EMS is a stepping stone

daedalus

Forum Deputy Chief
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Its not a career.

The new guy shows up at station for his first shift. He is excited, and after the usual greetings comes the inevitable question; "So what do you plan on really doing as a EMT/Paramedic".

This is the culture at DaedalusPrivateAmbulanceComapny where I work. When things are just wrong, like running an ill-equipped rig, not having the tools or even knowledge to handle patient care, a lack of medical terminology, a complete lack of even a passing concern about learning real medicine or patient assessment, and a culture of who cares nothing about patients; no body gives a sh*t.

"I plan on going to the fire department"
Thats the usual response to the inevitable question. Its a 4/5 response. Sometimes we will have someone, like myself, who mentions physician's assistant or RN. We even have an EMT who was accepted to John Hopkins Medical School. Very cool.

Among the problems I see the biggest: Making up vital signs. Its a regular thing. One sentence narratives. No one bothers with them. No knowledge of terminology or pharmacology. Hey daedalus, what does STEMI mean? Culture where you will be made fun of at the station if you actually think your patient was having a real emergency.

Why does EMS have to be a stepping stone? Why do my EMTs have to DEPEND COMPLETELY on the fire departments for real ALS? Why can the new guys be actually excited to start their first day of their CAREER? How come we cannot be medical professionals. This culture extends to local area hospitals, where because of our attitude towards patient care, nurses will not even give report to us, because they know most just do not care. They would rather look through paperwork or ask the patient themselves than listen to our history. We are a taxi and are treated like one.

Wake up people. What do we want, a stepping stone, or a profession?

This is not meant to read like a blog, but is a start of a discussion.
 
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OP
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daedalus

daedalus

Forum Deputy Chief
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Why should I try to keep learning as an EMT, why should I keep reading and practicing and practicing my knowledge and skills, when the lowest common denominator still gets payed the same for not doing any of that? When I will be made fun of for studying and relearning emergency medicine, why do it at all?

This is Los Angeles County.
 

schwing343

Forum Crew Member
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I want to work on a fire department, I talked to many Firefighters/Chiefs ect. They all said the same thing, get your EMS stuff taken care of. Always wanted to be a firefighter. Now that I work as an EMT, its not bad, but its the private ambulance sector. Not that exciting. Occasionaly we'll get something good but not often. Where I'm from the FD handles all ALS and 911 calls and all that stuff. Even the medics that I work with don't get to use their skills. They pretty much get to start lines, and use the monitor (our monitors are ancient). The equipment barely works, our squads are in terrible condition, i could go on forever about the equipment we have. But hey its experience that i need for hopefully a nice future in the field. It could be worse, lol.
 

rhan101277

Forum Deputy Chief
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Yes I have seen some of this on rides. Not making up vitals but people really glad to get a refusal form signed, instead of really evaluating the patient. I mean they do basic evaluation, but not to what I think I would do as a basic and this was a medic by the way. Maybe they have been doing it so long, they no longer need to do in depth assessments. Someone had fallen, they didn't want a drive to the hospital, no asking do you mind if I listen to your breath, heart sounds, no pulse check. Maybe they just guessed it was ok, after all they are talking and breathing and sitting down. Anyhow I really look forward to it, it is true that many don't care. All I can do is make sure I do care and I do the right job. One day you may really need to know how to do your job to save a life.
 

alphatrauma

Forum Captain
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The bar must be raised...

Until EMS standards are elevated (ie. degree based programs) across the board, unfortunately this is the cross that must be born.

I think it will happen eventually. Heck, we used to be guys who drove hearses that provided literally zero first aid... talk about cutting out the middle man
 

TropicalJosiah

Forum Probie
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I plan on it as a career myself, so there are people out there. Not EMT, but paramedic of some kind eventually. I have very little interest in fighting fires, I loved the variety and challenge as a lifeguard and expect an even wider variety of patients as an EMT.

In every profession you will see the transients, slacking standards, etc... As alphatrauma mentioned - the EMS services have come a considerable way in not that many years.

Making up vital signs though? Personally I'd report that, that's unacceptable.
 

Hastings

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Where I work, it's those that have chosen to make EMS their life profession that are really poor medics. Lack the knowledge, mostly. The best medics we have are those in their 40's that did another completely different job for 20 years before choosing EMS.

