Progression of EMS
- Thread starter VentMedic
- Start date
Ah screw it; I can't stay out of this discussion.
This is a big can of worms right here. I used to feel like you until I argued with rid about it on this site and now my attitude is changing. There's a link somewhere...
firecoins
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What exactly should go into an associate's degree in Paramedicine contain? I ask this because I choose to go to a hospital based paramedic program and not a Community College based program. I did this because I felt in the end the hospital based paramedic program was much better. Rotations were done in a learning hospital and rotations on a FDNY participating hospital rig.
The classes taken in excess of the medic program at the comminty college included math and english, a diversity class, medical terminology, an into to allied health class and A&P I & II. Some of these classes I already had in my BA degree.
The classes taken in excess of the medic program at the comminty college included math and english, a diversity class, medical terminology, an into to allied health class and A&P I & II. Some of these classes I already had in my BA degree.
so many good points out here, from many different contributers...
firstly, as i am not a paramedic, it wouldn't be fair for me to comment on the educational standards of paramedics...
but i am a proponent of better education, and i think it starts from the bottom up... the way basic ems is taught, at least in my state, is geared toward passing a separate "practical skills" exam, and the the written "knowledge" exam... however, as we all know, many students, als and bls, pass the skills exam without the applicational knowledge we would desire them to have...
case in point: you can pass a skills exam on CPR... get all your critical points checked off on rate of compressions, ventilations, etc... BUT if you are not sharp on your physiology, and you do not know WHY is is important to compress at least 1 3/4 to 2 inches, or WHY it is so important not to overventilate, you are much more likely to make a mistake here in the field than someone who does... yet both would have "passed" their skills exam...we were not really taught to really apply the physiological lessons learned to the skills being performed...
i believe this is one of Rid's earlier points about really knowing more physiology on even the basic level...
an obvious solution is to blend knowledge comprehension into the skills exam... to stop someone rattling off the hypoperfusion protocol, and see what they really know about hypoperfusion... i know from my own class, it would make the exam far more difficult...
the problem with this, as far as the state is concerned, is that it brings too much of a "subjective" element into the testing, which they want to be "objective"... the problem, of course, is that our job is very "subjective"... we have to choose a protocol, and much is based on our history taking, which can be very subjective, and referred to as the "art" in our job.
to me, that is a big problem... new emt's and i've even seen it at the ALS level, are being taught in an "objective" way, tested by and objective list of boxes to check, and our sent out to practice subjective thinking and decision making witout a good understanding of how the physiology really applies to what we do... we all see what the results of this are...
now, for the more motivated emt's this won't really be a problem... they will learn on there own... they will come to forum's such as this to stimulate thought, and learn some more... to marry the subjective to the objective...
the problem lies with all the emt's who don't visit this or other sites... who don't look for extra education... and they are the majority... all they have to rely on their prior education and testing methodology in place... and this is where a major bump up in the educational process is needed, in my humble opinion.
firstly, as i am not a paramedic, it wouldn't be fair for me to comment on the educational standards of paramedics...
but i am a proponent of better education, and i think it starts from the bottom up... the way basic ems is taught, at least in my state, is geared toward passing a separate "practical skills" exam, and the the written "knowledge" exam... however, as we all know, many students, als and bls, pass the skills exam without the applicational knowledge we would desire them to have...
case in point: you can pass a skills exam on CPR... get all your critical points checked off on rate of compressions, ventilations, etc... BUT if you are not sharp on your physiology, and you do not know WHY is is important to compress at least 1 3/4 to 2 inches, or WHY it is so important not to overventilate, you are much more likely to make a mistake here in the field than someone who does... yet both would have "passed" their skills exam...we were not really taught to really apply the physiological lessons learned to the skills being performed...
i believe this is one of Rid's earlier points about really knowing more physiology on even the basic level...
an obvious solution is to blend knowledge comprehension into the skills exam... to stop someone rattling off the hypoperfusion protocol, and see what they really know about hypoperfusion... i know from my own class, it would make the exam far more difficult...
the problem with this, as far as the state is concerned, is that it brings too much of a "subjective" element into the testing, which they want to be "objective"... the problem, of course, is that our job is very "subjective"... we have to choose a protocol, and much is based on our history taking, which can be very subjective, and referred to as the "art" in our job.
to me, that is a big problem... new emt's and i've even seen it at the ALS level, are being taught in an "objective" way, tested by and objective list of boxes to check, and our sent out to practice subjective thinking and decision making witout a good understanding of how the physiology really applies to what we do... we all see what the results of this are...
now, for the more motivated emt's this won't really be a problem... they will learn on there own... they will come to forum's such as this to stimulate thought, and learn some more... to marry the subjective to the objective...
the problem lies with all the emt's who don't visit this or other sites... who don't look for extra education... and they are the majority... all they have to rely on their prior education and testing methodology in place... and this is where a major bump up in the educational process is needed, in my humble opinion.
Healthcare as a whole as seen the evolution of new jobs, job titles, licensing, re-credentialing, departments (in hospital and prehospital) reorganize, jobs eliminated, jobs created and colleges constantly changing curriculums to meet the demand.
EMS as a SYSTEM has changed. Unfortunately not all components of the system have changed equally. Has prehospital care changed enough to warrant a re-evaluation of the standard? Has the perception of prehospital care by the providers themselves changed?
Hospitals have re-organized their care centers and resources which now require more critically ill patients to be transported between facilities. Twenty years ago, it was the occasional balloon pump patient that needed transport by the local ALS ambulance and it usually was no big deal. The balloon pump training was provided by the hospital classes with a little hands on. I have been criticized for mentioning that many hospitals saw a need to train nurses to do the transports where paramedics once ruled in that area. Hospitals unfortunately found that prehospital providers could not keep up with the changing inhospital technology. Also, not every crew, even though they were in a truck that said CRITICAL CARE TRANSPORT was equally prepared. It has nothing to do with who's turf or who should stay in the hospital or out of it. It's about being educated and skilled enough to provide the necessary care or at least know enough when you are not the most qualified to provide the care. For some, it is difficult for them to admit that their overall education is not as up to par as they would have one believe.
PHRNs, yes, in some areas there might be a need depending on that type of EMS system. Remember an EMS system consists of more than ambulances and fire fighters. If there was a need that could not be filled by other EMS providers of whatever title, than another title is created to fill the void. Eventually, the strongest survive as we have seen throughout the last 30+ years. EMS has practiced this patchwork of titles with 46 different certifications in the U.S.
So, when considering what must be done, the SYSTEM and how all the components fit must be examined. Many times the funding is for SYSTEM. Individual components then compete for their share.
