What I Hate the most about EMS

[FF894]

I was asked about becoming a Paramedic in a coffee shop... I was about to give my standard declaration of how heart warming, self fulfilling in nature, yes to save a life.. yadda.. yaddaa.. then I thought to myself

Always have coffee first, then reflect...


just kidding

 

[BossyCow]

Wow.. where to start?

Okay.. first.. marineman.. would you ask the same question about parenting being a full time job of a male entering the fire service? My husband is a parent that was able to juggle parenting our two boys while being a full time career ff/paramedic. Assuming that the mom bears the full brunt of the parenting burden is not realistic in today's society.

Second, if we assume that EMS is becoming an essential service, the current economic climate is going to see that we make best use of our infrastructure. To have one system that is set up to respond 24/7 to emergencies screams for a sharing of resources. I have heard of fire departments that devalue their EMS response, but I have had no direct contact with one aside from one old fire captain when my husband first entered the field, who was fond of complaining that they were 'turning us into a G.D hospital'

In my experience the fire based systems are setting a much higher standard of training and education for their employees than the private systems are. Probably because of the lack of a profit motive and the increased competition for fire service jobs.

My own personal experience with the non-fire related EMS systems are with either hospital based or privately owned EMS systems. Of the two, the hospital seems to be the one invested in a higher level of education while the private companies seem to be the life support system for the EMT Mills.

We need to determine if EMS is an essential service or a business and then proceed from there. Otherwise we will continue to have a very diverse set of goals and an equally diverse set of paths to get there. As long as there is inconsistancy in the definition of EMS, the types of agencies providing it, the funding to pay for it, the methods of billing for it and the expectations of the public, how can we expect to find any resolution in the inconsistancies in our training, certifications and protocols?

 

[JPINFV]

[long post]

Sounds like a lot of reasons why I've pretty much ruled out becoming a paramedic even if I don't get into medical school.

 

[JPINFV]

Benefits? yeah right. that must be it, or it could be the cool uniform. I may not have a lot to say about it yet but I will. do you honestly think that everyone goes into this profession just for those reasons? Well if you do you just met someone who is not enering this profession for that reason. I am going into ems because that is where I want and need to to be.

A good will doesn't pay my bills or protect me. Per the JEMS 2007 salary survey the average EMT-P gets paid about 40k/year (based off the 50th percentile on the salary per call volume chart. This corresponds with the salary by region except for the Northwest and Southwest regions, but I imagine that there are some outliers for Alaska and Hawaii that push those averages up). FTOs don't get paid much more, so I would end up essentially fighting for education and administration jobs. In the mean time I'd still have to make enough money to actually pay back my student loans for undergrad and grad school.

It also doesn't provide professional satisfaction. EMS, unfortunately, is a race to the bottom in terms of training, responsibility, and oversight. Too many people want to play with all the toys without a proper education while relying on medical control if their patient doesn't meet some nice predefined boxes on their algorithm. Too many companies are more than happy to comply since punting to medical control limits their liability and it's cheaper to buy a few toys for their crews than to pay a decent wage. Of course the average education level isn't high enough to justify higher pay anyways. Furthermore, too many companies are more than happy with having a QI program that consists of only reviewing calls that billing throws back. I'm sorry, but if I'm doing something wrong, I want to hear about it before it gets used as a lame reason to write me up over a call that didn't go how management thought it should. I also want to know what I'm doing wrong so I can fix it anyways and provide better service to my patients and my company.

 

[marineman]

Bossy, Yes I would hope that any parent entering any profession would be able to devote 100% to their children, that comment however was case specific as the poster mentioned her husband is in the military which is a very honorable and respectable career however it tends to cut into the home life quite a bit. I guess much like our training and protocols many of the problems within EMS vary depending on where you're from and what your experiences have been. From my experience there is an area just south of me where the fire department operates the ambulance, your first two years on the department are spent on the ambulance (like I said for rookies). Older guys only get on the ambulance if they request it or upset the chief. The service I have the most experience with is a sort of hybrid being a private NPO that is co-owned by 4 local hospitals (is that hospital based or private?). They have very high standards for care and education/training as Medics aren't in as high of demand in my area as some others they can be a little picky. Some of the high standards are passed down by the medical director who actually interviews each candidate himself to test for critical thinking skills and common sense because he demands both out of us.

