Something for us to think about

[fireflymedic]

Recently I sat down and was looking at the amount of unity that is had between the vast majority of EMS personnel over trauma and how we are complaining about it. It made me wonder - why do we think it is so important to unite and picket a show that in reality probably won't change much of the public's perspective about us. However, when it comes to an important issue that will affect the future of EMS we become so divided as everyone goes my way is best. We wonder why we are not taken seriously, and I think this in itself proves why. We come together to bicker and complain like little children, but when it comes to important matters we divide. Perhaps if the reverse were true or we learned to all come together as a profession to push for better recognition and to be seen as professionals then it might happen. If we can get NAEMT and JEMS and the other professional organizations to stand up against NBC for inaccuracies in a show, why can we not get them to stand to help us progress the profession? Just some thing to think about.

[Kaisu]

why can we not get them to stand to help us progress the profession? Just some thing to think about.

Probably because we can't get agreement on what progress would be.

[Niftymedi911]

Probably because we can't get agreement on what progress would be.

When people are willing to let things go and COMPROMISE for the betterment of the profession........ Oh wow, wait a minute that word exists? NO.. it can't........ You'll see a unity that will be able to bring down any wall or deterrent. Until then all we are left to do is bicker, back stab, lie, cheat, steal, and bicker some more. You hear all of us whinning about trauma, because we are in unity and will COMPROMISE our views to get something that we all view is negative out of the public's eye to save our profession.

On another note firefly...... A quote from my best friend who is also a medic...... "It takes less enegry and faith to whine, bitch, and moan about something. Then to change if for the better and expect someone else to do it for them."

At the end of the day, this world doesn't change.

[RavEMTGun]

When people are willing to let things go and COMPROMISE for the betterment of the profession........ Oh wow, wait a minute that word exists? NO.. it can't........

If two sides are diametrically opposed, compromise is difficult, no?

[HERBIE1]

I've said this in several different threads, on multiple topics- there is no universal answer to the problems in EMS, so a "compromise" is really not possible. Look at the attitudes here- volunteer vs paid. Fire based EMS vs 3rd service, single role vs cross trained- everyone has their particular niche they want to protect or one they pick on. What is a huge issue in NYC may be irrelevant in Chicago, or SF, so it's not even an urban vs rural problem. Pay scales vary widely, depending on who you work for and where you provide care. Some folks live barely above the poverty line while others are making quite a comfortable living.

In other words, there is no single issue that we can rally around, which makes things like political action difficult.

I don't know what the answer is, but I think we are at a crossroads in EMS. The push seems to be for fire to absorb EMS, and too many times, the group that loses out is EMS- as well as the patients.

I think that single role providers are being pushed out in many areas because of budget issues. From an economic standpoint (from a management perspective) anyone who can perform multiple tasks is the wave of the future. It is more cost effective, less complicated from a manpower standpoint (one person can perform multiple roles, depending on the needs of the day). The bottom line for municipalities is $$, and anything that costs less will be embraced. One of the favorite buzzwords of planners in recent years is "interoperability", which essentially means multiple diverse agencies need to play well with others. It also means we have turf wars and power grabs- nobody wants to be seen as irrelevant or nonessential, and groups like the IAFF have millions of dollars to play with. They can promote their service- even while fires are down, and because they have established assets and manpower, it's easier for them to crank out a few EMT's or medics from an EMT mill to keep their manning and justify jobs. Fire understands the need to tap into something that generates revenue to stay relevant and keep staffing, so the logical solution is to go after EMS. EMS does not have the numbers, organization, national recognition or power structure to absorb fire departments.

Notice nowhere did I mention what is best for the patient- that is the least of a city manager's concerns. As long as SOMEONE shows up, they are happy. "Hey look- we have 5 people and a fire engine here to provide care for you!" They never explain the level of training or skills of those 5 people- it's all for show.

[46Young]

I've said this in several different threads, on multiple topics- there is no universal answer to the problems in EMS, so a "compromise" is really not possible. Look at the attitudes here- volunteer vs paid. Fire based EMS vs 3rd service, single role vs cross trained- everyone has their particular niche they want to protect or one they pick on. What is a huge issue in NYC may be irrelevant in Chicago, or SF, so it's not even an urban vs rural problem. Pay scales vary widely, depending on who you work for and where you provide care. Some folks live barely above the poverty line while others are making quite a comfortable living.

