The 4 paths of EMS Personnel

[Fish]

Something I have been giving thought to lately, and mind you it is jut one mans thoughts so feel free to join in and add your two cents or opinions! And sorry that there is so much to read. I have terrible grammar, so don't mind the misplaced or lack there of comas and run ons.

A Background:
I have been in EMS for 7 years, 2-3 as an EMT, 4-5 as a Paramedic. I have been a Paramedic student Preceptor, an EMS Instructor, and an FTO. I Have worked in both Inner City busy, and Suburban/Rural Medium paced Systems. I currently work in a great system, I would say our ALS/BLS call ratio is more on the ALS side than most systems(although I have no way to prove or back this assumption up, just going off of hearsays) We pay well, have great leadership, Great Retirement, Equipment is top notch and the people I work with are excellent in both their Paramedic ability and just down right good people. Moral around here is high, burn out is very low, and people seem to enjoy the job. They treat the equipment and ALL patient's with great respect.

Now, something I have noticed is this. It seems to me that when new Paramedics come to the field(And mind you I am talking based off of experience from two systems from two areas that are 100% opposites) They have this expectation to run calls, "Good calls" and a lot of them. In Paramedic school that is what they did, they were run through scenarios that were full of Sick Patients our critically injured Patients. They then get into the field and find that the majority of what we do is BLS in nature, non-emergent, however you want to phrase it. This has an effect on new Medics....... "This is not what I busted my *** in Medic school for..." So what I have noticed is this, at about the 1-1/2 to 2 years mark they have a slight fall in moral and experience a bit of stagnation or "burnt effect" this can go on up until years 3-4 but right at about the 5 year mark it seems that they make a decision, or choose 1 of 4 paths.

Path 1: Complete burnout, decide they hate the job. It is not what they thought it would be. They do not like the hours, pay, patients, Company, whatever it may be, but they are done. And they get out of EMS completely.

Path 2: Decide while EMS was OK, it is not their end goal or not what they want to do for a career and set out to complete education in something else. Either While still working in EMS, or not.

Path 3: Complete burnout still, but also believe they have no other choice, they put all of their eggs into this basket and they now rely on it to pay the bills, support the family, whatever it may be. Now they continue in EMS even though they hate it.

Path 4: Path 4 is what I call ultimate Realization, the EMS personnel who goes down path 4 ultimately realizes that Paramedic school(by no fault of its own) Lied to them. They realize that the job is not GSWs and Full arrest everyday, it is Flu, General all over Pain, minor collisions with critical calls thrown in a few times a month. Path 4 people also have the realization that this job is just that, a job. And they come to work and do the job, whatever the job may be that day and they do not let "bls" calls anger them or make them bitter, because they have realized that this is what EMS is about.

I am a Path 4, 7 years in and I still love the job. I had my moment of "burnout" while transporting drunks, patient's with the flu, etc when I was younger in EMS..... Now I accept it as part of the job, the calls do not bug me like they did. And I show up to work to do just that, work. No matter what the work for that day might be. Now, I work in a good system, as stated above, and I completely understand that sometimes factors such as poor pay, poor employer can have drastic effects on ones thoughts towards the job.

This is just a thought I have been passing around in my head a while, tell me what your opinion is. Do you agree, disagree? To many paths, would you add a path?

 

[46Young]

Path 5:

Starts out as Path 1,2, or 3. The individual decides that they can still do EMS, but would prefer that it be only part of their job description, perhaps even marginalized to a great degree depending on how it's integrated. This would be the fire based EMS path (engine medic/EMT, maybe txp, maybe not), or the LEO/EMS path (Nassau County EAB or LEO, Maryland State Trooper/Flight Medic, Fairfax County Police "FFx One" Medevac) as examples.

Edit: I may have turned out as a Path 4 if I could have found a Third Service EMS employer outside of NY that paid what I was getting (more than $30/hr) pension, and good job security. You're absolutely right that poor employer and poor pay can be the difference from Path 4 and the others. It's a lot different running frivolous calls at 0230 when you're making $70k/yr on a 40-42 hour schedule than when you're making $40k (if you're lucky) on a 56 hour schedule. It's the difference in attitude running the toe pain at 0130 - it may be the final call that makes you get out of EMS, or you can say "Sure, I'll run these all night every night and laugh all the way to the bank - easy money!" It's different catching puke in the back of the bus for $12/hr than it is for $35/hr.

