Does this story sound a bit ridiculous? It should, but the sad fact is that it is a true story. Every single day, thousands of people that do not require any type of emergency or even basic medical care use ambulances for transport. You may be asking yourself, “How do people afford to pay for these transports?” The simple answer is that in almost every instance, the “patients” carry Medicaid for payment.

Medicaid, sometimes referred to as “The Gold Card” by medical service professionals, was designed to help make sure that even those that cannot afford health insurance receive needed medical treatment. Though Medicaid is funded by a joint effort between state and federal programs, the costs are ultimately placed upon taxpayers.

What is a paramedic?

Paramedics are among the most highly tried emergency medical professionals, outside of a hospital. Their training is centered on providing treatment to critically ill and injured patients. Due to the amount of time and effort required to complete the paramedic program, they are also some of the most sought after emergency professionals. Most cities employ only a small number of paramedics in comparison to other levels of responders. In most cases, especially in small to medium sized cities, there will only be one paramedic on duty that is responsible for providing coverage to their contracted area.

The training required to become a paramedic is rigorous. Aside from classroom hours, paramedics are also required to volunteer long working hours at hospitals and on ambulances under the guidance of mentors or preceptors. Their training allows them to utilize advanced airway systems, provide cardiac monitoring, applying various pharmaceutical treatments, and performing advanced trauma care. They are masters at treating patients in any type of emergency situation, and are often called upon, even by skilled doctors, to use their skills to start difficult IVs or obtain compromised airways. Many medical professionals, such as nurses and doctors, will freely admit their admiration for a paramedic’s ability to perform such techniques in the back of a moving ambulance with such precision.

Although there are a great many “career” paramedics, many others are using their experience as a paramedic to help propel and guide them into advanced emergency and medical careers. Some go on to become doctors, while others move on to advanced careers in Emergency Management. Paramedics often proceed to become nurses, utilizing a paramedic to rn program.

So why do people so often use a paramedic ambulance as a taxi for non-emergent transports?

There is no simple answer as to why so many paramedic ambulances are used on non-emergent, or convalescent transports. If you ask a paramedic, he will probably tell you there are a few reasons.

• Often times, the person requesting the transport cannot afford to drive themselves, or may not own their own transportation. It simply becomes too easy for them to pick up a telephone and schedule the ride.
• Many ambulance providers see these types of transports as “guaranteed money.” Since Medicaid is funding the transport, the provider is guaranteed payment. That means the provider will rarely have to worry about using the legal system to obtain payment.
• The system Medicaid has in place, allows providers to simply complete the needed paperwork, and then file the payment request online. Most times, this means that the request for payment and processing is made on the same day as the transport. Quite simply, it is fast, easy, and guaranteed money.
• Many times, the people abusing the Medicaid system lack the sort of responsible decision making skills that prevent others from doing the same.
• Medicaid continues to allow this type of abuse. Since it is considered a covered expense, many are more than willing to take full advantage of it.

The scenario described earlier in this article is not the only one of its kind. Each day, paramedics are called for emergency responses only to find patients openly abusing the system. While talking with Jerry, the paramedic noted at the beginning of this article, he began to tell me of other instances.

Jerry recalled a response recently where he was called out during the middle of the night for an unconscious male patient lying on a sidewalk. Upon arrival, jerry noted that the patient was a “frequent flyer”, a patient who calls often and sometimes daily for creative reasons. On this occasion, Jerry noted that his patient first complained of chest pain. After providing basic treatment, the patient refused more advanced care. Jerry loaded the patient in the ambulance and proceeded to transport him to the hospital.

After arriving at the hospital and turning the patient over to hospital staff, Jerry began to complete his documentation. Shortly after starting his documentation he noticed the patient was no longer in his hospital room. Upon inquiring with hospital staff, jerry found out that the patient had signed himself out of the hospital without any medical treatment given. It was then Jerry realized that the patient had a new address, and was now living across the street from the hospital. Jerry could only surmise that the patient had simply used the ambulance as a means of transporting him across town, so he could be closer to his home. Since then, the patient has made many more calls for similar reasons. All of the calls end in a similar fashion. It is now obvious to Jerry and his co-workers that this patient uses the ambulance service, and Medicaid, as a means to gain transport from one side of town to the other.

Why is this abuse of Medicaid allowed to continue?