EMS as a SYSTEM has changed. Unfortunately not all components of the system have changed equally. Has prehospital care changed enough to warrant a re-evaluation of the standard? Has the perception of prehospital care by the providers themselves changed?
Hospitals have re-organized their care centers and resources which now require more critically ill patients to be transported between facilities. Twenty years ago, it was the occasional balloon pump patient that needed transport by the local ALS ambulance and it usually was no big deal. The balloon pump training was provided by the hospital classes with a little hands on. I have been criticized for mentioning that many hospitals saw a need to train nurses to do the transports where paramedics once ruled in that area. Hospitals unfortunately found that prehospital providers could not keep up with the changing inhospital technology. Also, not every crew, even though they were in a truck that said CRITICAL CARE TRANSPORT was equally prepared. It has nothing to do with who's turf or who should stay in the hospital or out of it. It's about being educated and skilled enough to provide the necessary care or at least know enough when you are not the most qualified to provide the care. For some, it is difficult for them to admit that their overall education is not as up to par as they would have one believe.
PHRNs, yes, in some areas there might be a need depending on that type of EMS system. Remember an EMS system consists of more than ambulances and fire fighters. If there was a need that could not be filled by other EMS providers of whatever title, than another title is created to fill the void. Eventually, the strongest survive as we have seen throughout the last 30+ years. EMS has practiced this patchwork of titles with 46 different certifications in the U.S.
So, when considering what must be done, the SYSTEM and how all the components fit must be examined. Many times the funding is for SYSTEM. Individual components then compete for their share.
vent, i have to think it is a question of not seeing the forest through the trees...
in reality, there is no real "system"... there is no national standard, no national governing board...perhaps you could say that national ems is made up of all the thousands of "mini-systems" made up by different counties and localities across the country...some are better, some are worse... some more advanced, some less... you get my drift...
i believe the solution starts "grass roots", from the ground up...get the basic level more organized, and standardized, and you have a common surface to start building blocks from...
as it is now, it is too chaotic from state to state, even municipality to municipality, paid to voluntieer, etc... the majority of ems calls are bls, so it is a good place to start.
in reality, there is no real "system"... there is no national standard, no national governing board...perhaps you could say that national ems is made up of all the thousands of "mini-systems" made up by different counties and localities across the country...some are better, some are worse... some more advanced, some less... you get my drift...
i believe the solution starts "grass roots", from the ground up...get the basic level more organized, and standardized, and you have a common surface to start building blocks from...
as it is now, it is too chaotic from state to state, even municipality to municipality, paid to voluntieer, etc... the majority of ems calls are bls, so it is a good place to start.
Now for the bottom up to happen, funding and authority from the top down must be recognized.
Start with you state's EMS page. See how your EMS system is organized. Where does your trauma funds come from and go to? Where is FD in the hierarchy of the scheme? What legislators are sympathetic to the cause?
Find out what grant writing is being done. What taxation issues are being proposed? Which agency is benefiting from legislative pork? Why do some areas have volunteers, some have paid and some have municipal or county. How have the county systems evolved? A lot can be learned from our history. Many counties have gone from having 10 - 20 individual providers to one county system or a half a dozen municipal systems. Then, you see headlines about funding or lack of. Who has the better plan? There are college degrees based on just pondering this question.
An idealistic view of "grass roots" is fine, but, it is better to have an understanding of the government entities and how they factor into change.
Of course, if radical changes are made in healthcare, everybody may be scrambling back to the battle field for their cause. Those who read the legislative pages on their home EMS websites will be the most informed.
Does your state have its own EMT or Paramedic organization? Have you checked your state's EMS board for regional meetings? Until you actually start acquiring knowledge from the people or legislators that are supporting you, it is difficult to see what has been done to bring about change. Until EMS people do start taking part in what is available, the cause is will struggle.
Remember even for the education standards to change, colleges will have to be on board with it. Most have the same basic EMT or Paramedic curriculums but the degree may vary from college to college. Check out the organization that is rewriting the education curriculum. See what and who they have petitioned for change.
Start with you state's EMS page. See how your EMS system is organized. Where does your trauma funds come from and go to? Where is FD in the hierarchy of the scheme? What legislators are sympathetic to the cause?
Find out what grant writing is being done. What taxation issues are being proposed? Which agency is benefiting from legislative pork? Why do some areas have volunteers, some have paid and some have municipal or county. How have the county systems evolved? A lot can be learned from our history. Many counties have gone from having 10 - 20 individual providers to one county system or a half a dozen municipal systems. Then, you see headlines about funding or lack of. Who has the better plan? There are college degrees based on just pondering this question.
An idealistic view of "grass roots" is fine, but, it is better to have an understanding of the government entities and how they factor into change.
Of course, if radical changes are made in healthcare, everybody may be scrambling back to the battle field for their cause. Those who read the legislative pages on their home EMS websites will be the most informed.
Does your state have its own EMT or Paramedic organization? Have you checked your state's EMS board for regional meetings? Until you actually start acquiring knowledge from the people or legislators that are supporting you, it is difficult to see what has been done to bring about change. Until EMS people do start taking part in what is available, the cause is will struggle.
Remember even for the education standards to change, colleges will have to be on board with it. Most have the same basic EMT or Paramedic curriculums but the degree may vary from college to college. Check out the organization that is rewriting the education curriculum. See what and who they have petitioned for change.
VentMedic,
I have my degree since the 1980's and I also have my Bachelor and master's. The masters is in adult education. I am convinced that a degree will help with patient care, the main issue, and will help to bring the profession up in status. We need to get to the state Department of Education and let them mandate the level of education needed to become a paramedic. The individuals I talked to from the DOE have told me they just need to become involved. The cost of education will work out on its own as student will find the money for school. The fact of the matter there should not be a choice but rather it should just be a mater of fact.
Good article from JEMS published May 2007.
http://www.jems.com/news_and_articles/articles/EMS_Needs_a_National_Brand_Identity.html
EMS Needs a National Brand Identity
Matt Zavadsky
EMS Insider May 2007 Vol. 25 Issue 5
May 1, 2007
Editor's Note: In May EMS Insider , we promised you more from Matt Zavadsky on the topic of branding EMS. In a special Web exclusive, here's his take on how to create a national brand for EMS.
As a profession, EMS has a lot of work to do to create a respected image or "brand identity" on a state and national level. Perhaps the most poignant comment to illustrate this point came from an elected official in the Florida Senate when several of us were lobbying for an innovative change to the statutes that would dramatically improve patient care. One senator said, "We cannot vote to pave a road for you EMS people when you all want to take different roads." Painful. But you know, she was right. The measure failed.