I see this thread as many people expressing what's wrong with EMS but few suggestions on where us greenhorns can start working to fix it. Lets at least make this a productive thread to push for better medicine.

 

[Veneficus]

As many of the grand ideas and efforts of many of us old guys haven't been able to do more than start p****** contests and get into education to try and convince younger generations to demand what we think will help.

I can tell you what has been tried, what doesn't seem to help. But I think the answer is going to come from some of the newer members of EMS.

 

[VentMedic]

In my experience the fire based systems are setting a much higher standard of training and education for their employees than the private systems are. Probably because of the lack of a profit motive and the increased competition for fire service jobs.

Your area may still have a lot of very small community FDs. Other areas are the result of many mergers and consolidations. In one county for 1 FD, we have 65 stations and over 1000 Paramedics. And, we are just one of several counties like this in Florida. Besides being a Paramedic, they must also concentrate on Fire Fighting. That has to be just as important as the medical side. Just as I wouldn't want a half-arsed medic taking care of a patient, I wouldn't want a FF who has no interest in Fire Fighting watching my back or the back of my loved ones in the profession.

When you start to see you have only X amount of resources for training, what should get the priority? Patient care or the safety of FFs? Not all will be given equal time in larger departments. Many smaller departments are also unable to accomplish perfection for either specialty due to lack of adequate tax base to support it. They, too, may just scrimp by.

The benefits at the FDs also bring out everyone, interest or no interest in either Fire or EMS, to apply. Oakland, CA FD dropped their EMT requirement and got 10,000 applicants. It was such a circus there were national film crews watching the hysterical events unfold.

Right now Miami Dade FD has announced it will again be accepting applications this spring. There is not an opening left in many of the medic mills. Some are even opening more classes to cash in on this spectacular event. The last hiring announcement got 6000 applications with many of them having a Paramedic cert. Quality education or desperate show of training to get a county job?

 

[el Murpharino]

I think the answer is going to come from some of the newer members of EMS.

I find that hard to believe when more and more students attend medic mills and online paramedic courses. They view EMS as a stepping stone and leave once they get their desired job or realize that there is absolutely no career progression in EMS. I could probably get a job with a police or fire dept, work half the hours I do now and make the same amount I do with better benefits.

 

[Veneficus]

I find that hard to believe when more and more students attend medic mills and online paramedic courses. They view EMS as a stepping stone and leave once they get their desired job or realize that there is absolutely no career progression in EMS. I could probably get a job with a police or fire dept, work half the hours I do now and make the same amount I do with better benefits.

I have high hopes this financial crisis and medicare insolvency is going to come down hard on EMS providers that only think they are going to do emergencies, drive to the hospital or whatever. Those that do not commit to more of a healthcare role will find they are hiring less new people, and even laying off some older ones. All the medic mill graduates without the drive for medicine will not be able to compete in this new climate. Agencies that do not embrace an expanded role towards public health or primary care will likely find their budgets diminish as their dollar value to society fades.

As emergency professionals we have become quite arrogant about how much we feel we are worth. Maybe I am just getting old, but many of the people in emergency roles today seem to have an ignorant entitlement attitude from being called hero once too often.

 

[BossyCow]

I see this thread as many people expressing what's wrong with EMS but few suggestions on where us greenhorns can start working to fix it. Lets at least make this a productive thread to push for better medicine.

you might try looking at this thread: http://www.emtlife.com/showthread.php?t=10422


VentMedic

Your area may still have a lot of very small community FDs.

I think it has less to do with that and more to do with my location in the Pacific NW. We took an existing infrastructure and applied it to EMS response rather than duplicating services.

As to the training issue, there is a required amount of training for a medic, and a required amount of training for a firefighter. Being able to meet those requirements in an age where the fire calls are diminishing due to better building codes and fire prevention doesn't have to make crappy medics who are good firefighters or crappy firefighters who are good medics. If that's happening in your area, I'd suggest its due to the standards being set by the administration.