Medicaid abuse occurs because current laws protect those who abuse it. Using the patient above that uses Jerry’s ambulance as a means of getting across town, let’s imagine this scenario. Suppose this same patient would call for an actual emergency. Is it really feasible to allow the paramedics to refuse treatment or transport? The scenario brings forth a sort of “Boy who cried wolf” situation. If the paramedic refused transport, the patient could suffer dire consequences and possibly even die as a result. This is just too much of a liability and no paramedic or ambulance provider is willing to take that risk.

Patients willing to abuse Medicaid also have rights that protect them from being refused. Currently, it is unlawful for a patient complaining of an emergency symptom to be denied medical care. According to Medicaid, ambulance transport is included into the scope of “medical care.” And, since Medicaid providers are required to perform all medical interventions covered by Medicaid, they risk losing the ability to charge for Medicaid covered services.

How can we stop the blatant abuse of our Medicaid system?

The current economy in the U.S. dictates that we must find ways of improving our government expenditures. Finding ways to curb government spending, thus putting money back into the pockets of Americans, is the only way to recover from the current financial situation. If we want to ensure the financial security of our great nation, we must find ways to stop frugal spending and outright abuse that has caused so many problems.

Some possible ways of eliminating or reducing Medicaid abuse and fraud are:

• One of the first things that could be used to stop Medicaid abuse is a comprehensive audit system. Although there is currently a system in place to perform audits on Medicaid spending, the system is obviously failing.
• Create a closer working relationship between Medicaid, and providers of Medicaid services. There is no doubt that online filing and billing systems have streamlined procedures between providers and Medicaid, but they have also lessened the contact between the two. With such a robotic system in place, contact between them has been diminished.
• Stop the current “blanket” coverage that Medicaid currently has in place. By forcing all treatments to first be audited, before being approved for payment, fewer people would be willing to risk having to pay the bill themselves.
• Enforce consequences to those found to abuse Medicaid. The more people realize the consequences, the greater the chance they will resign themselves from abusing the system.
• Create a county level Medicaid audit system that can interact with providers. Leaving all of this to a system that is often hundreds of miles away from a provider causes problems.

As long as there are people and options, such as Jerry and Medicaid, there will always be those who try and abuse them. As time goes on, people become smarter and more effective in their endeavors to cheat and abuse the systems that are in place. Only by due diligence and persistent measures can we hope to combat these types of abuses. We have a responsibility to our children’s future to help create a secure and stable financial system for them. We must constantly adapt to needed changes, and stay educated in the means it takes to prevent things like Medicaid abuse.

As for Jerry, he says that he plans to retire as a paramedic. Doctors, nurses, and paramedics alike, have all voiced their concerns with the healthcare system in the United States. But, despite his frustrations with a broken health care system in the U.S., Jerry claims that he still truly loves his job. He says that the personal satisfaction he gains from helping those that need him will always outweigh any political and social problems that medical professionals face each day.

Share your thoughts on Medicaid abuse.

For the next year I volunteered my time. On almost every shift I volunteered, I was placed on a truck with just myself and a tech. I loved it, and learned the ropes of EMS along the way. It did not take long to realize what I wanted to do for the rest of my life, and I enrolled in the first EMT course I could find.

Becoming an EMT

In late 1990, I completed my EMT-Basic course. Although I did not immediately get hired into the department I had been volunteering at, I had no problems finding work at other departments. It seemed that almost every EMS department around was in dire need of EMTs, and having any kind of experience was something that none of them cared about. I took a full time position and without any type of “warming up” period, I was now beginning my new career.

The new service I was working for was much like the previous. I had a certification, and that was enough. Despite my lack of experience as an EMT, my partners often had even less. While no issues ever came up, I knew even then that something in the system was flawed.

Becoming a Paramedic

Just 1 year after becoming an EMT, I began to look for any Paramedic programs that had openings. In 1992, I was accepted, and by mid 1993, I was a full-fledged Paramedic that was ready to jump into my new position.

I was immediately hired back on to the county 911 service I had originally volunteered at. The training process was little more than riding a few hours with an experienced Paramedic to prove I was capable of handling things on my own. In fact, I had only ridden a total of 24 hours, when an emergency came in while we were short staffed. I was immediately cleared to function on my own, and was now cleared for “solo” duty.

I spent many of my adult years working as a Paramedic. Along the way, I met some really brilliant Paramedics and EMTs. However, I also met many more than I knew really had no business working on their own. The problem is that guidelines must be followed, and until someone makes a serious mistake, there really is not anything that can be done.