We've been so busy pursuing the public vs. private agenda that we've lost credibility on a national front. We've invested so many resources battling each other that we've almost lost the war.
There seemed to be a glimmer of hope when the lobbying group Advocates for EMS appeared to be making progress pursuing a truly cross-representative and singular voice for EMS on a national level. However, now as the April EMS Insider reported (in "Fire Service Groups Create EMS Coalition"), one sector has created its own advocacy group specifically geared toward promoting its own agenda for one type of service-delivery model.
So it's back to square one.
In the fog of this public vs. private war, EMS has lost its identity. We can ill-afford to invest our resources arguing which EMS "brand" is better. Instead, we must focus nationally on elevating the profession , working in unison toward common goals.
http://www.jems.com/news_and_articles/articles/EMS_Needs_a_National_Brand_Identity.html
http://www.jems.com/news_and_articles/articles/EMS_Needs_a_National_Brand_Identity.html
EMS Needs a National Brand Identity
Matt Zavadsky
EMS Insider May 2007 Vol. 25 Issue 5
May 1, 2007
Editor's Note: In May EMS Insider , we promised you more from Matt Zavadsky on the topic of branding EMS. In a special Web exclusive, here's his take on how to create a national brand for EMS.
As a profession, EMS has a lot of work to do to create a respected image or "brand identity" on a state and national level. Perhaps the most poignant comment to illustrate this point came from an elected official in the Florida Senate when several of us were lobbying for an innovative change to the statutes that would dramatically improve patient care. One senator said, "We cannot vote to pave a road for you EMS people when you all want to take different roads." Painful. But you know, she was right. The measure failed.
We've been so busy pursuing the public vs. private agenda that we've lost credibility on a national front. We've invested so many resources battling each other that we've almost lost the war.
There seemed to be a glimmer of hope when the lobbying group Advocates for EMS appeared to be making progress pursuing a truly cross-representative and singular voice for EMS on a national level. However, now as the April EMS Insider reported (in "Fire Service Groups Create EMS Coalition"), one sector has created its own advocacy group specifically geared toward promoting its own agenda for one type of service-delivery model.
So it's back to square one.
In the fog of this public vs. private war, EMS has lost its identity. We can ill-afford to invest our resources arguing which EMS "brand" is better. Instead, we must focus nationally on elevating the profession , working in unison toward common goals.
http://www.jems.com/news_and_articles/articles/EMS_Needs_a_National_Brand_Identity.html
http://www.jems.com/news_and_articles/articles/EMS_Needs_a_National_Brand_Identity.html
Ridryder911
EMS Guru
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As a member of Advocates for EMS, I realize what their goal is. Albeit, somewhat generic and watered down, it is at least a start building a coalition. Without large member participation and active members, we will NEVER get the legislation's attention. Remember, for every $1.00 there is about 3 million groups that want it as well. All with valid points and needs.
The difficult part comes with the "hidden agenda" each player brings with them in a coalition setting. There is no escaping it. Hopefully, we can place those behind us and actually agree that we are there for one ultimate goal.. that being for the patient.
Now it appears fire dogs, want to go and be sure that nothing changes to severe .. especially in regards of education. Since most FD's are geared for training rather than educating. The old saying FD's hire below the neck is unfortunately being more stressed and stressed instead of attempting to change their image. Unfortunately, since they have numbers.. we may have a large fight on our hand.
R/r 911
The difficult part comes with the "hidden agenda" each player brings with them in a coalition setting. There is no escaping it. Hopefully, we can place those behind us and actually agree that we are there for one ultimate goal.. that being for the patient.
Now it appears fire dogs, want to go and be sure that nothing changes to severe .. especially in regards of education. Since most FD's are geared for training rather than educating. The old saying FD's hire below the neck is unfortunately being more stressed and stressed instead of attempting to change their image. Unfortunately, since they have numbers.. we may have a large fight on our hand.
R/r 911
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firetender
Community Leader Emeritus
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The nature of the beast!
Before I went into EMS in 1973 I was one of the first males in an RN program in New York (Queens Hospital Center). Nursing was at a turning point. RNs were in the midst of a transition and that was all about legitimizing themselves as other than just a doctors’ prosthesis. They began taking control of their own internal standards and along the way showing us how what they did was important enough to help them better their working conditions. They started by establishing local, and then regional professional organizations.
Flash forward and I was an MICU paramedic in California with ten years under my belt working on building legitimacy for that profession. This included issues of equipment, modalities employed, hours (96 hr. work weeks), coverage areas (this address gets ALS: across the street; Basic), remuneration as compared to other vital protection agencies ($900/month vs. $1,300 for fire), response time, and on and on; you know the drill.
Neither local government nor the companies were listening. What we were saying pretty much had to do with raising the standards of the profession in that particular county. After five years beating our heads against the wall -- county and private company pretty much working hand in hand to keep all levels of service and care at a marginal level, while medics were burning out left and right -- myself and a couple other medics looked at what the RNs had done and saw the model.
We developed a professional organization, (that went on to be called the California Paramedic’s Association) and began developing a twofold program of becoming a “voice” to publicize the value of paramedic services to raise overall community standards and organizing to lobby for better working conditions.
We put together a platform that placed emphasis on standards of care first…just like the Nurses had done. After a couple years we were making headway in that direction but registering zero on the equitable professional treatment level. Backs against the wall, we turned to the SEIU (AFL-CIO) for support.
What we did was to develop a unique charter where there was separation between labor organizing and professional development. The Union was contracted to represent us solely in labor negotiations, while the CPA was assigned with the responsibility to lobby for setting higher standards in emergency care.
The union was voted in by better than 80% of the medics involved. The CPA was the first union for EMS West of the Mississippi. That’s where it ended though. Within a couple years, the union trucked along (don’t know today’s status) but the aspect of a medic-driven pursuit of higher standards for the profession pretty much dribbled away.
What happened?
Only a few of us held a greater vision at any one time. Medics would come in, participate, and when it got rough, drop out. We had the ears of the medics on the working conditions, but still, 99% of the work had to be done by those of us who were willing (or dumb enough!) to dedicate most of our off-hours to the task. We knew the union was only a vehicle of stability to help us do what we really wanted to do – legitimize the profession and put it on an even level with fire and police protection so we’d have a future in it.
Herding cats is one way to put it. But, for the most part – and this after at least five years personally dedicated to organizing (I was “Communications Officer” for at least four precursors of the union, almost without a break) – what I found was that the medics themselves viewed the position as transitory. They were interested in pay and benefits and hours, but they lost the vision for the future because they did not see themselves as having a future in EMS unless they went to management
In my experience, most of the medics who did stay in the job beyond ten years just wanted to do their shifts and go home. It’s about the job, not the profession. Why? Because all the other stuff is related to politics, uphill battles and a burnout that feels even more debilitating than call-related trauma. Personally, I never burned out on the work. I burned out on the politics.
