But first- The Pedro "I wouldn't want to hurt anyone's feelings" Disclaimer
I like and respect EMS providers of all levels- I started my career as an EMT-B, worked my way through Medic class and now work as an EMT- P. I like it, I like you... ok?
There's been alot of talk around the ol' neighborhood about fixing the Paramedic shortage by training EMT-Basics (B) to the EMT- Intermediate (I) level. I believe that there has already been one state that promoted all of their EMT-I's to Paramedic- because that was the only way they could get any Medics on the trucks. Well there's a flaw in that approach- I'll get to it, but first...
My partner and I walked into the EMS room of a major inner city hospital following a call. The ER was busy and the ambulance bay had been filled- as was the EMS room. The conversation seemed to be revolving around, what else, the EMT- B scope of practice.
One EMT-B, who was apparently from out of state, said "Back home I can start IVs", another EMT answered that "Back home I can intubate, well, Combi-tube anyways"
My partner that day was a hard core, long term city medic. He's also a really big guy with a pretty low tolerence for BS. He took a slow look around the room and then said " You idiots are all sittin' around here braggin' about monkey skills. Can any of you jackasses do a f****** Paramedic, ALS patient assessment?"
Ah- and there is the problem. You can teach a monkey to do an IV or to intubate- they could probably do it while riding in circles on a little bicycle. But you can't teach a monkey how to do a patient assessment- and it's the assessment that saves lives. It's the assessment.
So, here we are. On one hand we have a dwindling number of experienced Paramedics, who have done the training, the clinical time, the days and nights on the trucks to learn the ART of pre-hospital Advanced Life Support. And on the other hand we have the Dinosaurs who run EMS- the same folks who have made the field inhospitable enough to cause our current shortage.
The answer? Hell I don't know, but if you want a circus send in the monkeys- we've already got the clowns.