A mistake: What does that mean when dealing with the lives of patients?

Why I feel modern EMS is broken

I retired from EMS in 2006. I have to say that I truly loved the career, and to this day, I am still pro-active in supporting EMS. However, I do believe that changes need to be made, as NOTHING seems to have changed since I first started driving ambulances in 1989. Here are some examples of my views and opinions.

1. Training processes at all levels of EMS need some serious reconsideration: Every instructor I ever had or met was brilliant. The problem with EMS training lies in the requirements for completion, and even more, the requirements of various providers on releasing EMTs and Paramedics onto the streets. At every stage in the process, there are entirely too many people that have the ability to make subjective decisions on whether or not an EMT or Paramedic is capable of being released to work on their own. It leaves too much room for error, and even worse, it leaves too much of a margin of error. It also leaves too much leniency for liability.What needs done: Training requirements need to be more standardized. A person should NEVER be released to perform patient care without being fully trained and proven to be able to provide it in a more prudent manner.
2. Liability: If a cleared Paramedic is right out of school and is working the streets, then who is liable for his/her actions? During my career, I never met, or heard of, a Paramedic carrying liability insurance. It was just assumed that we would either never be held liable, or the service we worked for carried it for us. This is not the case. In fact there are some gray areas in laws that are taken advantage of when it comes to liability. Sure, the service we worked for carried liability insurance, but only to protect them. Had I ever made a serious mistake, I would have been held liable for my actions without having any type of malpractice insurance coverage to protect me. There is no requirement for it, and there should be.What needs done: There needs to be clarity on liability of EMS professionals. There should not be any gray area around this topic. We live in a world that includes people who are willing to sue, just to try and get rich. With the current situation, a frivolous lawsuit upon a Paramedic or EMT would not make anyone rich, but would perhaps ruin the career and financial security of a great person.
3. There was a time when I thought I might like to work in another state. Surprised to find out that the state I wanted to work in required licensure for their Paramedics. This meant that my current Paramedic certification was nearly useless, if I wanted to move. The reciprocity procedure would have required me to pay some money, take some tests, and then take an additional course to become “updated.” Huh? I thought I had already taken all the tests needed to be a Paramedic. Am I to believe that a sick person in Tennessee gets different treatments than a sick person in Indiana?What needs done: training of all EMTs and Paramedics in the nation needs to be more standardized. It also needs to be governed by a single body that outlines proper procedures. This is something that is detrimental to patient care, and should be a top priority in insuring that ALL EMS professionals are trained in the same patient care techniques and receive the same updates, across the country.
4. There is a National Registry of Emergency Medical Technicians, but why? If you ask them who they are, they will absolutely deny that they set any kind of standards or regulations. All they will claim to be is a group that does testing. Many states require a NREMT certification to become certified in their state, but yet they do not require you to keep the NREMT cert updated. In the state I worked in, I carried 2 certifications: One for the state, and one for the NREMT. After I was tired of paying the $45 re-certification fee to the NREMT, I stopped re-certifying it. There was no need. It was not a requirement to maintain in my state, and it did not really help in reciprocity to another state, so why even bother with it? Also, a Paramedic or EMT can let their cert expire for many years, yet only be required to take a very short refresher course to become certified again. There is no way that a person can retain enough information after such a long downtime that a ‘refresher’ course can get them back up to speed.What needs done: I feel that the current situation regarding the National Registry is a joke. There really is no other way for me to say it. I do not think we need an entity like the NREMT to “just do testing”. I think what we need is someone like the NREMT to handle teaching, testing, and governing, all done by one single entity. For lack of better words, EMS needs to have fewer “hoops” to jump, so that the focus can be primarily on training, and not on legalities.
5. While talking to a Paramedic from another state, I was shocked to find out that Paramedics in their state were not allowed to intubate. What? Isn’t intubation a staple in the Paramedic’s lifesaving care that is the top priority of all Paramedics? After all, the first thing they teach you is the ABC’s: airway, breathing, and circulation. Intubation is often required to maintain a clear airway. Why is it that some states allow Paramedics to do some skills they have been trained to do, while other states do not? Should a paramedic be a Paramedic, regardless of where they are?What needs done: Treatment of patients by EMTs and Paramedics across the country should only change when it is necessary for environment or region. In other words, providing oxygen to a patient in Alabama is no different to providing it to a patient in Missouri, so why do the treatments vary so much?