Most medics then and now know that they are just a few bad calls in a row from throwing in the towel. No one, not the medics themselves, not their employers, and not the governmental institutions that regulate the industry have taken steps to build outlets so those in the field are encouraged to stay in the field. This includes acknowledging the high-stress of the job and developing “safety-nets” for the medics. Just like always, the primary issue is keeping warm bodies in the rigs by taking advantage of the rookie’s altruistic impulses.
I would say there’s a coming together of influences: the high specificity of the job, the economics of actually supporting a high turnover rate to keep salaries and benefits in check, and maybe most important, the fact that it does take a lot of psychic energy to do the job and there just isn’t that much reserve left for the medic to enter political battles against people who still see medics as Ambulance Drivers, aka, glorified civil servants.
Look at this site alone. It’s rife with older medics tempering Newbies with sage advice, while warning, warning, warning about how it’ll be nothing like what they envision. This is twenty-five years later in each of the areas we were appalled at back then!
As long as there are young men and women doing out in the field what most doctors can’t do in the hospital there will be issues of power and responsibility dependent on local standards. At any point in its development, if the right person (with power) gets tweaked, it’s back to the drawing board and modification of what levels of care can and cannot be delivered. A lot more people react when something goes wrong in the back of an ambulance than when something goes wrong in the hospital. Why? Once again, these snot-nosed kids are not supposed to be doctors.
Nursing as a whole has many, many specialty career outlets and opportunities to cross over to from wherever you’re at. It also has a better-defined system of reciprocity from state to state. Standardization in pay, benefits and opportunities has come about through local professional nursing organizations bonding with others nearby and establishing unified, therefore effective, voices that eventually went National. In that respect nursing had the numbers to expand the web of their affiliations and support. This doesn't exist in EMS.
In conclusion (for this part, anyway), I think the odds are stacked against the medic to make this a bonafide profession like Nursing.
First comes the way medics view the profession as a no more than a stepping-stone to something with more stability. The agencies that render the service support this. I think there’s no plot there, they’re just working with what is. What is is that for the most part, medics are a transient work force.
Second is the high specificity of the job, which really limits flexibility and outlets for cross-training and placement. Besides, most medics just want to run calls, and “good” ones at that.
Yet Fire and Police departments have, within the context of high specificity, integrated themselves into the fabric of society as ESSENTIAL services. They have built avenues that support internal movement and opportunity such that they can maintain relatively stable work forces.
Could that be because you can pretty much eliminate fires and crime, and Firemen die in fires and Cops get shot, but for the most part the medic is in a losing battle against death and the only thing that dies in the medic is his or her soul which doesn’t make good copy?
The final (and perhaps unifying) factor is that there are very few people built for the onslaught that is emergency medicine. It takes a certain kind of person to deal with the territory, and usually, there is a prime time in life when that can happen. It is a limited period of time where the attraction to the field is sustainable only during one’s vital second and third decades. And then, for the most part, the cumulative pressures wear you out.
Next round, I want to talk about the way things are and potential avenues for expanding the job description to meet the changing face of medical care.
Before I went into EMS in 1973 I was one of the first males in an RN program in New York (Queens Hospital Center). Nursing was at a turning point. RNs were in the midst of a transition and that was all about legitimizing themselves as other than just a doctors’ prosthesis. They began taking control of their own internal standards and along the way showing us how what they did was important enough to help them better their working conditions. They started by establishing local, and then regional professional organizations.
Flash forward and I was an MICU paramedic in California with ten years under my belt working on building legitimacy for that profession. This included issues of equipment, modalities employed, hours (96 hr. work weeks), coverage areas (this address gets ALS: across the street; Basic), remuneration as compared to other vital protection agencies ($900/month vs. $1,300 for fire), response time, and on and on; you know the drill.
Neither local government nor the companies were listening. What we were saying pretty much had to do with raising the standards of the profession in that particular county. After five years beating our heads against the wall -- county and private company pretty much working hand in hand to keep all levels of service and care at a marginal level, while medics were burning out left and right -- myself and a couple other medics looked at what the RNs had done and saw the model.
We developed a professional organization, (that went on to be called the California Paramedic’s Association) and began developing a twofold program of becoming a “voice” to publicize the value of paramedic services to raise overall community standards and organizing to lobby for better working conditions.
We put together a platform that placed emphasis on standards of care first…just like the Nurses had done. After a couple years we were making headway in that direction but registering zero on the equitable professional treatment level. Backs against the wall, we turned to the SEIU (AFL-CIO) for support.
What we did was to develop a unique charter where there was separation between labor organizing and professional development. The Union was contracted to represent us solely in labor negotiations, while the CPA was assigned with the responsibility to lobby for setting higher standards in emergency care.
The union was voted in by better than 80% of the medics involved. The CPA was the first union for EMS West of the Mississippi. That’s where it ended though. Within a couple years, the union trucked along (don’t know today’s status) but the aspect of a medic-driven pursuit of higher standards for the profession pretty much dribbled away.
What happened?
Only a few of us held a greater vision at any one time. Medics would come in, participate, and when it got rough, drop out. We had the ears of the medics on the working conditions, but still, 99% of the work had to be done by those of us who were willing (or dumb enough!) to dedicate most of our off-hours to the task. We knew the union was only a vehicle of stability to help us do what we really wanted to do – legitimize the profession and put it on an even level with fire and police protection so we’d have a future in it.
Herding cats is one way to put it. But, for the most part – and this after at least five years personally dedicated to organizing (I was “Communications Officer” for at least four precursors of the union, almost without a break) – what I found was that the medics themselves viewed the position as transitory. They were interested in pay and benefits and hours, but they lost the vision for the future because they did not see themselves as having a future in EMS unless they went to management
In my experience, most of the medics who did stay in the job beyond ten years just wanted to do their shifts and go home. It’s about the job, not the profession. Why? Because all the other stuff is related to politics, uphill battles and a burnout that feels even more debilitating than call-related trauma. Personally, I never burned out on the work. I burned out on the politics.
Most medics then and now know that they are just a few bad calls in a row from throwing in the towel. No one, not the medics themselves, not their employers, and not the governmental institutions that regulate the industry have taken steps to build outlets so those in the field are encouraged to stay in the field. This includes acknowledging the high-stress of the job and developing “safety-nets” for the medics. Just like always, the primary issue is keeping warm bodies in the rigs by taking advantage of the rookie’s altruistic impulses.
