How to evolve EMS

[NysEms2117]

Hello everybody, I'm asking some of the more "experienced" providers, and even some of us newer folks(myself) the following question: How can EMS be Evolved, into a "reputable" profession, why do you think what you do, and how realistic do you feel it is to do what you are suggesting. The reason I put reputable is because most people thank first responders and thats all well and good, but i'm talking about the healthcare side, people that are RN's seem to be more reputable then folks in EMS, that may be due to Education and things like that, i'm still not 100% sure. Maybe I can help raise some topics at the state level? who knows!? Just looking for some opinions, PLEASE DO NOT BASH ANYBODY!

 

[Summit]

Change culture so that knowledge is valued over skills.

Raise initial entry requirements, associate degree minimum.

 

[NysEms2117]

Change culture so that knowledge is valued over skills.

Raise initial entry requirements, associate degree minimum.

Could you explain knowledge over skills?
Initial entry requirement: would you still keep EMT-B as the lowest? or would paramedic now be the lowest "ranked" care provider since Associate would be the minimum?

 

[Summit]

Could you explain knowledge over skills?

EMS culture is permeated by a focus on what skills can you do with your cert (an usually an attached desire to do the most with the least training). Example:

Oh can you start IVs? Our EMTs can start IVs!
Wow we got this new drug in our formulary!
We are cooler than healthcare profession X because we can do skill Y with Z fraction of the educational hours!

It is the attitude of a trained technician, not an educated practicioner.

The practicioner values knowledge first and focuses on when to act/not act, rather than valuing individual acts. EMSers with the practicioner outlook get more respect from the other healthcare professionals.

Initial entry requirement: would you still keep EMT-B as the lowest? or would paramedic now be the lowest "ranked" care provider since Associate would be the minimum?

Set the rules...

Do we have to live in the real world where the IAFF exists and current political/reimbursement structures will not allow any meaningful change in timeframes shorter than multiple decades?

Can we set a desired path in a fanciful world with AAS degree like AEMT as the entry minimum for ambulance care kind of like a Canadian PCP?

Because this exact thread has happened many times over the years and I suggested AAS AEMTish entry over 10 years ago on this forum. In the interim 10+ years all that actually happened was we took entry level educational hours up 10% (NSOP) and are cutting CE requirements by 45% (NCCP) and there are two states that kind of sort of maybe sometimes require an AAS for their medics.

Pictured below is the crossroads we find ourselves in progressing EMS:

I'll let you figure out who is who.

 

[Qulevrius]

Could you explain knowledge over skills?
Initial entry requirement: would you still keep EMT-B as the lowest? or would paramedic now be the lowest "ranked" care provider since Associate would be the minimum?

I'll give it a try.

A light bulb goes off and the room is dark. A regular person will assume the bulb burned out and go on with replacing it. If that won't help, they maybe check the fuse box and flip the breaker. If neither works, they'll wait til the electrician arrives. Then there are people who know a bit more about electricity than just 'flip the switch and light goes on or off'. In this scenario, these people will start looking for a faulty power line. That's the difference between knowledge and skill that applies everywhere. A good, competent provider needs to understand the underlying mechanics on a much deeper level than they do today, not just blindly follow the workflow that's been drilled into them. Medic school educates the providers on a much broader range of subjects than just 'splint, bandage, O2 & diesel' and in return gives them more tools and perspective. That effectively translates into decision making in regards of treatments and procedures. It will also shift the balance in the dual role <-> single role equation, to the right. Let EMS providers practice prehospital medicine, and firefighters put wet on red.

As it stands right now, EMTs are mostly a joke. A very small percentage of graduates actually have some idea of what they're doing, and are curious/ambitious enough to advance their knowledge/education. The rest are pretty content with having whatever the job offers them. A higher entry-level education will filter most of these people out. Not saying there still won't be bad EMTs/medics, but hopefully we won't see monkeys with hand grenades everywhere.