6. Documentation is extremely flawed. While chatting with a Paramedic from another department, after a mutual aid run, I was shocked to see that their paperwork was a mere 3 forms to fill out. The service I worked for had a whole bundle of paperwork that needed completed after each run. Why is it that requirements for details and patient information are different, depending on the service and location? Also, it is my belief that documentation protocols are directly related to how easy we can make it on the billing secretary of the provider. The most time consuming part of paperwork is done for billing purposes, and has nothing to do with the transfer of important patient information between health care professionals.What needs done: Paperwork and documentation procedures need to be the same across all EMS platforms. One service should not be required to gather different information than another. Too many times, we see that a volunteer service that does not bill patients are required to only document patient care, yet other services spend thousands of dollars a year on documents that help billing purposes.
7. Protocols are something that are created in tandem between the sponsoring hospital and the service provider. However, protocols vary widely between one service and another. This is wrong, and we have known it for years. Obviously certain treatment protocols are bound to vary a little, depending on the treatment guidelines of each hospital, but why are Paramedics in some services given the “go ahead” for multi-dose Epinephrine, while others are required to use bare minimums. Why do some services promote the “stay and play” philosophy, while others emphasize “load and go”?What needs done: the way protocols are currently in place, leaves too much variance between providers. When involved in a mutual aid run, there should not EVER be a reason for the two departments to argue “My protocols say we get to sit on the scene and stabilize the patient”, while the other states “our protocols say we have to load the patient and get them to the hospital quickly”. The idea of scene time is only the beginning of the arguments on why protocol procedures need changed, but in my opinion, it is a good start.
8. Supporting certifications are additional certifications that can be obtained by EMTs and Paramedics. Examples are, ACLS, BTLS, PhTLS, PALS, etc… Not all services require the same supporting certifications. In fact, many only require their state’s minimum. In the state I worked, the only supporting cert. we were required to carry were CPR and ACLS. However, many other providers required a whole different set.What needs done: All EMS providers should require the same set of supporting certifications among EMTs and Paramedics. The only variance on this would be to suit environmental or regional needs. An example would be that if a Paramedic is working for a pediatric hospital, then PALS would be required. However, in my opinion, there is no reason why the basic supporting certifications should not already be included in a Paramedic program, and re-certified automatically by completing re-certification for your Paramedic cert. Examples of the basic supporting certifications would be: CPR, ACLS, and PALS. Having all of the current supporting certifying bodies does nothing but offer a means for those governing bodies to make money from courses and re-certification processes. A Paramedic should know how to perform CPR, and it should be the most basic requirement for Paramedic certification each year. We do not need the American Heart Association or the American Red Cross to be separate certification options. Pick one as the standard for a Paramedic cert. include it in the EMT or Paramedic program, and include the re-certification in the annual or bi-annual re-certification or licensure for the Paramedic, not a separate cert.
9. If you really stop to think about it, the job of a Paramedic is really a “dead-end” job. Because of the extreme differences between states in requirements, there is no real way for a Paramedic to insure his/her future in medicine. Some states require certification, others require licensure. Some states require NREMT certification, while others do not. Some providers are beginning to require college level education, while other never will. All this does if blur the lines of whether or not an EMT or Paramedic is a legitimate profession, and offers no real means for a Paramedic to advance. Because of this, pay rates for EMS are nearly frozen in time, as providers know that there are so few choices.What needs done: Currently, the only viable options for EMTs and Paramedics are: Using their experience to get one of the few jobs at a fire department, which may offer more alternatives in the future. Taking advantage of the few actual college programs, such as the EMT to EMS Management or the Paramedic to RN. EMS training needs revamped to give EMS professionals a long standing future. The current design, for lack of better words, is designed for young people that can afford to spend some time in EMS before moving on to a new career which would provide for a family. Training needs to be designed so that it provides a means for EMS professionals to advance.
10. Lastly, let’s discuss patient care. Patient care is the single most important factor in why we are even on the streets. Why is it that there has never been a standard in how QA is performed among providers? QA/A&R is an integral part in ensuring that proper patient care is always being performed. It COULD be a way that EMTs and Paramedics learn from medical directors and peers. Instead, in many providers, it is simply a way that other EMTs and Paramedics can subjectively pick apart another’s patient care or documentation. Rarely do Paramedics and EMTs get “Official” treatments that are new. In other words, I cannot recall a single time in my career where my certifying body contacted all Paramedics to say “We have discovered something new that all EMTs and Paramedics need to learn.” Instead, once you receive a certification, the knowledge you gain from then on is left up to you and your sponsoring hospital. This makes it difficult to stay up to date on new patient care techniques, and to maintain the ability to provide the very best care to our patients.What needs to be done: QA/A&R should be a requirement across all providers, and not just an option. It should also be redeveloped into a standard format that is provided as a learning tool, and not as a tool that can be used as a contest between EMS crews. I once overheard the crew from one shift bragging about how only 2 of their run reports had been pulled for A&R; while the crew from another shift had 4 of theirs pulled. This is a detriment to patient care, and it only serves to either boost the egos of some or derail the confidence of others.