I would say there’s a coming together of influences: the high specificity of the job, the economics of actually supporting a high turnover rate to keep salaries and benefits in check, and maybe most important, the fact that it does take a lot of psychic energy to do the job and there just isn’t that much reserve left for the medic to enter political battles against people who still see medics as Ambulance Drivers, aka, glorified civil servants.
Look at this site alone. It’s rife with older medics tempering Newbies with sage advice, while warning, warning, warning about how it’ll be nothing like what they envision. This is twenty-five years later in each of the areas we were appalled at back then!
As long as there are young men and women doing out in the field what most doctors can’t do in the hospital there will be issues of power and responsibility dependent on local standards. At any point in its development, if the right person (with power) gets tweaked, it’s back to the drawing board and modification of what levels of care can and cannot be delivered. A lot more people react when something goes wrong in the back of an ambulance than when something goes wrong in the hospital. Why? Once again, these snot-nosed kids are not supposed to be doctors.
Nursing as a whole has many, many specialty career outlets and opportunities to cross over to from wherever you’re at. It also has a better-defined system of reciprocity from state to state. Standardization in pay, benefits and opportunities has come about through local professional nursing organizations bonding with others nearby and establishing unified, therefore effective, voices that eventually went National. In that respect nursing had the numbers to expand the web of their affiliations and support. This doesn't exist in EMS.
In conclusion (for this part, anyway), I think the odds are stacked against the medic to make this a bonafide profession like Nursing.
First comes the way medics view the profession as a no more than a stepping-stone to something with more stability. The agencies that render the service support this. I think there’s no plot there, they’re just working with what is. What is is that for the most part, medics are a transient work force.
Second is the high specificity of the job, which really limits flexibility and outlets for cross-training and placement. Besides, most medics just want to run calls, and “good” ones at that.
Yet Fire and Police departments have, within the context of high specificity, integrated themselves into the fabric of society as ESSENTIAL services. They have built avenues that support internal movement and opportunity such that they can maintain relatively stable work forces.
Could that be because you can pretty much eliminate fires and crime, and Firemen die in fires and Cops get shot, but for the most part the medic is in a losing battle against death and the only thing that dies in the medic is his or her soul which doesn’t make good copy?
The final (and perhaps unifying) factor is that there are very few people built for the onslaught that is emergency medicine. It takes a certain kind of person to deal with the territory, and usually, there is a prime time in life when that can happen. It is a limited period of time where the attraction to the field is sustainable only during one’s vital second and third decades. And then, for the most part, the cumulative pressures wear you out.
Next round, I want to talk about the way things are and potential avenues for expanding the job description to meet the changing face of medical care.
Ventmedic- I'm still not sure what you're getting at with the year the degree was given, other than pointing out that initially EMS was concerned with the amount of knowledge/training required and tried to make it a good system. And failed unfortunately. It does bring up a good point though: look at what a paramedic can do and must know compared to what could be done in the beginning. If people 30 years ago recognized the need for a long, extensive training program...what the hell is going through people's heads today!?
Now, be honest. I haven't critisized you for wanting RN's to do transports, far from it. I have, and will continue to critisize you for wanting to introduce PHRN's, a certification that could, and very likely would be used to compete with paramedics in systems that respond to emergency calls instead of improving the training given. Now we've gone over that ad infinitum, don't know why you'd try and misrepresent what was said.
EMS is not really a unified system nationally. If you want that to change, why not advocate for it? Why sit back and let it continue instead of trying to get some group or another involved to help fix the problem?
Now, is there anyway I can convince you to answer any of the questions I've brought up and refute anything I've said, or will you just continue to ignore it? I'm ok with either one at this point.
Gaurdian- it is a big can of words, and I'd be happy to open up that can, but in a different thread.
firecoins- the program I went through required A&P 1,2,3, chemistry, biology, Intro to EMS (hx, CISM, ethics, etc) EMT-Rescue, communication/transport (how to write a chart basically), math, speech, english, basic health course, medical terminology, psychology, a couple of electives, computer course and maybe one or two other core classes, I can't recall. Plus the EMT-basic course. I'd like to see a pharmocology class added, but that isn't bad for the minimum standards as I see it. With a system like that the paramedic course itself is focused ONLY on paramedicine; the rest has allready been covered.
skyemt- yes, changing the testing process for all new EMT's is definetly a must. The same with the internship. Look back a couple of posts for more.
Rid- got anymore info on Advocates for EMS? Never heard of it before.
firetender- my hat is off to you and I'll shake your hand if we ever meet. What you tried to do back in the 80's is what is needed today, but on a larger scale. Unfortunately, the problems that you experienced would probably pop up again today. You tried though, and for having the vison and drive to do that...thank you, it sets an example for everyone to follow.
I think that there are more people now who are getting into this field because it is what they want to do and not just to use it as a stepping stone. I realize that may not hold true everywhere; a lot depends on how difficult it is to become a medic I think; if it's a 2-3 year commitment vs 1 year or less, the people who just want to cert as an extra merit badge will (hopefully) be scared off from trying it.
Fire and police definetly do have their niche carved out for them. But, that has taken place over 200 years, wheras EMS has only been around for 30 odd years. Hopefully we can get there ourselves. But, to do that, we need to be unified, and we need a voice. Like you've allready tried, but bigger, if that is at all possible.
Curious, when you had the union and CPA going, how did it work initially? Did they work together? Did they need to? Were any advances made in training, education, working conditions, eet etc? Or did it fall apart immedietly?
Now, be honest. I haven't critisized you for wanting RN's to do transports, far from it. I have, and will continue to critisize you for wanting to introduce PHRN's, a certification that could, and very likely would be used to compete with paramedics in systems that respond to emergency calls instead of improving the training given. Now we've gone over that ad infinitum, don't know why you'd try and misrepresent what was said.
EMS is not really a unified system nationally. If you want that to change, why not advocate for it? Why sit back and let it continue instead of trying to get some group or another involved to help fix the problem?
Now, is there anyway I can convince you to answer any of the questions I've brought up and refute anything I've said, or will you just continue to ignore it? I'm ok with either one at this point.
Gaurdian- it is a big can of words, and I'd be happy to open up that can, but in a different thread.
firecoins- the program I went through required A&P 1,2,3, chemistry, biology, Intro to EMS (hx, CISM, ethics, etc) EMT-Rescue, communication/transport (how to write a chart basically), math, speech, english, basic health course, medical terminology, psychology, a couple of electives, computer course and maybe one or two other core classes, I can't recall. Plus the EMT-basic course. I'd like to see a pharmocology class added, but that isn't bad for the minimum standards as I see it. With a system like that the paramedic course itself is focused ONLY on paramedicine; the rest has allready been covered.
skyemt- yes, changing the testing process for all new EMT's is definetly a must. The same with the internship. Look back a couple of posts for more.
