If you could change one thing about EMS what would it be?

[HERBIE1]

As an aside, I think its time to stop using the "were a young industry" phrase to excuse [red]deficits[/red] in EMS. We have been around since the 1970's, that is more than enough time to get our shit worked out. The PC industry really didn't get rolling till the 1980's, now there is a computer in everyones home. Whats our problem?

I wouldn't call them deficits, I would call them growing pains. The thing is, the provision of prehospital care is so splintered, it's difficult, if not impossible to come up with a single pronged solution applicable to all areas. What is needed in a rural area served by volunteers is NOT what is needed in an urban area served by a 3rd service provider or a fire based EMS system. There is no panacea for these problems- they are too vaired in nature.

The problems we are seeing are the results of these growing pains. The industry IS changing, and problems are revealing themselves when these changes occur. Think about the resistance we had not long ago from docs and especially RN's. No, it's not all hugs and kisses now, but it is far better than it used to be just a few years ago. When medics were first used in ER's to supplement the nursing shortages, think about all the grief we got. You're stealing our jobs, you don't belong here, etc. Hospital administrators realized they had at least a short term solution to their chronic nursing shortage and if a prehospital provider wanted to be a nurse and make RN pay, they still had to go to nursing school. Most nurses finally realized that medics don't want to be nurses or they would go to nursing school, so their feelings of being threatened also faded. Yes, there are still die hard EMS haters out there but those numbers are dwindling.

We need to maintain our professionalism, push for education, and the recognition and rewards will come. We just have to remain vigilant.

[Dustdevil]

That's one thing I can't get behind. There are already two mid-level providers as it is. I can see no good reason to re-invent the wheel on that. It only serves to alienate us from other practitioners. And let's face it, we need all the allies we can get. And if you broaden our scope too much, we lose our focus on what we are here to provide, which is EMERGENCY Medical Service, not general healthcare. Medics who want to go to PA school are welcome to do so, and in fact well positioned to do so. But I don't support making paramedicine an alternative pathway to mid-level providership.

Perhaps you meant something different than what I was thinking?

Edited March 26, 2009 by Dustdevil

[VentMedic]

Agreed once again Dust. I am actually working on getting aboard an initiative out here in Pittsburgh to propose an out of hospital practitioner professional title, educated to the level of a PA with emphasis on the out of hospital delivery of medical care. This also entails all facets of healthcare, not just the 5% true emergency calls that we all generally deal with.

Since NPs and PAs are already working on that project and already have the education to step into this role, why not work on something more realistic like a 2 year degree for the Paramedic? A Master's or Doctorate degree might be a little unrealistic at this time as is getting a DEA number for another profession.

As an aside, I think its time to stop using the "were a young industry" phrase to excuse deficits in EMS. We have been around since the 1970's, that is more than enough time to get our shit worked out. The PC industry really didn't get rolling till the 1980's, now there is a computer in everyones home. Whats our problem?

!970s? Try 1967. The Freedom House Ambulance service had some of the first Paramedics. It was hospital based and if EMS had followed its intended path, the word Medical in EMS might actually mean something.

Several states, including Florida, already had two year degrees for EMS established in the 1970s. I graduated in 1979 with an EMS degree and I believe Rid and Dust graduated from a degree program just before that. At that time we were told that was the future and a degree was a must have. That also included many of the FD Paramedics at that time.

Edited March 26, 2009 by VentMedic

[HERBIE1]

I hate to say it, but I don't envision a day any time soon where EMS will be on equal footing with fire for funding, recognition, or political actions groups. Fire NEEDS EMS to maintain their future. Even within a fire based EMS system, there are variations. Are the EMS providers all ALS? Are they simply a transport group and the FSR people provide initial care? Are the EMS providers single role or crossed trained as firefighters? Are they sworn members? Are they in the same union or do they have a separate union solely for EMS? Is there a pay disparity between the 2 groups?

In any case, EMS is a minority member of these groups- especially when you are talking about single role and 3rd service providers. Thus, unless you can demonstrate a benefit to the controlling majority, anything that's simply an EMS issue will face an uphill battle.

My point is, there are no simple solutions here and this is a complex issue, but I agree that education is a key, and not only just in the case of medical knowledge. The more you know about management, fire service, leadership, business, and politics, the better able you will be to offer integrated solutions to the problems we face. I think too many people think that because what we do is so important, the public and powers that be should automatically realize the problems we face. It doesn't work that way and the issues are way too complicated for that mentality.

It's all about money, power, and being smart about what we are trying to accomplish. Folks need to look at the bigger picture- especially in these economic times.

[ncmedic309]

There is NOTHING that we cannot fix with education.

That sums it all up right there...

[cynical_as_hell]

I would like to see the patients have more credibility. Just because a paramedic documents that a patient was ALOC doesn't mean that the patient isn't aware of what went on. I see alot of paramedics automaticly acuse teenagers of drug use and treat them like crap, down talk them, and flat out call them liars when the teenager is having a medical problem and states that they haven't used any drugs. If the patient or parent calls and makes a complaint, they aren't taken seriously because the medic's first care form states that the patient was ALOC. EMS documentation isnt the end all be all of proving what happened on that scene.

[Doczilla]

More paying full time jobs for doctors.

'zilla

[wrmedic82]

[EMS Solutions]

I think there needs to be better incentive.

Get rid of the volunteers - well no incentive. Why would a county pay for EMS when they can get it for free.

Get EMS out of Fire - no incentive there. Why remove a portion of your budget and response numbers.

Get better education - 2 years great! Wait, no incentive there either. Why go to school for 2 years to get paid 12 bucks an hour with no growth or career path. When you can do the same and be a nurse for 2x the pay or more with plenty of career options.

As long as you have commercials showing nurses in the back of ambulances ventilating a patient with a BVM and running to the aid of a downed motorcyclist. Theres no incentive to have the public care about us and OUR profession.

Getting real public and political support is the first step to getting support for the changes we need. Until they can truly undertsand what we do, no amount of education requirements, national guidelines and upteen levels of certification will help us.

No amount of fancy stickers given away or free public tours of the ambualnce during a fair at EMS week is going to make anyone turn their head to support us.

We need real PR. Not PR that tries not to step on anyones toes or hurt anyones feelings. Do you think that nursing commercial cares? Or that every Fire rescue operation rarely mentions a medic or emt that saved a life? It's always "firefighters help victims from car wreck" when you can plainly see the "paramedic" label on the jacket.

As far as the public knows we are the ones who drive the thing to the hospital, the ones who are wearing the flip flops or the big bat belt that jingled so nicely.

Get that public outcry about how they may or may no get an ambulance response from that volunteer agency, or let them in on how some providers are barely trained to use the oxygen cynlinder never mind poke them with a needle. Show them the training we should have nationwide, the calls we do and are expected to handle for $12 an hour. Just maybe then they will support us in our goals.

OK - now I went on much longer than I wanted and it's all just my 2 cents. There are people with much bigger brains than me.

But everyone has their own 2 cents. Isn't that the real underlying problem?

[CharleeFoxtrot]

I think there needs to be better incentive.

...

Get better education - 2 years great! Wait, no incentive there either. Why go to school for 2 years to get paid 12 bucks an hour with no growth or career path. When you can do the same and be a nurse for 2x the pay or more with plenty of career options.

That's the one thing I'd change, well two. More education which (in my fantasy world) would translate into better wages.