The rest of the story

In 2006, I not only retired from EMS, but I also allowed my certification to expire. I have since remained active in the EMS community. I love the career I had. In fact, I would say that I am extremely passionate about it. I loved every aspect of it, including the people I worked with, the patients I had the pleasure of meeting, and even the training I had to undergo. However, it saddens me to see that nothing really changes. Many brilliant people fought so hard to carry EMS from the 1960s to what it is today, yet nothing has really changed in the past 20 years. Sure, new equipment, new trucks, better radios, better ways to diagnose (oops, did I just use the “D” word while talking about EMS?), but has anything really changed?

I will forever be happy that I had the opportunity to be involved in such a remarkable career. It taught me things about myself, and about “the ways of the world” that many people live sheltered from. I had the opportunity to be part of a “brotherhood” that will forever remain in my heart. I love what I was able to do for patients, and how I may have affected the lives of countless people in the world. But most of all, I like knowing that I may have saved the life of someone who may someday save the life of another.

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“I went to nursing school due to my desire to move forward and be more productive with my knowledge and skills. I love being a medic, but I also enjoy both ends of the spectrum. Both positions keep me sharper in regards to the other; they are a good mixture for me.”

John chose a bridge program from paramedic to ADN through a local campus, but for his BSN, John is going to school online. Having weighed all of his options against a grueling schedule, John found the convenience of online education too perfect to pass up.

“Online courses have allowed me to continue my education. With the combination of my busy life and lack of time or ability to attend the brick and mortar (conventional) setting, my education would have been stalled.”

Andy Wiegand is another firefighter-paramedic, 31 years young, and considering nursing school. Andy was my paramedic student protégé nine years ago in a Detroit Trauma Center. I shared my best tips and secrets, and Andy’s older sister Tracy, a RN in the same ER, reinforced the value of education. Andy wants to expand his knowledge base and proficiency, but is also concerned about two things we all ponder at one point or another: more money, and better job security. The median nursing salary last year was $62, 450.

“There are budget cuts happening in the township where I work. They are laying-off nine people. I’m not one of the nine, but if they lay off more, I could be in line to be cut.”

Paul Sorrell, a paramedic for 25 years, is preparing for a medic to RN transition program. Working several years for a private ambulance company in Southfield, Michigan, Paul completed 2.5 years of a traditional nursing program 20 years ago before leaving due to professional conflict.

“The clinical coordinator was a lady who felt that men did not have a place in society as nurses, and I was getting sub-par evaluations on clinical rotations. I would do the exact same stuff as other students, the same way, and get much poorer marks.”

A man in emergency medicine does not translate exclusively to either paramedic or doctor anymore; more men these days are nurses. These changes have encouraged those who have served many years as paramedics, like Paul, to continue to do what they love in a related branch of medicine.

“I want to get into an ER and get back to some real patient care, and Online courses have allowed me to continue my education…with the combination of my busy life and lack of ability/time to attend the brick/mortar setting my education would have been stallethen complete my BE (bachelor’s in education).”

Being an educator has been part of Paul’s life for almost as many years as he has been a medic. As we spoke, Paul was conducting a paramedic refresher course. The dual-licensure of paramedic and RN opens up a world of opportunities for educators with a strong background in emergency medicine.

There is a growing trend for paramedics to expand their knowledge and level of licensure. When I completed that path 15 years ago, paramedics whispered among themselves about going to nursing school. Now more paramedics view nursing as a logical next step.