 

[Clare]

There are a few here who sign up for the Degree with ambitions that it is all lights and sirens, blood and guts high profile priority 1 stuff, they are either turned away because they show a lack of genuine interest/maturity or quickly learn that it's not and either adjust, or drop out.

I must say the lights and sirens sick patients never was my main attraction, it certainly helps but its not the be all and end all. Most of what is done in ambulance is the simple, everyday jobs with a few sick people sprinkled in for good measure. There are people here on the PTS vehicles who all they do is discharges and appointment pickups or whatever and never see any emergency work and it keeps them coming back so the lights and sirens fast paced gore can't be the only thing that keeps people in the job.

 

[Anjel]

I am path 2 and 4. I love EMS. I will always work in EMS in some fashion. I am almost done with medic school, and I have no false hopes as to what the job is. But I want more knowledge. I want to be able to provide my family a good life. Which is possible in EMS, but not around here and I am not in the position to move.

I love my job. I won't give up a part time spot on the truck. But I'm going to nursing school. It's what I have I so do me.

 

[eprex]

Path 6 - Got into EMS to pad resume for college or medical/PA school

 

[Veneficus]

Path 7

Realize to make any difference in EMS, you must be a physician.

 

[NYMedic828]

Path 8 - Stepping stone to firefighter promotion.

 

[Clare]

\I won't give up a part time spot on the truck. But I'm going to nursing school. It's what I have I so do me.

I think its interesting that you can do both. Nurse and Paramedic here are two totally different, totally separate careers with two totally different degrees which get some cross-credits in terms of science papers but you'd still have to do 2.5 years instead of 3 for each but in terms of the actual practicality of having a foot in each as far as a paid career goes it just don't exist to any serious extent. You can volunteer to cover the more high or larger events as part of the Nursing and Medical Team but that is totally different from being an AO, even as a casual I don't think it's overly possible.

Most Nurses here work 5 on 3 off or 5 on 2 off whereas the ambulance watch system is 4 on 4 off (except yellow but anybody on a yellow watch position holds it so dear that they will never give it up not even for death!). How do you get round things like hours and fatigue and driving regulations?

 

[JPINFV]

Path 7

Realize to make any difference in EMS, you must be a physician.

Pretty much this since the prevalent mentality among EMS seems to be that everything must be geared towards the LCD, thus everyone must act like the LCD, and everything that you ever need to know and do is taught in EMT or paramedic school.

 

[Anjel]

I think its interesting that you can do both. Nurse and Paramedic here are two totally different, totally separate careers with two totally different degrees which get some cross-credits in terms of science papers but you'd still have to do 2.5 years instead of 3 for each but in terms of the actual practicality of having a foot in each as far as a paid career goes it just don't exist to any serious extent. You can volunteer to cover the more high or larger events as part of the Nursing and Medical Team but that is totally different from being an AO, even as a casual I don't think it's overly possible.

Most Nurses here work 5 on 3 off or 5 on 2 off whereas the ambulance watch system is 4 on 4 off (except yellow but anybody on a yellow watch position holds it so dear that they will never give it up not even for death!). How do you get round things like hours and fatigue and driving regulations?

Here once I obtain my paramedic license I use that to bridge to RN. It's 1 year instead of 2. Then I transfer to a university for a year for my bachelors.

Nurses here work normally 2 days during the week and every other weekend.

As part time on the ambulance you are required to work 1 shift per month. So as long as I do that minimum I can have both jobs. Also I plan on being a CCEMTP and working in critical care as a nurse. The two will over lap if I can get a spot on a MICU.

 

[Bullets]

I think its interesting that you can do both. Nurse and Paramedic here are two totally different, totally separate careers with two totally different degrees which get some cross-credits in terms of science papers but you'd still have to do 2.5 years instead of 3 for each but in terms of the actual practicality of having a foot in each as far as a paid career goes it just don't exist to any serious extent. You can volunteer to cover the more high or larger events as part of the Nursing and Medical Team but that is totally different from being an AO, even as a casual I don't think it's overly possible.