In other words, there is no single issue that we can rally around, which makes things like political action difficult.

I don't know what the answer is, but I think we are at a crossroads in EMS. The push seems to be for fire to absorb EMS, and too many times, the group that loses out is EMS- as well as the patients.

I think that single role providers are being pushed out in many areas because of budget issues. From an economic standpoint (from a management perspective) anyone who can perform multiple tasks is the wave of the future. It is more cost effective, less complicated from a manpower standpoint (one person can perform multiple roles, depending on the needs of the day). The bottom line for municipalities is $$, and anything that costs less will be embraced. One of the favorite buzzwords of planners in recent years is "interoperability", which essentially means multiple diverse agencies need to play well with others. It also means we have turf wars and power grabs- nobody wants to be seen as irrelevant or nonessential, and groups like the IAFF have millions of dollars to play with. They can promote their service- even while fires are down, and because they have established assets and manpower, it's easier for them to crank out a few EMT's or medics from an EMT mill to keep their manning and justify jobs. Fire understands the need to tap into something that generates revenue to stay relevant and keep staffing, so the logical solution is to go after EMS. EMS does not have the numbers, organization, national recognition or power structure to absorb fire departments.

Notice nowhere did I mention what is best for the patient- that is the least of a city manager's concerns. As long as SOMEONE shows up, they are happy. "Hey look- we have 5 people and a fire engine here to provide care for you!" They never explain the level of training or skills of those 5 people- it's all for show.

That all seems pretty accurate, generally speaking. I've suggested in the past that EMS take a page from the fire service's book and use similar organization and political action to make gains form the industry. There seem to be several problems, however.....

It's difficult to organize a group that is as fragmented as EMS. For every career single role EMS worker, there are seems to be several that are in it for the short term, either completing a degree, waiting on a civil service list (which may or may not make use of any EMS certs), or lose interest and leave due to burnout. Many use EMS as a quick way to get a job and support themselves until a better opportunity comes along.

Along with organization, there needs to be higher educational standards. The problem is, nearly every single person (no exaggeration) I've spoken to who opted for a paramedic assosciates degree rather than a cert program (or mill) did so with the reasoning that they can use the degree to help obtain other degrees in the healthcare profession. the common sentiment is that they don't intend to be a FT paramedic as a career, maybe just per diem after they get their next degree. Even if they did two years of schooling, unless they land a job at a stellar agency, they won't put up with the industry standard low pay, substandard working conditions, etc. "Why am I putting up with this BS? I have two years of college, I have all these credits already, I think I'll just knock out RN/RT/PA school, and do this on the side, on MY terms." So, the educated tend to leave for greener pastures (based on what I've been told face to face by those who have done so), leaving those from the previous paragraph.

The third problem is that the fire service is absorbing more and more EMS agencies. In some cases it's for a good reason, the best choice for the area. However, I've heard numerous accounts of FD's doing hostile takeovers displacing single role workers, cannabilizing the EMS side to reallocate funds to the fire side, and having an apathetic attitude towards QA/QI in EMS.

There will always be groups that oppose increased education for EMS. FD's that don't offer enough of a desirealbe package to attract quality medics, states with expansive rural areas that would rather not pay for medics, getting by with EMT-A's and EMT-I's, really any employer who doesn't offer enough to attract properly educated personnel.

I wish that I had a real, workable solution to all this, but unfortunately I don't. Unless there is a large self motivated movement from medics that choose to only get their cert via a two year degree, thereby putting cert programs/mills out of business, I don't see there being any significant organization of serious professionals actively seeking to improve EMS. No one wants to do two years of college to make 10-15 bucks an hour. And I wouldn't blame them.

As long as mills are allowed to exist, there will always be more individuals that go that route (easier, and the employer doesn't generally care where you got your cert, as long as it's current) than there are those who choose to complete a paramedic degree.

Edited October 9, 2009 by 46Young