“We have had two other FF go to nursing school after me; seems as though a trend is emerging. Though the online transition from paramedic to RN can certainly present challenges, the rewards of furthering your education can only benefit you as a professional, and those you care for and serve.”

There is never a convenient time to fit school into one’s schedule. Nobody knows what tomorrow may bring, so working toward a better future, and becoming more marketable while enhancing skills and professionalism now as opposed to later, is imperative.

John’s last words to me prove my point. Ending the interview, John said, “Gotta go: CPR in progress.”

From reading the article, it is alleged that an EMT acted not only illegally, but extremely unprofessionally. Thankfully, the driver of the ambulance involved reported the incident, even before the patient did. So, I think the driver deserves recognition for upholding the high standards that represent public servants.

Reading the comments of the article, you can already see how the actions of a single individual can have such a negative impact on the profession. Already, there are people screaming to change ambulance services for the town. It is depressing to know how hard EMS has fought to gain the respect of the community, and how easy it can be torn down by a single act of one person. One commenter claims it places a “black eye” on the profession as a whole. Regrettably, I could not agree more.

Emergency responders need to consider a few things when going out on call. We are there to help those that rely on us. When our car, truck, engine, ambulance, or even helicopter leaves the station, all eyes are on us. You have to not only conduct yourself in a legal manner, but all of us in public service need to act in a manner that brings pride on our profession.

I certainly hope the patient/victim of this incident can move past this and use it to help promote something positive. I also hope that if this EMT is guilty, he pay for his actions in not only the eyes of the law, but also for the hurt and shame he has brought upon the rest of us.

Read the full report by the paper here.

Written by: HemiMedic

Contributing Author Public Safety Blog

We responded to a local convenience store for a person being disruptive. Upon arrival, law enforcement was there, and advised that we needed to check the patient out. After an exam, the only thing we could conclude was the possibility of some sort of brain injury or even more possibly it was some sort of illicit drug reaction.

The patient presentation was:

He was walking and talking at the scene, but was confused. Although the patient could readily say his correct name, address, and d.o.b, he could not tell us the correct year, the city he was currently in, or why he was at the convenience store. His speech was slurred, but he did not show any other signs indicating a possible stroke. He was also somewhat combative, in that he tried numerous times to walk away, and became aggressive when we tried to stop him for further evaluation. The patient’s vitals were normal, given the current circumstances, and the slightly elevated heart rate and blood pressure did not alarm us.

We eventually managed to convince the patient to allow us to transport to the ER, so we placed him on oxygen, started an IV and loaded him up. During transport, the patient had a period of unresponsiveness. The heart monitor was applied showing a sinus rhythm with an occasional pvc. It was only about a 10 minute transport time, so no further treatment was given.

Later at the station

A couple of other Paramedics, EMTs, and me were sitting around station. We had not given a lot of thought about the patient we transported earlier, as it did not seem like anything really out of the ordinary for a Friday evening.

The phone rings, and it is the emergency room. It was the charge nurse giving us an update on the patient we had brought in. Apparently, very soon after we dropped the patient off, he suffered a cardiac arrest. Despite efforts by the emergency room staff, they could not resuscitate him and he was pronounced dead. The diagnosis was Water Intoxication!

I had a hard time comprehending how someone could have died of this, so I did some reading, and a background check on our patient. From the reports of the family, the patient had recently become obsessed with drinking water as part of a diet plan. They claimed he was drinking several gallons daily, but they had never given much thought about it being dangerous. Now, I may not have been taught what water intoxication is, but with my training and some common sense, I did understand how that much water could be harmful. It dilutes just about every electrolyte in the body. Working especially against sodium levels, it causes hyponatremia. While it certainly can be dangerous, it is rarely fatal. However, in the case of our patient, untreated for weeks, this was a fatal mistake.

Along with learning about water intoxication, I also learned another important thing that night. It does not matter how long we have been doing what we do, or how many runs we see, we have NEVER “seen and done it all”.

The role of a Paramedic in today’s EMS structure is at the top of the employment ladder. In the past, this has been because the Paramedic has extensive training in advanced procedures that other levels of EMS workers simply did not have available. Now, much of that has changed. EMTs at virtually every level have education and skills available to perform those advanced procedures, tightening the scope of practice between those levels.