Rid- got anymore info on Advocates for EMS? Never heard of it before.
firetender- my hat is off to you and I'll shake your hand if we ever meet. What you tried to do back in the 80's is what is needed today, but on a larger scale. Unfortunately, the problems that you experienced would probably pop up again today. You tried though, and for having the vison and drive to do that...thank you, it sets an example for everyone to follow.
I think that there are more people now who are getting into this field because it is what they want to do and not just to use it as a stepping stone. I realize that may not hold true everywhere; a lot depends on how difficult it is to become a medic I think; if it's a 2-3 year commitment vs 1 year or less, the people who just want to cert as an extra merit badge will (hopefully) be scared off from trying it.
Fire and police definetly do have their niche carved out for them. But, that has taken place over 200 years, wheras EMS has only been around for 30 odd years. Hopefully we can get there ourselves. But, to do that, we need to be unified, and we need a voice. Like you've allready tried, but bigger, if that is at all possible.
Curious, when you had the union and CPA going, how did it work initially? Did they work together? Did they need to? Were any advances made in training, education, working conditions, eet etc? Or did it fall apart immedietly?
Ridryder911
EMS Guru
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Firetender, you brought some very interesting points. I agree, the "politics" of the business is what usually "burns" out the professionals. The eager Johnny Go Rescuer, usually exits much sooner. You will have some that attempt to change things, and finally after years of hitting a brick wall, and their head, they finally leave EMS dissatisfied.
The problem is, that those that serve (like yourself) make progress and then it stops when no one else will replace the fallen. Then years later another poor soul will attempt, then the cycle continuous.
I was fortunate to meet with an EMS professional in the education department of a university. I was impressed (as I believe she was as well) on our similarity of views and visions of EMS. I have to admit it was refreshing to meet another one, whom wants to remove the "good ole boys" system in EMS. Education actually matters, that improving entry requirements to screen those that are really interested in EMS as a profession, that actually are willing to prepare themselves mentally and physically for the profession.
I have to admit it is shameful; when most colleges will not recognize EMS textbooks due to the lower level it is written at. When the whole profession can be placed into one text, one must realize there is something wrong.
In regards to PHRN's I am not worried, nor should anyone in EMS feel threatened. In fact instead of worrying about them, we need to focus on ourselves. If we become replaced, it will by our own doing.
Let's focus on subject(s) at hand :
> Poor to no education, rather trained at any building that can store CPR dummies.
> EMS instructors only education in teaching is a week long lecture. EMS administrators that endorse multiple levels and poor training for many reasons: ability to charge for higher rates & maintain poor pay scale, limit possibility of employees leaving for diverse positions.
> Fire Chiefs that finally realized that EMS is the best PR tool. They can demonstrate productivity, allow EMS to wear the FD logo (although technically they are not really F/F) and pay them cheaper salary and no benefits.
> EMT's that have a apathetic attitude, as long as the check clears.. who care.. then there are the ones whom will even fight any advancement in education improvements secondary of worrying about volunteerism.
> Poor pay and no career ladder all lateral movement, no matter what position is obtained.
We can not approach law makers (locally or federally) if we do not come in unionization (not union) presenting our case. Lawmakers do not presume anyone (organizations) represents their profession if they are made up of > 25% of the number of their profession. This is why active participation is so crucial from multiple organizations in agreement so a coalition can be made. This is what make me so disgruntled. About the time we advance to upward, special interest groups (IAFC, Volunteers) pull the card of being worried to advance, protecting themselves rather than having interest of the patient in mind.
Hopefully, with forums such as this we can educate all members of EMS to participate and improve EMS standards.
Info: http://www.advocatesforems.org/
R/r 911
The problem is, that those that serve (like yourself) make progress and then it stops when no one else will replace the fallen. Then years later another poor soul will attempt, then the cycle continuous.
I was fortunate to meet with an EMS professional in the education department of a university. I was impressed (as I believe she was as well) on our similarity of views and visions of EMS. I have to admit it was refreshing to meet another one, whom wants to remove the "good ole boys" system in EMS. Education actually matters, that improving entry requirements to screen those that are really interested in EMS as a profession, that actually are willing to prepare themselves mentally and physically for the profession.
I have to admit it is shameful; when most colleges will not recognize EMS textbooks due to the lower level it is written at. When the whole profession can be placed into one text, one must realize there is something wrong.
In regards to PHRN's I am not worried, nor should anyone in EMS feel threatened. In fact instead of worrying about them, we need to focus on ourselves. If we become replaced, it will by our own doing.
Let's focus on subject(s) at hand :
> Poor to no education, rather trained at any building that can store CPR dummies.
> EMS instructors only education in teaching is a week long lecture. EMS administrators that endorse multiple levels and poor training for many reasons: ability to charge for higher rates & maintain poor pay scale, limit possibility of employees leaving for diverse positions.
> Fire Chiefs that finally realized that EMS is the best PR tool. They can demonstrate productivity, allow EMS to wear the FD logo (although technically they are not really F/F) and pay them cheaper salary and no benefits.
> EMT's that have a apathetic attitude, as long as the check clears.. who care.. then there are the ones whom will even fight any advancement in education improvements secondary of worrying about volunteerism.
> Poor pay and no career ladder all lateral movement, no matter what position is obtained.
We can not approach law makers (locally or federally) if we do not come in unionization (not union) presenting our case. Lawmakers do not presume anyone (organizations) represents their profession if they are made up of > 25% of the number of their profession. This is why active participation is so crucial from multiple organizations in agreement so a coalition can be made. This is what make me so disgruntled. About the time we advance to upward, special interest groups (IAFC, Volunteers) pull the card of being worried to advance, protecting themselves rather than having interest of the patient in mind.
Hopefully, with forums such as this we can educate all members of EMS to participate and improve EMS standards.
Info: http://www.advocatesforems.org/
R/r 911
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firetender
Community Leader Emeritus
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Two points for triemal04:
I think very few of the people who come into EMS come in with the intent that being a paramedic is a stepping stone. There are some who consciously do this (i.e. to get higher priority for Fire Service hire), but most enter because they want to provide EMS. Once they're in and see the nature of the (monkey) business, however, THEN they decide it is just a stepping stone.
and...
Haven't thought about this in a long, long time.
The truth is within a week (or so?) of the successful vote of the company paramedics for union affiliation, me and my partner got fired by the private provider for a minor infraction. They fired me, talked the county (Santa Barbara) into revoking my paramedic certification, got California to revoke my ambulance driver's certificate, and denied me unemployment benefits based on "Gross negligence in the performance of your duties"!
