care is available. Thoughts on this? Alexfox29 (talk) 01:40, 6 March 2008 (UTC)

Is it not true, though, that flight crews generally provide a higher level of care, in terms of knowledge, critical care/emergency experience, and skill set, than ground ambulances, and that a characteristic component of flight crews over ground ambulances are the presence of a flight nurse, mid level provider, or physician (of which are generally not found on emergency ambulances)? JPINFV (talk) 03:58, 6 March 2008 (UTC)
Your point is not unreasonable. I don't dispute that flight crews can be more skilled than ground crews, often because they were hired with a great deal of EMS or critical care experience already under their belt. And it is true that the provider components of many flight crews are exactly as you have enumerated. However, I think the way the entry was made, it could be interpreted to mean that the RN, when utilized, represents a higher level of care in the field than the paramedic. While a handful of EMS flight nurses may rival paramedics (and may actually be paramedics themselves), can nurses really provide a higher level of EMS care than paramedics in any meaningful way? This is an honest question, so if you have specifics as to the different skill sets, please fill me in. Also worth remembering, mainstream RNs, PAs and MDs facing medical emergencies regularly reliquish care to paramedics, so I think we have to be careful about giving the impression that in any field context where RNs (or even PAs and MDs) are utilized, they necessarily represent a higher level of emergency care than paramedics. Alexfox29 (talk) 07:38, 6 March 2008 (UTC)
How would something like this be? "Paramedics.. working independently and under the direction of emergency medical control physicians, generally provide the most advanced level of emergency medical care available to the public outside of a hospital setting, although in some cases EMS flight crews utilize advanced level providers such as physicians." Alexfox29 (talk) 15:25, 6 March 2008 (UTC)
That would work.JPINFV (talk) 02:29, 7 March 2008 (UTC)
Coming from someone who works on a flight team, most states and agencies require the RNs be trained as EMT-Bs, Is or Paramedics before they can fly, with special experience areas in Critical Care (ICU, PICU, NICU) or ED work. These aren't just regular floor RNs that fly. Also, Flight Paramedics have certifications and advanced creditials all their own, expecially those services that are CAMS or CAMTS accredited. But, you have to remember as well, there are specialized ground transport teams that work for corporations such as Rural/Metro, and specialty hospitals such as Mercy Childrens or Lebonheur Childrens that also run ground EMS Critical Care transport trucks as well. I think limiting this article to just the definition of the Street Paramedic is misinforming people. Also, alexfox29, I don't know of very many flight teams that are rotar-wing based that utilize physicians in the transport. Most utilize an RN/Medic model, or an RN-Paramedic and Respiratory Therapist if it is a Pediatric team. Physicians are more common in smaller hospital or rural area transport teams, where there may be insufficient trained staff to staff a MICU truck.

198.254.16.200 (talk) 14:48, 10 April 2008 (UTC) Chance Gearheart, EMT-IV, LeBonheur Childrens Medical Center Pedi-Flite Critical Care Team

One thing to consider, though, is that numerous emergency medicine residency programs require time, both as a provider and observer, on ambulance and aeromedical units. While these physicians aren't board certified yet, they are licensed physicians (assuming that the physician isn't PGY 1). Overall, the article, like most of the EMS articles, really needs a complete rewrite with proper sourcing. There should be way more than the 15 references already included. Even the EMT article is over 30 references and doesn't cover nearly the scope of this article. -JPINFV (talk) 15:58, 10 April 2008 (UTC)

RN v Paramedics part 2. Simply put, licensed physicians do make up parts of flight teams in plenty of systems with emergency medicine residencies. The physicians in these cases can very well be fully licensed physicians, and as such, represent the highest level of medical care. Furthermore, there are systems that only use paramedics. In terms of medical control, the system's medical director (again, physician) ultimately determines what paramedics can and can't do and what they have to call in to do, if they even need base hospital permission at all. Out side of systems (cough, Southern California, cough) that extremely limit any degree of latitude in patient care without base hospital contact, it is very probable that a paramedic will be talking to a physician, not a registered nurse. JPINFV (talk) 03:28, 14 May 2008 (UTC)

[edit] Fair use rationale for Image:NYCEMS paramedic.jpg

Image:NYCEMS paramedic.jpg is being used on this article. I notice the image page specifies that the image is being used under fair use but there is no explanation or rationale as to why its use in this Wikipedia article constitutes fair use. In addition to the boilerplate fair use template, you must also write out on the image description page a specific explanation or rationale for why using this image in each article is consistent with fair use.

Please go to the image description page and edit it to include a fair use rationale. Using one of the templates at Wikipedia:Fair use rationale guideline is an easy way to ensure that your image is in compliance with Wikipedia policy, but remember that you must complete the template. Do not simply insert a blank template on an image page.

If there is other fair use media, consider checking that you have specified the fair use rationale on the other images used on this page. Note that any fair use images lacking such an explanation can be deleted one week after being tagged, as described on criteria for speedy deletion. If you have any questions please ask them at the Media copyright questions page. Thank you.

BetacommandBot (talk) 14:58, 8 March 2008 (UTC)

This was resolved. Alexfox29 (talk) 07:32, 10 March 2008 (UTC)

[edit] Added section on Critical Care/flight Paramedics

I added some information on Critical Care Team certification and Flight paramedic certifications to the Professional Discrepancies section. Feel free to move it or give it it's own section if you'd like. I'm ashamed of you EMS people out there. There are actually SEVERAL different professional branches for Medics, like Tactical Operations, Wilderness Ops, Flight Medicine, and many other! 198.254.16.200 (talk) Chance Gearheart, EMT-IV, LeBonheur Childrens Medical Center Pedi-Flite Critical Care Team. —Preceding comment was added at 14:45, 10 April 2008 (UTC)