If I were the boss of EMS....

[usalsfyre]

Pay. Easily.



Not hugely, but yes, it can be.

I hate to say it but...

Why pay us more when we're willing to do the job for what they pay us now?

 

[Shishkabob]

I hate to say it but...

Why pay us more when we're willing to do the job for what they pay us now?

If you're not willing to pay more, don't expect more.




The adage "You get what you pay for" holds true in salaries as well.

 

[usalsfyre]

Up your pay, up your standards of who you hire.


Basic business management 101.

But when your managers have the business sense of a rock, what do you expect?

 

[Shishkabob]

But when your managers have the business sense of a rock, what do you expect?

Exactly. It's a cycle.


If you expect more, you pay more. If you pay more, you can expect more. If you pay crap, you'll get crap. If you pay wonderfully, you can require all that you want to hire people. So yes, this ALL does go back on the upper-management, and not on the individual provider as some would like to say.

I can get a BS in EMS, a PhD in Biology... and I'm still going to get the same pay as the Paramedic next to me. Regardless of what I'd like, it makes no sense to get an advanced 4 year degree for a job where the average pay is $35,000 a year.

 

[usalsfyre]

The adage "You get what you pay for" holds true in salaries as well.

Very true. Very, VERY true. But how many people you work with think they deserve more when they probably don't deserve what they get now?

 

[Melclin]

(3) You can train someone for 2 years just to provide good BLS. I think at this point it would be reasonable to throw in a BIAD, CPAP, 12-lead interpretation and possibly aspirin and IM / SC epinephrine, maybe some ventolin, perhaps entonox. There's no reason why an EMT can't have a decent education in physiology, pharmacology, pathophysiology.

If I was king, 2 years to EMT, 4 years to paramedic, and a real 2 year certification for a higher end critical care level. Someone who can fly or do critical LDT work, who can actually interpret x-rays, reduce dislocations, put in arterial lines, intelligently read blood work, manage a vent with ABGs, and manage electrolyte derrangements. You could maybe even make an argument for this type of medic to work in a rural ER, although this is probably starting to overlap the PA role in the states.

There needs to be real EMS research. There's very few programs right now, and very few people producing good data. We need to more critically examine what we're doing well, what we're doing poorly, and how we can improve it. We need to develop treat and refer protocols, and arrange billing in a way that encourages physicians to support this development. There's plenty of patients that could be referred to a family physician, instead of being taken to the ER to wait for 8 hours in the waiting room.

...

There needs to be widespread amalgamation of EMS services and response areas, so that every little town doesn't have it's own service. There needs to be an integration of EMS into healthcare and away from public safety.

You're pretty much describing our system. While I agree with you that these things are positive steps forward (I do like our system after all), they don't come without problems of their own.

You get this odd dichotomy of educational standards where on one hand the degree encourages independent thought and practice, research, academia etc, on the other hand, when it comes down to it, if you just apply the clinical guidelines with some degree of accuracy and take everyone to hospital, the job can basically be done by a trained monkey. The degree's curriculum is stuck between those two positions. People would complain when forced to learn a whole pile of stuff that wasn't in the clinical practice guidelines (CPG) or directly related to ambulance practice. But at the same time, without learning all of that extra stuff, you really can't safely say that you are qualified to be exceding your guidelines or doing things like leaving people at home/make more complex decisions about care pathways.

Take a patient I went to this evening. Head ache, nausea and ear pain after a tumour was removed from her inner ear earlier in the week. She had called her specialist and he had called back telling her that if her pain was bad, simply to call an ambulance. Seeing her ENT specialist in approx 24 hours.

To decide whether or not a person is fine to stay at home and go to their appointment in the afternoon, there is a lot you have to know to make an informed decision beyond, "Meh, I'm sure she'll be fine, its only till morning". What problems could the presentation indicate? How will it be investigated in ED? What specialities are required? Will they be available at this time? How appropriate is her current PRN anagesia plan considering the procedure? But you try and teach a paramedic class here about the complications of inner ear surgeries or about indications for ED investigations and you get an uproar of "but there isn't a CPG for that, why do we have to learn it WAHHHHHH". The curriculum is then changed in response to "feedback" to become more “relevant”. So the unis end up failing to really provide a comprehensive and broad education, other than just a longer, more involved, more expensive version of the older vocational courses without any of the benefits of those older systems.

As I said, we do currently leave people at home/refer to doctors as you mention but its not without risk. There really isn't much in the way of formal frame work for doing so and there is no protection for those that do so and make innocent mistakes. If we make a mistake (and inevitably we do) then there is hell to pay, and all the same people who were fine with you leaving people at home before, start chanting, "Paramedics shouldn't diagnose, just drive to hospital". Where as if a GP buggers up (and they do more often than we do), there is a certain understanding that they're not perfect, mistakes happen and not everyone presenting with a little nausea needs an ED/ID referral. But if we go to Johnny Idiot with nausea and it turns out he has Ebola and we leave him at home, guess whose getting in trouble. If we're ganna use this extra education (which as I already said, is less than adequate), there needs to be some formal recognition of, and protection from, the fact that if we are to leave people at home/refer to LMO using a formal educational framework to inform our clinical decision making, we WILL make mistakes, just like everyone else and that eventually people will get hurt, but that’s the price of a healthcare system that accepts necessary risk.