 

[JPINFV]

I have high hopes this financial crisis and medicare insolvency is going to come down hard on EMS providers that only think they are going to do emergencies, drive to the hospital or whatever. Those that do not commit to more of a healthcare role will find they are hiring less new people, and even laying off some older ones. All the medic mill graduates without the drive for medicine will not be able to compete in this new climate. Agencies that do not embrace an expanded role towards public health or primary care will likely find their budgets diminish as their dollar value to society fades.

As emergency professionals we have become quite arrogant about how much we feel we are worth. Maybe I am just getting old, but many of the people in emergency roles today seem to have an ignorant entitlement attitude from being called hero once too often.

Ironically enough, an article I just downloaded deals with this to an extent (I was bored yesterday and started flipping through an old JEMS magizine. As I read it, I felt myself getting dumber so I downloaded some articles from Emergency Medicine Journal to keep me entertained tomorrow).

Effectiveness of emergency care practitioners working within existing emergency service models of care
Suzanne Mason1, Colin O’Keeffe1, Patricia Coleman1, Richard Edlin2, Jon Nicholl1

1 Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
2 Sheffield Health Economics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK

Correspondence to:
Correspondence to:
Dr S Mason
Health Services Research, School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield S1 4DA, UK;s.mason@sheffield.ac.uk

Background: An emergency care practitioner (ECP) is a generic practitioner drawn mainly from paramedic and nursing backgrounds. ECPs receive formal training and extended clinical skills to equip them to work as an integral part of the healthcare team working within and across traditional boundaries of emergency and unplanned care. Currently, ECPs are working in different healthcare settings in the UK.

Objectives: (1) To evaluate appropriateness, satisfaction and cost of ECPs compared with the usual service available in the same healthcare setting, (2) to increase understanding of what effect, if any, ECPs are having on delivery of health services locally and (3) to evaluate whether ECP working yields cost savings.

Methods: Using a mixed-methods approach, data were collected quantitatively and qualitatively from three different types of health provider setting where ECPs are operational, in three areas of England. Data were collected by sending two questionnaires to each patient eligible to be seen by an ECP, at 3 and 28 days after presentation; telephone interviews were conducted with a sample of staff that included ECPs, other health professionals and stakeholders (eg, managers) in each of the three settings; and routine data were analysed to provide a perspective on costs.

Results: After adjusting for age, sex, presenting complaint and service model, some differences in the processes of care between the ECPs and the usual providers in the three settings were observed. Overall, ECPs carried out fewer investigations, provided more treatments and were more likely to discharge patients home than the usual providers. Patients were satisfied with the care received from ECPs, and this was consistent across the three different settings. It was found that ECPs are working in different settings across traditional professional boundaries and are having an impact on reconfiguring how those services are delivered locally. Costs information (based on one site only) indicated that ECP care may be cost effective in that model of ECP working.

Conclusion: Care provided by ECPs appears to reduce the need for subsequent referral to other emergency and unscheduled care services in a large proportion of cases. We found no evidence that the care provided by an ECP was less appropriate than the care by the usual providers for the same type of health problem.

http://emj.bmj.com/cgi/content/abstract/24/4/239

 

[csly27]

Wow.. where to start?

Okay.. first.. marineman.. would you ask the same question about parenting being a full time job of a male entering the fire service? My husband is a parent that was able to juggle parenting our two boys while being a full time career ff/paramedic. Assuming that the mom bears the full brunt of the parenting burden is not realistic in today's society.

Second, if we assume that EMS is becoming an essential service, the current economic climate is going to see that we make best use of our infrastructure. To have one system that is set up to respond 24/7 to emergencies screams for a sharing of resources. I have heard of fire departments that devalue their EMS response, but I have had no direct contact with one aside from one old fire captain when my husband first entered the field, who was fond of complaining that they were 'turning us into a G.D hospital'

In my experience the fire based systems are setting a much higher standard of training and education for their employees than the private systems are. Probably because of the lack of a profit motive and the increased competition for fire service jobs.

My own personal experience with the non-fire related EMS systems are with either hospital based or privately owned EMS systems. Of the two, the hospital seems to be the one invested in a higher level of education while the private companies seem to be the life support system for the EMT Mills.