Closing the gap between Paramedics and long term health care

Where does this leave Paramedics? The Paramedic to RN Bridge online is helping to close the gap between Paramedics and long term health care. As basic EMT levels receive the training that was once only available to a Paramedic, it allows Paramedics to look further into health care. Making this option available to Paramedics not only helps solve staff shortages in long term care, but it also enters in a new king of nursing professional: One that has the experience in handling emergency situations in virtually every type of setting.

The online Paramedic to RN Bridge program made available by The College Network and Excelsior College offers Paramedics the chance to enter a nursing industry that, before now, was just simply not available. A Paramedic can now finally use the knowledge and skills they have learned throughout their career and training towards an accredited nursing program, thus shortening the RN program so that a Paramedic can become an RN in as little as 1 year.

What does this do for EMS and health care?

The Paramedic to RN Bridge seems to be giving health care another inlet in finding qualified professionals. It opens doors in long term care to professionals that were never before available. Previously, the idea of an EMT or Paramedic transitioning into nursing meant they had to basically start from scratch in terms of education. The Paramedic to RN Bridge finally recognizes the training and hard work that Paramedics have put into their career, and rewards them with an education and a whole new career.

The Paramedic to RN Bridge offers benefits in every aspect of providing health care to Americans. Patients benefit because of a decreased nurse to patient ratio, nurses benefit because some of their huge job load can be reduced by having more nurses in the industry, Paramedics are no longer at the end of their role in medicine and can find new careers, and basic EMTs see their scope expanding into areas never before available.

Are you a Paramedic that is now ready to move on to a new career in nursing? Contact the College Network today!

To summarize, a husband, who is also an emergency medic, noticed his wife displaying stroke like symptoms. Since his wife is a cancer patient, the medic knew the potential seriousness of her symptoms. Deciding that he could be at the hospital 20 minutes before an ambulance could have them there; he loaded the wife into the car and took her in. He used his flashers, but did not heed normal traffic regulations. According to the officer in question, the man ran a couple of stop lights, and nearly caused the officer to crash. Upon arrival at the ER, the husband carried the wife into the ER, and did not stop when the officer requested. In fact, claims the officer tried to physically stop the man, yet the man shrugged him off and went in anyway. So, now several felony charges have been filed by the officer against the husband.

To Call or Not to Call an Ambulance?

I think that it is safe to say that all of us in EMS have asked ourselves, or talked among our crew mates, did that person really need an ambulance and couldn’t they have gotten there quicker on their own?

I myself have been guilty of these same questions. One example is a call I received right across the street from the hospital. It was for a boy who had cut his arm pretty severely. When we arrived, the wife, who was a nurse, had the bleeding contained, and the boy was somewhat calm. We loaded him up and took him for the 30 second ride across the street. Basically, he needed absolutely zero care from us, and all we did was provide the ride. Afterward, my crew and I talked among each other and wondered why. We all know an ambulance is not a cheap ride, and to inflict those cost, take a truck out of service, and waste the time of waiting while the boy could have been receiving care, is something we all debated.

The story in the CNN article raises the question again for me. At which point should it be most wise for a family member to simply take the patient in themselves?

We all know that a family member will almost always perceive an emergency as more severe than a trained professional that has probably seen the injury or illness a hundred times. Should those “panicked” family members be behind the wheel of a car? Should they face criminal charges if they do?

According to the CNN story, the husband was an “emergency medic”. Does that mean he is trained to drive differently in an emergency? Is it ok that he does not yield to traffic laws? How can we expect a panicked family member to remain calm enough and to not disobey those laws?

I wonder what I would do in the same situation. As I sit here now, I feel as though I would keep a level head. However, I also know that if I come to an intersection and it looks clear, I would probably proceed. What happens if I make a mistake during my moment of panic and hurt someone else? Should I be charged criminally?

Should we require that all emergencies be transported by ambulance? Think of the costs that would incur, and how many more ambulances would be needed across the country.
I guess there probably is no clear answer. In my opinion, the safest thing would be for everyone to call an ambulance during a medical emergency. However, does the end justify the means?

These days, paramedics have options. Such programs as the EMT to EMS Management program and the Paramedic to RN program are opening up new avenues. Many EMS workers are taking full advantage of these programs and finding new careers, while still performing the tasks they have loved for so long. The Paramedic to RN program can be completed in as little as 12 to 18 months, and students can walk away knowing they have just secured a future for themselves in a career they can retire from.