 

[thegreypilgrim]

(1) Convert all proprietary ambulance services to not-for-profit status, compensate investors for past investment.

(2) Convert all fire-based EMS to independent public agencies.

(3) Transfer federal oversight of EMS from NHTSA to HHS.

(4) Create a professional association representing EMS at national level which also sets professional standards.

(5) Eliminate the EMT and AEMT provider levels.

(6) Replace EMT and AEMT with Paramedic and Advanced Paramedic provider levels.

(7) Redesign educational curricula, transfer training programs to accredited universities.

(7a) Paramedic licensure requires completion of 4-year undergraduate degree.

(7b) Advanced Paramedic licensure requires at least 3 years experience and completion of 2-year graduate degree.

(8) Update Medicare billing standards for ambulance services to no longer require transport for reimbursement.

 

[JPINFV]

Up your pay, up your standards of who you hire.


Basic business management 101.

Increase your education level, legitimately increase the quality and scope of your services, demand more reimbursement from payers, increase pay. Basic economics 101. The problem is, as it stands now, there are more than enough people willing to work for the current pay level, or less, who meets the standards the trade currently sets.

 

[Shishkabob]

Very true. Very, VERY true. But how many people you work with think they deserve more when they probably don't deserve what they get now?

A few. (And they tend to be from the EMS of old...) We should fire them and combine their salary with mine!



But I also know just as many who don't get paid their worth, too.

 

[Shishkabob]

Increase your education level, legitimately increase the quality and scope of your services, demand more reimbursement from payers, increase pay. Basic economics 101. The problem is, as it stands now, there are more than enough people willing to work for the current pay level, or less, who meets the standards the trade currently sets.

And it all comes back to Medicare, and the crap reimbursement they give, and the crap rules they have that you have to transport to be reimbursed.


Yeah, that's not holding back EMS at all...

 

[JPINFV]

And it all comes back to Medicare, and the crap reimbursement they give, and the crap rules they have that you have to transport to be reimbursed.


Yeah, that's not holding back EMS at all...

So prove to Medicare that paramedics are more than horizontal taxi drivers.

 

[thegreypilgrim]

And it all comes back to Medicare, and the crap reimbursement they give, and the crap rules they have that you have to transport to be reimbursed.


Yeah, that's not holding back EMS at all...

The problem is you really have no grounds to negotiate any of these changes without an industry-wide trend toward higher education. It just can't happen.

 

[Shishkabob]

So prove to Medicare that paramedics are more than horizontal taxi drivers.

Kinda hard to when they pay you as one, and treat you as one.

If you pay me to do cook food, and only to cook food, there's no incentive to do anything else in the kitchen, regardless of how much better it will make the restaurant run or the food taste.


They pay us to transport and nothing else. They are what's perpetuating the idea of "You call, we haul, screw treating the patient on scene, 'we don't diagnose' "

The problem is you really have no grounds to negotiate any of these changes without an industry-wide trend toward higher education. It just can't happen.

We DO have a trend going on right now... and to be honest, it IS moving at a faster pace than other, more established, healthcare fields did at the same age.

 

[JPINFV]

Kinda hard to when they pay you as one, and treat you as one.

...except no one is going to pay you more, and then hope that you deliver better quality goods.

 

[nwhitney]

I like the idea of increasing the educational requirements for Basic.

I would also implement "No Pants Wednesdays"

 

[thegreypilgrim]

We DO have a trend going on right now... and to be honest, it IS moving at a faster pace than other, more established, healthcare fields did at the same age.

Really? Paramedics are all going to university and getting degrees in paramedicine en masse? This is something that's not happening in a haphazard, inconsistent manner but is an actual recognized standard for the profession? There's a standardized set of core concepts/principles universities can use to develop curricula from?

 

[Shishkabob]

I'm starting to agree with the people who say EMS must fail in order to succeed.



I say Jan 1, 2012, we give the people exactly what they expect. If Medicare physicians, the news, and the bystanders that call 911 think we're a ride to the hospital and nothing else, let's do that.

We'll stock ambulances with bandages. No drugs. No EKGs. No airway supplies. No BVMs. There will be no STEMI alerts, there will be no stroke alerts... if you have an MI or a stroke and the cath lab is at home sleeping, sucks for you. There will be no pain control. Break your leg? Tough it out until you get to the hospital. While we're at it, let's cut back on ambulances.



Should be an enlightening year, no?

 

[JPINFV]

I like the idea of increasing the educational requirements for Basic.

I would also implement "No Pants Wednesdays"

We could wear skirts...
http://emtlife.com/showthread.php?t=24171

 

[usalsfyre]

At some point the impetus has to be on us, as stewards and guardians of the field, to push change and recognize that education may not pay divedens now, but will in the future.

However, try telling average joe paramedic who a)got his medic to go into the fire service, b)is doing this because it's easy c)is immature this and you'll be met with howls. I honestly think the reason most good providers leave EMS is less about the pay (not that much less than teachers really) and more about the ungodly hours EMS is expected to work.

 

[Shishkabob]

and more about the ungodly hours EMS is expected to work.

To get said pay.




Honestly, what I make isn't BAD. Not what it should be, not what I'd like it to be, but I know people older than me who work in retail who make less.