Is EMT/PHEMS Seen As "Low Hanging Fruit"?

[mycrofft]

OBSERVATION: prehospital EMS (PHEMS) is flooded with low-paying jobs and low-paid or volunteer workers. (There are some exceptions but I think many are linked to firefighting unions).

QUESTIONS:
1. Why do people still flock to this field for work?
a. Is it primarily because it is relatively cheap and fast to get in?
b. Looking for excitement and glory?
c. Trying to put volunteer or military experience to work because it seems to be their best shot at a career?

2. Does this support any future for advancement of PHEMS towards truly professional level and the perks (pay, benefits, help with working conditions)?

3. This situation was intentional at first to quickly and cheaply flood America with better-trained PHEMS workers. Is that still needed in some areas, or can everyone afford to pay and staff PHEMS at professional instead of quasi- and actual volunteer status?

 

[Ewok Jerky]

OBSERVATION: prehospital EMS (PHEMS) is flooded with low-paying jobs and low-paid or volunteer workers. (There are some exceptions but I think many are linked to firefighting unions).

QUESTIONS:
1. Why do people still flock to this field for work?
a. Is it primarily because it is relatively cheap and fast to get in?
Most peeps getting into EMS are young and without a college degree. I think the majority think EMS will be a fulfilling and rewarding (financially) career.
b. Looking for excitement and glory?
Fo sheezy. I don't want to put a number on it but how many EMSers do you think are holding out for a fire job?
c. Trying to put volunteer or military experience to work because it seems to be their best shot at a career?
I don't actually know that many ex-military medics. I know a few, but the majority of EMS folk I know are civilian. If you want to put your military training into a career, doesn't law enforcement make more sense?
2. Does this support any future for advancement of PHEMS towards truly professional level and the perks (pay, benefits, help with working conditions)?
No way. I would bet most EMSers don't stay in it more a full career. For most I think its a stepping stone to hospital based medicine or fire. And the majority of those who stay in it for a career don't care about advancing the profession. They are cookbook medics who are comfortable with their job and skills and don't want any more responsibility. Unfortunately, the few who think of EMS as a branch of MEDICINE are too few.
3. This situation was intentional at first to quickly and cheaply flood America with better-trained PHEMS workers. Is that still needed in some areas, or can everyone afford to pay and staff PHEMS at professional instead of quasi- and actual volunteer status?

The reality of EMS is that we are in the delivery business. Most Pts don't need anything more than ride. I don't see the culture we have in america supporting higher training and pay to provide adequate pre-hospital advanced level of care...unless we are wearing bunker gear on medical calls.

 

[mycrofft]

Does America have differing needs due to geographic areas? I don;'t think rural Montana has many cases needing a ride, versus Greater Los Angeles.

 

[abckidsmom]

Does America have differing needs due to geographic areas? I don;'t think rural Montana has many cases needing a ride, versus Greater Los Angeles.

I work in rural central Virginia, and fully 40% of our transports are people needing a ride.

 

[Milla3P]

I work in rural central Virginia, and fully 40% of our transports are people needing a ride.

That means that about 60% actually need help. That is pretty significant.
Out of the couple of dozen I do a week, I'm happy if I genuinely help just one.

 

[EpiEMS]

1. Why do people still flock to this field for work?
a. Is it primarily because it is relatively cheap and fast to get in?

The barriers to entry are extremely low -- it's a year-long course, or even less than that to get to the "entry level" (EMT) role. That depresses wages, especially if lower skilled personnel are seen as substitutable for higher skill/cost personnel.

b. Looking for excitement and glory?

I think you've hit the nail on the head. It's a (primarily) young male field, and that's what the drive fast with lights-and-sirens culture (in some areas) generates

c. Trying to put volunteer or military experience to work because it seems to be their best shot at a career?

When experience is encouraged, then you have to have some. If it were a true profession, no experience would be requisite -- the training period would cover it. Nobody expects a BSN candidate to come in as a CNA, or an MD to come in with anything other than a BA or BS with the science prereqs.

The system, in the US, is saturated with the "better trained" PHEMS personnel that the system designers in the '70s would be impressed with. Moving to a higher level is the next step -- from technician to clinician.

 

[mycrofft]

Rural rides

I wonder if rural rides are rising because family ties are stretched geographically, and where once people would stay home and ride it out (be found dead sometimes, too) they now go in or have an appointment to fill.


All good points. More people with rural or frontier experience?

 

[abckidsmom]

That means that about 60% actually need help. That is pretty significant.
Out of the couple of dozen I do a week, I'm happy if I genuinely help just one.

40% who get just a ride. More who are just BLS, and most of my ALS care is pain and nausea medication. I probably see max 10% who are actually sick.

 

[CFal]

I know this is going to seem like blasphemy to some here, but here it goes. Why use a 10 cent word when a 5 cent word will do. All these EMS advancements seen well and good, but how much will it actually improve patient outcome relative to cost?

 

[ExpatMedic0]

I know this is going to seem like blasphemy to some here, but here it goes. Why use a 10 cent word when a 5 cent word will do. All these EMS advancements seen well and good, but how much will it actually improve patient outcome relative to cost?

Oh i Don't know, when its you laying on the ground and some firefighter with a GED and 6 months of vocational training is RSIing you, maybe then it will seem more relative ;-)
Or the same guy, who passed a 2 week critical care certification course and is now operating the intrathoracic balloon pump keeping you alive.

 

[CFal]

Oh i Don't know, when its you laying on the ground and some firefighter with a GED and 6 months of vocational training is RSIing you, maybe then it will seem more relative ;-)
Or the same guy, who passed a 2 week critical care certification course and is now operating the intrathoracic balloon pump keeping you alive.