Most Nurses here work 5 on 3 off or 5 on 2 off whereas the ambulance watch system is 4 on 4 off (except yellow but anybody on a yellow watch position holds it so dear that they will never give it up not even for death!). How do you get round things like hours and fatigue and driving regulations?

This is my plan. I already have a bachelors in another subject. I got into EMS as a volunteer and love it but i realize that EMT is BS certification and want to go further. One college offers a 1 year program to bridge your BA to a BSN. Once the RN is complete all i have to do is ride the MICU truck for 100hrs and go through a rotation on intubation. Then i will have my MICN. RNs in hospitals work 12hr shifts so i only work 3 days on 4 off. Those other four days i can work on an ALS or CC truck and make $60+hr part time.

 

[46Young]

This is my plan. I already have a bachelors in another subject. I got into EMS as a volunteer and love it but i realize that EMT is BS certification and want to go further. One college offers a 1 year program to bridge your BA to a BSN. Once the RN is complete all i have to do is ride the MICU truck for 100hrs and go through a rotation on intubation. Then i will have my MICN. RNs in hospitals work 12hr shifts so i only work 3 days on 4 off. Those other four days i can work on an ALS or CC truck and make $60+hr part time.

I feel this should be the standard for IFT ground ambulance txp. A nurse will train in a specialty and can then do IFT's in that field. BLS can handle all the convalescent txps. Most medic programs don't teach you anything about IFT, but we can be running someone on a vent (which we weren't taught in school), on a few drips (meds that we weren't taught about in school save for a brief overview in a pharm class), anything regarding lab values, how to manage a Cerebral Shunt, Cx tubes, IABP, etc.

Speaking of vents, many of us can't even tube well, and don't understand the relationship of hyperventilation and impedance of venous return, but we're trusted with managing a vent pt in the acute setting.

 

[NYMedic828]

Speaking of vents, many of us can't even tube well, and don't understand the relationship of hyperventilation and impedance of venous return, but we're trusted with managing a vent pt in the acute setting.

Dat dere respiratory and skeletal muscle pump is a myth. The heart is the only thing controlling blood flow. Atleast that's what my instructor said :wacko:

 

[EpiEMS]

This is my plan. I already have a bachelors in another subject. I got into EMS as a volunteer and love it but i realize that EMT is BS certification and want to go further.

I would disagree with the assertion that EMT is a "BS" cert -- the epidemiological data demonstrates that strong BLS skills are the foundation of good EMS care and systems. Now, that's not to say it's a difficult cert -- it's not at all hard to get: mostly common sense and a bit of memorization. Of course, I am jealous that you are able to go further -- I'm vainly trying to find an AEMT program around me.




NB: I, too, got into EMS on the volley side. I'm an undergrad in a quantitative discipline only perhaps tangentially related to EMS.

 

[JPINFV]

I would disagree with the assertion that EMT is a "BS" cert -- the epidemiological data demonstrates that strong BLS skills are the foundation of good EMS care and systems.

Strong "BLS" skills has nothing to do with whether the EMT certification and education requirement, as it currently stands, is BS or not.

 

[EpiEMS]

Strong "BLS" skills has nothing to do with whether the EMT certification and education requirement, as it currently stands, is BS or not.

I guess I was unclear: I think the EMT cert requires too little education and too little clinical time, but that doesn't make it "BS."

 

[NYMedic828]

I think saying it is BS is a little harsh. If anything I would call it less than necessary.

 

[EpiEMS]

I think saying it is BS is a little harsh. If anything I would call it less than necessary.

I'll join you in calling it less than necessary, most assuredly.

 

[Bullets]

Ok maybe BS is a little harsh, but it is weak for what we need to do or what could be done. i like a two tiered system but the minimum standard should be AEMT at least. But thats another thread

I was blessed when i started volunteering in that i found a squad with EMTs who have almost universally used it as a step into a more advanced field. While the truck may be a BLS truck, my crew tonight is a Paramedic Clinical Coordinator, a Orthopeadic PA and a Trauma PA along with myself. We also have two RNs who ride with us, some county EMA coordinators and some county HAZ-MAT guys who run with us. They all started by volunteering, fell in love with the idea of EMS but realized they needed to go further and pursued an advanced degree.

 

[usalsfyre]

Me thinks a few folks here have never run into a truly knowledgable CCT medic....

4 1/2: enjoy your job but realize more good can be done in management/education.