We had been running non stop during the 72 hour shift and a little sleep deprivation was creeping into our brains. But true to our calling as EMT’s, we kept going for the sake of “our community” and self preservation! One of the last calls we received that day was a “man down” call on a farm about five miles from where we were at the time. I cinched the seat belt down and my partner hit the gas. We made record time getting to the scene, thank God traffic was light! As we pulled up to the scene, we saw the man lying on the ground with a younger lady holding his head. We marked out on the scene and I jumped from my rig with my O2, kit and defibrillator pack. I checked for pulses and found none, secured and airway, hooked up the defib. The machine showed a “course v-fib”, so I proceeded to deliver a shock to the older, pale lifeless man, and prayed for the best. I had done this so many times in the past, it was like second nature. At this point I thought something had gone wrong with my defibrillator. I checked everything and found nothing wrong. “What is going on”, I asked myself. I have done this many times in the past and never had a “regular” heart rhythm show up on the machine. I checked…wow…”I’ve got a pulse”, I exclaimed to my partner. She checked and just smiled. We continued to deliver oxygen to the man throughout the transport and turned him over to the emergency department staff with no problems.

I went to write my report and got all my information gathered up. My partner walked in with times from the run and looked at me. She said, “one minute”. I asked, “One minute, what”? She told me it was one minute from the time we marked on scene until the time I delivered the first “shock” on my patient. I sat there and thought, man that was quick. I smiled to myself thinking about our “competition “, and had to ask her if she had any quicker ones. She looked at me and told me she didn’t think the defibrillator turned on that quick. “Looks like I win that one, huh”? She smiled and said, “Yup, you won, but the competition wasn’t between you and me”. I asked her what she was talking about. She looked at me and told me. “He is alive”. Wow, I never thought of it like that. We got there, did what we were supposed to do and it worked!

I saw that man later, once he got out of the hospital. It made me thank God that I was able to help him and his family continue on with their lives. He continued to farm and live a productive life for several more years. I read later he passed away at the ripe old age of 88. I have since left the Emergency Medical Technician behind for a career in law enforcement, but I never will forget the time I took on my biggest competition and beat it!

By Richard, EMT

Our trip was to take about an hour, and heading out, it seemed like just another ordinary inter-hospital transport.  About 10 miles on to the interstate, we started to hear some chatter on the radio. Something about an officer needing assistance, but we could not make out a location, and there was no report of what sort of problem had occurred. Suddenly, we noticed a state trooper along the interstate and he had another vehicle pulled over. As we got closer, we noticed another trooper running through the median to flag us down.

We pulled to the side to see what the problem was, and the trooper advised us that another trooper had been hit by a passing car while writing a ticket to a motorist. I contacted the ER and they advised we could hold their and assist, instead of continuing onward to our destination.

I stayed in the ambulance with my patient, and my EMT driver/partner hopped out to assist the officer. A couple of minutes later, my partner returned and asked for me to send more help, and advised the officer was critical. I sent word to dispatch and my partner returned to his patient with supplies. It would be about 5-10 minutes before another ambulance would be able to arrive.

While looking out the rear doors of the ambulance toward my partner to try and get an idea of the patient condition, it becomes apparent to me that my patient is tapping my leg with his foot. I turned to look and noticed my patient struggling to breathe. A quick glance to the heart monitor and I see the patient is in Ventricular Tachycardia. Emotions and desperation suddenly took a while new direction. I am sitting on the edge of the interstate, my patient is about to arrest, and my partner is too busy with the injured officer to be of any assistance.

I began to treat my patient, and he did go into cardiac arrest. About the same time, my partner sent the other officer to my truck to ask for my assistance. I notified the officer of the happenings and he quickly turned away and returned to my partner to deliver the bad news.

Three shocks, and 30 seconds of compressions later, my patient has a pulse return. I hung appropriate meds, and started on the phone to the ER. Meanwhile, a second ambulance arrived and we now have help. I quickly grabbed a new driver, and we returned toward the original hospital. While enroute, I hear a helicopter is arriving to help with the trooper and a second helicopter being called to meet at the ER with myself to pick up my patient.

Later that evening, like all emergency workers, we all sat around to reminisce about what had occurred. A normal inter-hospital transport, something we had done a thousand times a year, suddenly became a life or death manner for my patient and a police officer.

Reports on both patients came back that evening. Both patients would survive, and neither was expected to suffer any long term consequences. It was a run I would not soon forget.