If you look at survival rates of BLS v. ALS, studies have shown little if any benefit to ALS.

http://www.ncbi.nlm.nih.gov/pubmed/16128477

 

[ExpatMedic0]

It really completely depends on the circumstances. The authors conclusion in their abstract is really quite detailed. "ALS shows little to no benefit for urban trauma." That is one small piece of the pie, sure, I can buy that under most circumstances. I guess ALS can't help anyone with a ruptured spleen and a liver lac much more than BLS. They need a surgeon.

However, riddle me this... What constitutes ALS? How much training and education is required and what tools, guidelines, and resources can we pull? ALS in Denmark is 1 Doctor who is an anesthesiologist, and 1 Paramedic, together. Some special operation units in the Army use Aeromedical PA-C's as ALS. Seattle's Paramedics have over 3000 clock hours of training versus a fire department in Texas where they get 800 hours of training. Do you think their outcomes are better (excluding patients that require immediate surgery?)
We have to analyze all the variables and possibilities. Do you think EMT's would be able to help someone better having a STEMI, over a paramedic?

 

[ExpatMedic0]

http://www.ncbi.nlm.nih.gov/pubmed/21555177

http://www.ncbi.nlm.nih.gov/pubmed/21092256

 

[JPINFV]

If you look at survival rates of BLS v. ALS, studies have shown little if any benefit to ALS.

http://www.ncbi.nlm.nih.gov/pubmed/16128477

Because survival to discharge is the only metric that matters?

 

[Dan216]

The ladies.

 

[Dan216]

OBSERVATION: prehospital EMS (PHEMS) is flooded with low-paying jobs and low-paid or volunteer workers. (There are some exceptions but I think many are linked to firefighting unions).

QUESTIONS:
1. Why do people still flock to this field for work?
a. Is it primarily because it is relatively cheap and fast to get in?
b. Looking for excitement and glory?
c. Trying to put volunteer or military experience to work because it seems to be their best shot at a career?

2. Does this support any future for advancement of PHEMS towards truly professional level and the perks (pay, benefits, help with working conditions)?

3. This situation was intentional at first to quickly and cheaply flood America with better-trained PHEMS workers. Is that still needed in some areas, or can everyone afford to pay and staff PHEMS at professional instead of quasi- and actual volunteer status?

Honestly I think there is something about this field.. The rush of going on calls, to help the public, and yes the glory. We don't do it for the money because of obvious reasons. For me, I just love the feeling of helping people.

Sorry I only felt like answering the first question.

 

[CFal]

I don't mean to say that there is no need for ALS at all, but the vast majority of the time there isn't.

"advancement of PHEMS towards truly professional level and the perks"

would vastly increase the cost spent on EMS, at a time when healthcare is already at an astronomical cost.

 

[ExpatMedic0]

I don't mean to say that there is no need for ALS at all, but the vast majority of the time there isn't.

"advancement of PHEMS towards truly professional level and the perks"

would vastly increase the cost spent on EMS, at a time when healthcare is already at an astronomical cost.

I am wagering that the responsibility of EMS is going to increase even more with the recent healthcare changes. Part of these changes will demand even more from EMS to cover a full spectrum of issues and not just "scoop and run to the hospital" which is not only economically unsound, but part of the problem in the first place regarding the bigger picture. Mobile Inter graded Healthcare by EMS happens to be up by about %100 lately if you have not noticed and as our healthcare system becomes more of a truly universal system you will see even more education, responsibility, and funding, handed down to EMS

 

[CriticalCareIFT]

Oh i Don't know, when its you laying on the ground and some firefighter with a GED and 6 months of vocational training is RSIing you, maybe then it will seem more relative ;-)
Or the same guy, who passed a 2 week critical care certification course and is now operating the intrathoracic balloon pump keeping you alive.

Great resume, you are hired

 

[CriticalCareIFT]

OBSERVATION: prehospital EMS (PHEMS) is flooded with low-paying jobs and low-paid or volunteer workers. (There are some exceptions but I think many are linked to firefighting unions).

QUESTIONS:
1. Why do people still flock to this field for work?
a. Is it primarily because it is relatively cheap and fast to get in?
b. Looking for excitement and glory?
c. Trying to put volunteer or military experience to work because it seems to be their best shot at a career?

2. Does this support any future for advancement of PHEMS towards truly professional level and the perks (pay, benefits, help with working conditions)?

3. This situation was intentional at first to quickly and cheaply flood America with better-trained PHEMS workers. Is that still needed in some areas, or can everyone afford to pay and staff PHEMS at professional instead of quasi- and actual volunteer status?

If your goal is to become a midlevel or a physician this line of work allows fast graduation and certification to work. Good experience, and have down time to study for your college classes. I never seen EMS as a "career" more of a job one does during college.

As long as seniority and undedicated people with rank/title hold positions that govern hiring and advancement they will continue hiring the same ilk, people with the same credentials: years on the job, seniority, and no formal education. As long as a low number on your EMT card or registry card is somehow gives you "status" and "knowledge" this same crap will go on.

EMS will never be the utopia that you guys dream it would be. Majority of physicians and nurses who have medical education cannot tell the difference between EMT or a Medic or what we even do. I routinely hear "Doctor Smith the driver would like to speak with you about patient X in the ICU regarding his infusions" etc.

EMS is like a bad hangover that will only go away once you remedy it with a real career. Because what you guys seek already exists in the form of PA's and NPs time to face the facts stop whining and attend real college.