We need to determine if EMS is an essential service or a business and then proceed from there. Otherwise we will continue to have a very diverse set of goals and an equally diverse set of paths to get there. As long as there is inconsistancy in the definition of EMS, the types of agencies providing it, the funding to pay for it, the methods of billing for it and the expectations of the public, how can we expect to find any resolution in the inconsistancies in our training, certifications and protocols?

ok, yes being a parent is a full time job, I have been doing it for almost 13 years. It is not realistic to stay home and raise kids as it once was. With my husband being in the military it helps finacally, but I have never been one to stay at home I have to be able to have adult interaction and parents know what I mean by that. Any job that I have ever had I have always givin 100% of myself I can find a balance in everything.

I know that this job will be hard I never said it was not. I feel that by me going into this feild not only is it something I want to do It runs in my family. I feel that it will teach my kids the importance of working and having a jcarrer that is worth something. education is very mportant to me, and I plan to continue it I plan on staying in ems not just using it as a stepping stone as some call it. I may skip around with in the ems system but this is where I want to be.

as of next month I am not sure where we will end up. I suppose some people dont understand my reasoning for wanting to go into ff then medic school, there are a couple of reasons. first of all knowledge is power correct? well I feel the more I know The better I can be. Another reason is that if I can be come a ff then medic I will have a better oppertunity to be able to get on with a fire station opposed to a private company. Realize I am still just a student but as of this point I have not heard many good things about private companys.

Someone had mentioned about being able to give 100% to 3 diffrent I beleive the answer to be yes. as a mother first and always I realize that I may not at home as much as I am now. But I beleive that I will be doing more for children than I am now. thats is why we have familys to help support one another right? and as a ff/medic. you bet. nobody seems very supportive of that, it seems to me like people want you to be either one or the other but I seem to beleive that by being both your gonna be available and knowledgable to help more than just med or trauma pts. How could you not want that?

As rid911 had mentioned earlier I cant say alot about this subject because i have not been there done t hat yet. But what I can say is that there is nothing that can discourge me from entering this feild and doing the best I can, plain and simple. As for the problems between wether it should be ff/ medic and education, I dont know how it all works yet but I think that pre sreening is a good first step to try and weed out the people who are in this because it seems like a cool job.

 

[FutureFlightMedic]

Wow. Having just spent the last 2 years to obtain my Associates Degree in Paramedicine, graduating with Honors at the Top of my class and just getting my Paramedic cert this week, I am deeply disturbed by this post. I truly understand where you all are coming from, and all of your points are vaild; I agree big changes need to come to EMS for the better. This won't happen if those willing and able to do the job are discouraged to ever enter into it. ALL healthcare has it's drawbacks; I have worked in several busy ER's and volunteer at my local Fire Department. Why do I want to be a Paramedic? Because my brother nearly died of cancer, and he inspired me to do my best, because someday I WILL be caring for someone's brother. Yes, it is what I want to the very depths of my soul. I did not kill myself for a year of pre-reqs and 2 of medic school to be told it is not important. Please know I mean NO disrespect to any of you, I am in agreement with you all. Let's work together to change this! We need to be PROUD of this career we've chosen and work to make it the PROFESSION that it is...[/I][/I]

 

[JPINFV]

Wow. Having just spent the last 2 years to obtain my Associates Degree in Paramedicine, graduating with Honors at the Top of my class and just getting my Paramedic cert this week, I am deeply disturbed by this post.

To be honest, though, I can say something similar. I didn't work hard for 4 years for a BS and 2 years for a MS to be lumped in with people who think that a 800 clock hour course with no prereqs besides a 2 week A/P course and a year as an EMT-B makes them all that and a bag of potato chips (/me makes note that this isn't directed at you).

 

[el Murpharino]

All the medic mill graduates without the drive for medicine will not be able to compete in this new climate. Agencies that do not embrace an expanded role towards public health or primary care will likely find their budgets diminish as their dollar value to society fades.

You're absolutely right, but what "new climate". Right now, it's the same ol' same ol'. I'm sure many medics out there would like to expand their knowledge base and provide care similar to those in Europe and other countries, which will in turn alleviate the congestion in ER's. But the truth remains that there are just as many medics who don't view EMS in the same way and continue to hold our profession back. But what would it take for EMS to perform in that capacity in our healthcare system? In this political climate....an act of God, I'm afraid.