 

[Qulevrius]

@Summit get out of my head

 

[NysEms2117]

Because this exact thread has happened many times over the years and I suggested AAS AEMTish entry over 10 years ago on this forum. In the interim 10+ years all that actually happened was we took entry level educational hours up 10% (NSOP) and are cutting CE requirements by 45% (NCCP) and there are two states that kind of sort of maybe sometimes require an AAS for their medics.

Understandable, I am just trying to see what you guys/girls are saying who are "in the sht" everyday kind-of-speak. I do EMS part time, so I don't see many "flaws" aside from the obvious ones. But, my new job if i take it. (main job) may allow me to bring up certain topics, and Emergency response would technically be under my "domain"(EMS included).

 

[NysEms2117]

As it stands right now, EMTs are mostly a joke. A very small percentage of graduates actually have some idea of what they're doing, and are curious/ambitious enough to advance their knowledge/education. The rest are pretty content with having whatever the job offers them. A higher entry-level education will filter most of these people out. Not saying there still won't be bad EMTs/medics, but hopefully we won't see monkeys with hand grenades everywhere.

I agree here, I personally think the bar is too low for EMT-B's and part of me thinks get rid of them all. Because currently you can get a decent living at 40-45k/year, with 200 hours of "knowledge". Which i think is absurd, and jips the medics out of ~~10-15k/year. Do you have any potential fixes? I have never worked in a Firefighter EMS based system, so I won't even begin to assume or say anything about that.

 

[Summit]

It is mostly to do with lobbying combined with funding models why Fire is paid more that pure EMS.

@Qulevrius hit it on the head. EMS has to figure out if we are public safety (emergency technicians working for the FD) or healthcare (prehospital medicine).

If EMS wants to be healthcare, it is a long uphill battle to both increase standards to meet that role and throw off the yoke of IAFF which definitely does not want degree requirements for medics much less for entry level.

I do not have any hope that such a thing will happen in our current reimbursement/funding system.

 

[Qulevrius]

I agree here, I personally think the bar is too low for EMT-B's and part of me thinks get rid of them all. Because currently you can get a decent living at 40-45k/year, with 200 hours of "knowledge". Which i think is absurd, and jips the medics out of ~~10-15k/year. Do you have any potential fixes? I have never worked in a Firefighter EMS based system, so I won't even begin to assume or say anything about that.

Radically ? Grab IAFF by the ears and drag them away from municipal EMS, then demote EMT-B's a.k.a. 'life saviours' to a strictly support role. They want more responsibility ? Tell them to go back to school and earn at least an AAS in Prehospital Medicine. Alternatively, rework the entire EMS nomenclature to put NPs on every ALS rig (3-man crews of B's, P's and NPs). That kind of team could handle anything prehospital care.

 

[NysEms2117]

@Summit Do you feel that if the minimum is an Associates degree, that Paramedics should have to have a bachelors degree? or do you feel that Critical Care, lumped in with a few EMS management classes should be the bachelors degree?

 

[NysEms2117]

Radically ? Grab IAFF by the ears and drag them away from municipal EMS, then demote EMT-Bs a.k.a. 'life saviours' to a strictly support role. They want more responsibility ? Tell them to go back to school and earn at least an AAS in Prehospital Medicine. Alternatively, rework the entire EMS nomenclature to put NRPs on every ALS rig (3-man crews of B's, P's and NRPs). That kind of team could handle anything prehospital care.

Well not sure that can happen overnight but, by NRP- nationally registered paramedics?? Because changing the minimum req's of who is on rigs can absolutely be done, due to the fact NYS has started that ball rolling... ever so slowly, but rolling.

 

[Qulevrius]

Well not sure that can happen overnight but, by NRP- nationally registered paramedics?? Because changing the minimum req's of who is on rigs can absolutely be done, due to the fact NYS has started that ball rolling... ever so slowly, but rolling.

Typo, NPs (Nurse Practicioners). You quoted before I finished editing.