I love EMS, but it's not going to be what I live on. I'm going to become an RN, and go on from there. But I'll tell you one thing, as long as it's reasonable, I'm going to be doing this on the side.
 

Ridryder911

EMS Guru
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The problem is there is NOT proper screening for EMS programs. Why do we even allow the statement of "why are you in EMT class" to happen? Sorry, during my nearly three degrees of Nursing; have I ever been asked .."So why are you taking a nursing course or what profession do you plan upon going into after nursing?"

Seriously, I doubt that those that attended RT, P.A. programs where asked .. "So you are just doing this until.....?" Yet, we still allow those that really never want to enter EMS or worse having to be an EMT to obtain into another career that has no similarity to medicine at all. Yes, Firefighting. Sorry folks as a former one, there has never and nor will there be any similarities to real medicine and real medicine is what we are going to have to deliver to make it a profession.

Does this mean some of those in Fire Service are wrong? No, but over all the requirement of making every Firefighter an EMT is ludicrous and establishing every firefighter to be a Paramedic is DANGEROUS. Studies are verifying this by the lack of credibility of being able to maintain proficient skills and the Paramedic mills that are required to meet the employer (Fire Service) demands. Like it or not, unfortunately this is the way it is.

Cities and even private cannot compete with the so called hero's. With the tradition of high paid lobbyist from union dues and a remarkable public campaign and marketing scam it will be difficult to impossible to fight against Fire Service municipality employment benefits.

The only resource is for EMS to gather as one. It is amazing how cities can actually wish to continue poor monies (in proportion) into fire services, when in reality there is NO revenue (except ISO ratings) and primary responses are nearly a 10:1 or less in responses to EMS. Again, most fires services only want EMS for justification of personal and equipment.

In regards to nursing, I feel many are very disillusioned. Unfortunately, many are seeing the almighty buck rather than the profession that it is. In reality the pay is very similar. If one does not mind being on their feet and working in a dangerous area for safety of licensure then one will be happy. Like I described earlier, I have seen and taught many that were left EMS to nursing. I have yet met one that describes that were overall pleased to do so and that do not miss working in EMS. Understandably there is some over all benefits such being out of the elements of weather, usually better working conditions, and sleeping at home in your own bed. Yet for enjoyment and autonomy... nothing in comparison. Yes, its also nice that there is branches and expansion one can explorer or move into other than traditional nursing, not alike EMS. Something we will have to develop to sustain medics in the profession.

I believe communities will have to awaken that it is cheaper and to be able to provide the best care, third party services will have to be developed and established. Alike our Northern neighbors, total separate services.
 
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mycrofft

Still crazy but elsewhere
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Rid that's pretty close to spot on about ex-EMS nurses.

The majority of the male classmates I had were ex-corpsmen, med techs, and a couple vollie/paramedics. Most quit the program before finishing the degree because the culture is so different, very hostile to one another in many places and ways, and out experiences were not honored but ridiculed.

I have waxed notalgic over my days in private and quasi-private ambulance because of the relationships and shared experience it offers. I'm too old for that now, but I did find a 'way out there branch of nursing so I could still have some of that...but mostly with the deputies and not my peers.

As long as the hours pay and benefits are noncompetitive, thousands of starry eyed newbies still pour in, and job security is zip, it's not easy to recruit and hold career minded pro's.
 

TropicalJosiah

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Ah just to throw another quick 2 cents in - I've met plenty.. way more then should have.. RN's and even Doctors (lets not go there) who just don't give a crap, horrible service, education, etc... enough so that I would not want to be a nurse, could have been the area though.

Where I'm from, EMT/Paramedics wear vests ya dig?
 

jochi1543

Forum Captain
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I have hopes of getting into med school, and I was very upfront about it during my EMT entrance interview - my program had no problem with that. Neither did my employer during my job interview. EMS may not be my *dream* career, but it has a lot in common with it. As long as I am doing a good job as an EMS practitioner and am honest about my goals with the people I work for, it shouldn't really matter.
 

John E

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In response to the OP....

why are you still working there?

John E.
 

EMTCop86

Forum Captain
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It's a stepping stone for some and a career for others. For me it could be either. I want to become a police officer but things are preventing that from happening at the moment. My next career is EMS so I decided to start that now. So if I later become a police officer then it will be a stepping stone. If I don't become a police officer then it will become my career.
 