I spent the next 9 months of my life challenging them at every turn at hearing after hearing after hearing, until I got everything reinstated. Everything, that is, except a favorable ruling from the (Reagan-directed) National Labor Relations Board showing that the firing was a direct result of my union activity.
From what I understand, the transition went smoothly, though I didn't get to see how it developed. The union did not come to my defense in other than a marginal way. I suspect I was a sacrificial lamb, like my company saying: "Let's not start off by fighting. He's always been a rabble-rouser. You got what you want (spelled d-u-e-s ? ) so let's move cooperatively from here."
AirwayGoddess is still in touch with a couple of my co-conspirators. At this late date, I, too, would like to hear how things unfolded or unravelled as the case may be.
After I got everything reinstated, I decided I had enough, wrote a screenplay and spent the next nine years of my life trying to get it made as I explored more of the incredible world of the healing arts. I suppose I was bitter for a while, but that's really not who I am.
I've been much too busy -- and this is no joke -- spending the last twenty-five years of my life assimilating the precious things I learned in the back of an ambulance.
Without that spin, I wouldn't be here, and I can't tell you how happy I am to be here!
...Oh, and don't squirm when you reach out your hand for a shake and get a hug back!
I think very few of the people who come into EMS come in with the intent that being a paramedic is a stepping stone. There are some who consciously do this (i.e. to get higher priority for Fire Service hire), but most enter because they want to provide EMS. Once they're in and see the nature of the (monkey) business, however, THEN they decide it is just a stepping stone.
and...
Haven't thought about this in a long, long time.
The truth is within a week (or so?) of the successful vote of the company paramedics for union affiliation, me and my partner got fired by the private provider for a minor infraction. They fired me, talked the county (Santa Barbara) into revoking my paramedic certification, got California to revoke my ambulance driver's certificate, and denied me unemployment benefits based on "Gross negligence in the performance of your duties"!
I spent the next 9 months of my life challenging them at every turn at hearing after hearing after hearing, until I got everything reinstated. Everything, that is, except a favorable ruling from the (Reagan-directed) National Labor Relations Board showing that the firing was a direct result of my union activity.
From what I understand, the transition went smoothly, though I didn't get to see how it developed. The union did not come to my defense in other than a marginal way. I suspect I was a sacrificial lamb, like my company saying: "Let's not start off by fighting. He's always been a rabble-rouser. You got what you want (spelled d-u-e-s ? ) so let's move cooperatively from here."
AirwayGoddess is still in touch with a couple of my co-conspirators. At this late date, I, too, would like to hear how things unfolded or unravelled as the case may be.
After I got everything reinstated, I decided I had enough, wrote a screenplay and spent the next nine years of my life trying to get it made as I explored more of the incredible world of the healing arts. I suppose I was bitter for a while, but that's really not who I am.
I've been much too busy -- and this is no joke -- spending the last twenty-five years of my life assimilating the precious things I learned in the back of an ambulance.
Without that spin, I wouldn't be here, and I can't tell you how happy I am to be here!
...Oh, and don't squirm when you reach out your hand for a shake and get a hug back!
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Every time I start agreeing with you, you write something like this. Have you worked on an ambulance in the last 15 years? I would say the vast majority of people knowingly see ems as a stepping stone before they even take emt-b. Stepping stone to FD, RN, MD, PD, STD, and the ever sickening "Flight Medic." I can't stand these people who decide they want to be "flight medics" before they even take emt-b. Worst yet are the people who want to be "flight medics" simply for the "prestige" and "excitement", and not the authentic desire to provide great paramedical care. That's a lot of quotation marks, but they are there to point out the idiotic delusions that piss me off the most. Largest still, are the people who use ems as a stepping stone for excitement, and have no real interest in helping people. Anyway, I’m digressing.
I’m doing college research on theories involving sociological commodification (mass manipulation). One of the great lines is “to offer and to deprive them of something is one in the same.” So Zavadsky’s article was right up my alley; thanks for posting vent. When I get some free time, I hope to combine some of these theories and apply them to ems in relation to its national brand and/or lack thereof. Stay tuned.
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Ridryder911
EMS Guru
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I agree. This is some of the points me and this college EMS coordinator was discussing. Even many of those that are entering an associate degree no longer have intentions of working in the field, rather immediately to leave into another profession.
Collegiate level courses usually have lower number of applicants than some other traditional programs. Even with the number of applicants in other programs it is estimated that only about 1:10 to 1:12 have any intention of working in the field. This of course leads us into having one to two students that have any intention of working in the EMS profession. This is not even accounting the points that "if" they pass or "if" they are desirable to be employable.
Most of the programs I have seen, (not just in my area) are now breeding grounds for pre-fire employment, pre-nursing, other medical occupation to hobbyist.
With FD's increasing the number of Paramedics on their staff, many will even enter and complete the Paramedic program in hopes this will increase their chances of employment with a FD. Even though, they have no intention, or desire to ever to work in that capacity.
The same true for those wanting to enter or are on hold for a nursing program. Many feel this will increase their chances, or will be able to accomplish "bridge" programs.
These are some of the major problems we have seen in multiple areas. In fact I am consulting some peers today in to attempt to form a coalation addressing this very problem.
There are EMS services that pay decent comparable salary within the region however; are loosing any potential interested candidates and even experienced Paramedics. Metro cities that are located across the state border (approx 1 hr) that having starting salaries that are double to almost triple what any EMS can pay. Due to the region the EMS is in, Medicare will never pay reimbursement rates enough to be competitive enough.
As well, we need to be objective and honest. Why would anyone really consider entering EMS? Very few services offer competitive wages, as well as retirement, full medical and dental benefits, and retirement? Even my EMS, which the second highest paid in my state, caps out the salary after just 10 years.. so yes, we have many "lifers" leave due to no more expectations and growth.
As well, why should anyone ever enter a profession that is dead end? Seriously, after the Paramedic level there is no where for a person to go. They either enter education or management level... that's it. Some will still perform in the field, but after years of trivial pay increases become discouraged.
How do you approach a young person to enter EMS with those facts? Knowing, within five years they have hit the high point of their career. That within ten yrs or so, they have reached their full career ladder.
We need to explore other avenues and develop career opportunities. Expand the role of the Paramedic, and not limit ourselves. Promote programs instead of fighting educational development. Participate in local, state, and national organizations that promote EMS development.
R/r 911
Collegiate level courses usually have lower number of applicants than some other traditional programs. Even with the number of applicants in other programs it is estimated that only about 1:10 to 1:12 have any intention of working in the field. This of course leads us into having one to two students that have any intention of working in the EMS profession. This is not even accounting the points that "if" they pass or "if" they are desirable to be employable.