 

[NysEms2117]

Typo, NPs (Nurse Practicioners). You quoted before I finished editing.

my bad, im on lunch lol. Do you feel NP's are necessary? could CCRN's do the job NP's can? While i'm looking to see what I can do to change, NP's seem realllllllly far fetched due to the $ factor. I understand the difference between CCRN-> NP is only 1-2 years in grad/doctoral school? but a simple google pay search it's like a 45-50k/year difference.

 

[EpiEMS]

Change culture so that knowledge is valued over skills.

Raise initial entry requirements, associate degree minimum.

This is the best solution, in my mind. AEMT as an associates degree as entry to practice, with paramedic as a bachelors. Then we can have bridge programs to medic for folks with a previous degree (and standalone AEMT programs for those with previous degrees?).

I agree here, I personally think the bar is too low for EMT-B's and part of me thinks get rid of them all. Because currently you can get a decent living at 40-45k/year, with 200 hours of "knowledge". Which i think is absurd, and jips the medics out of ~~10-15k/year. Do you have any potential fixes? I have never worked in a Firefighter EMS based system, so I won't even begin to assume or say anything about that.

[Rant]Fire-EMS is probably the biggest offender in terms of waste. Privates run too lean, and third-services are a heck of a lot better...[/Rant]

I will say this - the idea of a middle-wage job with low skills is pretty much gone in most sectors. I can't think of a single private business that would run that way...you either have high-skill/high pay or low skill/low pay.

It is mostly to do with lobbying combined with funding models why Fire is paid more that pure EMS.

Even worse, fire is subsidized* by EMS! Firefighters don't fight fires, they do EMS runs, and everybody knows it. The move, in my mind, is to work from the municipal level and start forcing efficiency on fire departments - consolidation and/or better mutual aid agreements combined with aligning staffing models to the actual community needs (i.e. EMS).

*Both directly and indirectly, insofar as that they run $1MM ladder trucks into the ground doing EMS runs with 6 providers when a $50,000 SUV with 2 would be just as helpful.

 

[Qulevrius]

my bad, im on lunch lol. Do you feel NP's are necessary? could CCRN's do the job NP's can? While i'm looking to see what I can do to change, NP's seem realllllllly far fetched due to the $ factor. I understand the difference between CCRN-> NP is only 1-2 years in grad/doctoral school? but a simple google pay search it's like a 45-50k/year difference.

CCRNs will do fine as long as they have proper protocols. Basically, we're looking at a box staffed with at least 1 undergrad lvl provider, 1 entry lvl provider and 1 tech. They have technical tools and pharmaceutics, can handle any prehospital emergency and make the ED job much easier (reducing stress & wall times).

There's another problem though which has to do with the nature of the 911 system as a whole. The vast majority of 'emergency' calls are not really emergencies, so dispatching a stellar crew for a stabbed toe, is wasteful. That partially explains the overabundance of Basics in the system.

 

[EpiEMS]

There's another problem though which has to do with the nature of the 911 system as a whole. The vast majority of 'emergency' calls are not really emergencies, so dispatching a stellar crew for a stabbed toe, is wasteful. That partially explains the overabundance of Basics in the system.

Also an excellent point! And the revenue model, oh that revenue model (transports = getting paid) is problematic.

Nurse triage and taxi vouchers could go a long way towards rationalizing the system.

 

[NysEms2117]

There's another problem though which has to do with the nature of the 911 system as a whole. The vast majority of 'emergency' calls are not really emergencies, so dispatching a stellar crew for a stabbed toe, is wasteful. That partially explains the overabundance of Basics in the system.

Possible fixes?


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[Qulevrius]

Also an excellent point! And the revenue model, oh that revenue model (transports = getting paid) is problematic.

Nurse triage and taxi vouchers could go a long way towards rationalizing the system.

Or simply make EMS exclusively municipal -> abolish privates (keep gurney vans, but don't call them 'ambulances' ffs) <- will require an overhaul of healthcare insurance (NOT talking about the Obamacare horror show). If a 911 is not a 911 -> downgrade to private, otherwise respond with municipal.

 

[Qulevrius]

Possible fixes?


Sent from my iPhone using Tapatalk

See post above.