TropicalJosiah

Forum Probie
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The career is life for me. Most people can pretty much do whatever they want within reason if they are reading this.

It's just more a matter of what do you want to do?

Job's are not the end goal for myself, it's how I weant about my day, no matter what the day.
 

phabib

Forum Lieutenant
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Well, I'm just now looking for my first EMS job. I'm thinking about it as a career. I want to do basic for a bit then get into to medic school.

The only thing that worries me is what to do then. so I'll be a paramedic. How long can I do that for? I'll be doing continuing education throughout my career so I might as well do a degree program. If I want to stay on as a paramedic, the only thing I see from there is finding a great city service and moving up the ranks until I teach. A lot of the old timers who taught me did EMS till their backs gave out or until they simply got tired of the mobile office.

I'm 21, the mobile office seems like one of the biggest perks to me but how will I feel when I'm 50? After 30 years of dealing with drunks and going to court will I still love my job?

I think it's a stepping stone because us kids want to ride in an ambulance and 'save lives' for a living. Then we want the nice car and the big house and the yearly salary job.

From everything I've read so far, it seems like the ones with real passion for patient care stay in the field. I haven't had much experience yet, but I enjoyed the time with patients, whether it be in the ER or in the rig. It was that time that made me realize that I wanted this as a career. Those without that passion in patient care will fall away or lose interest. If they don't last, good riddance. More room for those of us who want to work EMS.
 

fortsmithman

Forum Deputy Chief
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We have a member here in Fort Smith who is applying to the RCMP whie using his EMS experience to join.
 

boingo

Forum Asst. Chief
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We have EMT's and medics leave for other occupations, but as a whole, most of our medics have been here a long time, and make it their career. The majority of EMT's either go on to be medics, or leave for another profession eventually, although we have a few EMT's who have worked here in excess of 30 years.
 

VentMedic

Forum Chief
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After 30 years of dealing with drunks and going to court will I still love my job?

You deal with those situations in almost all of the medical professions. The age can be a factor since there are relatively few opportunities in EMS to move into once you are injured and can no longer work the trucks. It can be tough at 50 to start from scratch for a 4 year degree.

Many of us got other degrees in medicine to see more of medicine. Both RRTs and RNs have a wide range of opportunities to get advanced degree, critical care training and knowledge as well as many "skills".

Often, those that want to know more about medicine get frustrated when paired with partner after partner who are 3 month wonders. Any mention of education sends them into a frenzy. I found flight to be somewhat better but even that has changed over the past few years as more flight companies are worrying about the bottom line and doing the warm body criteria for hiring.

Unfortunately, with more FDs making an attempt to train their own again, as in reference to the recent Memphis FD thread on another forum and breaking even a state tradition to maintain the education within the colleges, there will be little advancement. As EMS stands now, FDs will use Paramedics just to fill a need and not to be counted as a medical professional. Thus, in areas like most of Florida and California, if you want to do medicine, you may have very few options if you are a Paramedic and even in the FD you may be very limited in what you will be able to do.

I see nothing wrong with getting more education and if you decide that you want something more challenging...go for it. I have waited for 30 years for EMS to evolve. If anything, it has taken a few steps backward. Make the most of the opportunites that present themselves if you want more out of medicine as a profession. Sticking with something "out of loyalty" may not pay the bills and may leave you feeling unfulfilled later.
 

EMT-G36C

Forum Crew Member
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Mad props to the OP.

Tomorrow is my first day of working in EMS, and I look forward to starting my career. B)
 

Dominion

Forum Asst. Chief
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Many long posts in here so I admit that i didn't read them all but a couple. I see this as a problem both as "EMS is not a career" and the puppy mill proceedures that are kinda making it as such. For example in my paramedic course there is only one of us that doesn't have EMS for a career (excluding teaching etc). He wants to be a paramedic for awhile and then maybe move into a nursing career. However we are running parallel to another paramedic course, that is poorly run and very puppy mill. Both of our classes are run by long time FTO's at the county 911 service (reatively busy service) however my instructor is more interested in turning out a well rounded, educated paramedic and the other course is just interested in getting medics on trucks as quick as possible.

i feel it is an issue with the system and in the grand scheme of things EMS is still relatively young vs. Fire and Police. I hope that it improves and I hope I can help it improve with my actions as a potential educator myself later in life.
 
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