Most of the programs I have seen, (not just in my area) are now breeding grounds for pre-fire employment, pre-nursing, other medical occupation to hobbyist.
With FD's increasing the number of Paramedics on their staff, many will even enter and complete the Paramedic program in hopes this will increase their chances of employment with a FD. Even though, they have no intention, or desire to ever to work in that capacity.
The same true for those wanting to enter or are on hold for a nursing program. Many feel this will increase their chances, or will be able to accomplish "bridge" programs.
These are some of the major problems we have seen in multiple areas. In fact I am consulting some peers today in to attempt to form a coalation addressing this very problem.
There are EMS services that pay decent comparable salary within the region however; are loosing any potential interested candidates and even experienced Paramedics. Metro cities that are located across the state border (approx 1 hr) that having starting salaries that are double to almost triple what any EMS can pay. Due to the region the EMS is in, Medicare will never pay reimbursement rates enough to be competitive enough.
As well, we need to be objective and honest. Why would anyone really consider entering EMS? Very few services offer competitive wages, as well as retirement, full medical and dental benefits, and retirement? Even my EMS, which the second highest paid in my state, caps out the salary after just 10 years.. so yes, we have many "lifers" leave due to no more expectations and growth.
As well, why should anyone ever enter a profession that is dead end? Seriously, after the Paramedic level there is no where for a person to go. They either enter education or management level... that's it. Some will still perform in the field, but after years of trivial pay increases become discouraged.
How do you approach a young person to enter EMS with those facts? Knowing, within five years they have hit the high point of their career. That within ten yrs or so, they have reached their full career ladder.
We need to explore other avenues and develop career opportunities. Expand the role of the Paramedic, and not limit ourselves. Promote programs instead of fighting educational development. Participate in local, state, and national organizations that promote EMS development.
R/r 911
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One thing that has not really been touched upon is the fact that the EMS system, if you want to call it that, is predicated on having sufficient numbers... this is a major reason that states are not eager to increase the educational standards... it will come at a cost of decreasing numbers of emt applicants, as well as those who pass the exams, and the states do not want to risk losing too many numbers...while we can agree or disagree on that, we do know that it is a concern on the administrative level...
the other thing, reading between the lines, is that there is no glamour in EMS... in fact, many view EMS as a "taxi ride" to the hospital, where they can get real care...of course, i disagree with this, but there is a generally poor public perception of EMS, which is a hurdle to achieving what you all want...
public perception can not be underestimated... in fact, the 70s tv show "emergency", did a lot to further the cause of Paramedicine, and while unlikely, this type of mass media glamourization would do the same thing today...
i know even in my system, which i believe works very well, there is a general lack of knowledge of what EMS really does... it is a challenge to educate the public, and perhaps, some of you have had positive experiences with this... any thoughts?
the other thing, reading between the lines, is that there is no glamour in EMS... in fact, many view EMS as a "taxi ride" to the hospital, where they can get real care...of course, i disagree with this, but there is a generally poor public perception of EMS, which is a hurdle to achieving what you all want...
public perception can not be underestimated... in fact, the 70s tv show "emergency", did a lot to further the cause of Paramedicine, and while unlikely, this type of mass media glamourization would do the same thing today...
i know even in my system, which i believe works very well, there is a general lack of knowledge of what EMS really does... it is a challenge to educate the public, and perhaps, some of you have had positive experiences with this... any thoughts?
The public gets mixed messages about EMS from both the media and the EMS systems. Since there are so many different systems that each vary in everything from skills to retirement benefits as well as the education level, it is hard to put anything other than a generic definition on the many aspects of EMS.
While the paramedic can go out and talk about what great education and skills they prossess, there will be a TV ad in the background for a Medic Mart school that says "in just a few weeks you too can do all this".
In Florida, some of the county and municipal EMS systems are excellent for employees to grow and move throughout the system as they continue their education. The medical and retirement benefits are excellent also. But, then we also have large and small private or municipal companies that may be the exact opposite.
Someone wanting to go into EMS may get mixed messages depending on who they choose to ask for advise. The questions I posted earlier were meant to discover if there were roles models that pointed out the need for further education in one's career path.
As Guardian pointed out:
This may be the advice one receives in their career infancy and thus, that is the direction they go because someone has discouraged them from discovering any positive aspects of a career in EMS.
Maybe once Paramedics and EMTs define themselves through a national organization and standards and not the agency they work for, then we can offer a better explaination to the legislators and the public.
Firetender/Gaurdian- ok, I can agree with that, up to a point anyway. First, depending on the dept, I wouldn't call getting on a FD leaving EMS or moving on; in this part of the country the majority of ambulances are FD run, and in all honesty, if someone wants to work on an ambulance run by a FD vs a private, does that make them less of a medic or a copout? No. (I do agree though that people who become medic's with the sole intention of riding on an engine and never on a medic unit are not doing anyone any favors, including themselves). But, I can see people working in EMS for a few years and then moving on to other medical work; this is where increasing wages and benefits to an appropriate level comes in; if medics are getting paid what they should, then I think that less (not all) would want to move on. And if someone is willing to spend 2-3 years getting that degree, they may be more inclined to use it. The rest of your post...that sucks. It looks like you've come out ok in the end though and are back at it, so congratulations.
A couple of half-truths have been floated here that need to be addressed. First, not every fire department that runs an ambulance uses civillian employess like FDNY does; some of the larger ones do, but look at the country as a whole and it is absolutely false that medics working for a FD are "not really FF's" and are getting paid less. The majority of dept's crosstrain their personell, and often the medic get's EXTRA pay for being a paramedic, not less. Second, if the educational requirements are changed, if it is MANDATED AT THE NATIONAL LEVEL that a AAS degree is required, and that states may not go below this education and still certify paramedics, it won't matter if ANY service wants to train medic's faster...there won't be a way to do it. Of course this won't happen unless some group steps up to the plate, but hopefully that will happen. If EMS is to survive, it needs to.
A couple of half-truths have been floated here that need to be addressed. First, not every fire department that runs an ambulance uses civillian employess like FDNY does; some of the larger ones do, but look at the country as a whole and it is absolutely false that medics working for a FD are "not really FF's" and are getting paid less. The majority of dept's crosstrain their personell, and often the medic get's EXTRA pay for being a paramedic, not less. Second, if the educational requirements are changed, if it is MANDATED AT THE NATIONAL LEVEL that a AAS degree is required, and that states may not go below this education and still certify paramedics, it won't matter if ANY service wants to train medic's faster...there won't be a way to do it. Of course this won't happen unless some group steps up to the plate, but hopefully that will happen. If EMS is to survive, it needs to.