 

[Veneficus]

You're absolutely right, but what "new climate". Right now, it's the same ol' same ol'. I'm sure many medics out there would like to expand their knowledge base and provide care similar to those in Europe and other countries, which will in turn alleviate the congestion in ER's. But the truth remains that there are just as many medics who don't view EMS in the same way and continue to hold our profession back. But what would it take for EMS to perform in that capacity in our healthcare system? In this political climate....an act of God, I'm afraid.

according the the christian bible, a rather large flood was an act of God. I think climate will change because of economic hardship. In order to keep all of US healthcare afloat, medics will have to become something more in order for the public to continue to be able to justifyably fund EMS. This idea of medics acting as public health agents is not new in the US. but I think it is economics that will force the change, not the desire of the people in the profession.

 

[daedalus]

Wow. Having just spent the last 2 years to obtain my Associates Degree in Paramedicine, graduating with Honors at the Top of my class and just getting my Paramedic cert this week, I am deeply disturbed by this post. I truly understand where you all are coming from, and all of your points are vaild; I agree big changes need to come to EMS for the better. This won't happen if those willing and able to do the job are discouraged to ever enter into it. ALL healthcare has it's drawbacks; I have worked in several busy ER's and volunteer at my local Fire Department. Why do I want to be a Paramedic? Because my brother nearly died of cancer, and he inspired me to do my best, because someday I WILL be caring for someone's brother. Yes, it is what I want to the very depths of my soul. I did not kill myself for a year of pre-reqs and 2 of medic school to be told it is not important. Please know I mean NO disrespect to any of you, I am in agreement with you all. Let's work together to change this! We need to be PROUD of this career we've chosen and work to make it the PROFESSION that it is...[/I][/I]

You do us all well by holding a degree. Congratulations on this accomplishment.

 

[Outbac1]

Well Rid from what I have read here and other people I've talked to in the past year, EMS in the USA certainly has a boatload of problems as you have described. Fortunatly here on Canadas east coast much of what concerns you has been addressed. Not that we don't have our problems. We do. There is still an old boys club in management. We are slowly moving from training to education. Our pay has gone up and is more respectable. We are not mixed in with fire. We are both stand alone entities. We have national standards and reciprocity accross the country is just around the corner.

This didn't happen overnight. It took a lot of hard work from a relatively small number of people over several years to achieve.

The point is if we can do it, you can too. I doubt very much if you are alone in your fight for a better system. Every person whose attitude you change or instill to be better will have reaching effects. For they will instill new and better ideas in others and change will come. You and other like minded individuals are making a difference. Keep up the good work you are doing. Change will come, slowly, but it will come.

 

[lightsandsirens5]

I like to think EMS is like a crack additction, you know it's bad for you, but you just can't pull yourself away

Hey! Dont you dare compare me to all those druggies I get to pick up.

Well....you know, come to think of it, veneficus is right! AHHHHHHHHHHHHHHH!!!!!!!!!!!!!

 

[Anu]

Since becoming a part of this forum, I realize the essence of this subject comes up rather frequently..

In a nutshell, I truly believe what holds emergency medicine back is the integration of Fire Services into the practice of emergency care. It is impossible to have a clear vision of what the the educational or accreditation requirements for an emergency care provider ought to be when there exists such a lack of definition for the role in itself. You have FF's and Police personnel getting certified as EMT's and Paramedics only to enhance their roles as public officers, but in reality such practices contribute little to the field of emergency care as public safety becomes enmeshed with clinical care practice. What is more disastrous is that EMS personnel and the public alike cannot seem to distinguish between these roles, providing a false pretense for what the role of an emergency care provider (and an emergency medical system) should be.

Many of you have become eager to take action on behalf of the profession. I suggest what EMS needs is to lobby for is for its separation from all kinds of Fire Based Services. Realistically, this might not be possible, but I firmly believe emergency medical services needs to find its place within the medical community and not with public safety organizations. Canada should serve as an example of what a true EMS ought to be.