New Standards/Levels

[cosgrojo]

I don't see how my statment is incorrect.

Apparently you wouldn't, because you are not listening to what I am saying. I am not saying give them money and hope they get more education. I am saying increase the standard of education, then reward them with more money. I'm not sure how you could see otherwise.

Don't teachers also have to take a certain amount of continuing ed to keep their certification?

Yes, so do we... but theirs is often paid for by their school district in the ubiquitous "work-shop" days. Just like EMS, they can choose how much education they want to receive after the minimum is achieved. Their minimum just happens to be higher than ours, AND, they have a strong union presence and established educational standards.

Does you wife not find it strange that a Paramedic with a 6 month education can make more than what she does with a 4 or 6 year degree? Our teachers in FL average $42k per year. The teachers had 6 years of college to "choose" their career path but yet they still did the education time. Does you wife believe her education is necessary or that it was a complete waste of time and does little to benefit her students? Maybe a teacher's assistant with a few weeks of training could do just as well as your wife. Do you think the parents would want someone with a few weeks of training teaching their kids over an educated teacher? It is unfortunate that the wages of the teachers are so low compared to their education and that they no longer enjoy job security. But, many of those who have been laid off have easily found employment due to their education.

She would... if it were true. There are no 6 month Paramedic programs that I know of in my area. The Medic "trade" schools are 1 1/2 year courses, and a lot of programs are now being offered in technical colleges, awarding 2 year associate degrees for completion. I can not speak for Florida... but if you are putting Medic's through in 6 months... I would be concerned. BTW... you changed the criteria with your reply. We were comparing entry level to entry level, then you gave average salary for Teachers in FL. If beginning teachers with no experience get paid 42k to start... we live in the wrong state.

Here are the numbers for one county that has a third service and FDs.

Starting pay (based on experience) is as follows:

Part time EMT : $12.41 - $17.70 p/h (maximum 160 hours per 2 week pay period)

Now you are fixing the numbers. 160 hours a pay period, I haven't been able to work 80 hours a week in a while. It is not an appropriate comparison... your numbers are useless. Based on your entry level EMT base pay of 12.41, with a regular 40 hour work week that is $25,812.80. Based on starting Medic pay of $46,845 on a 40 hour work week, that is $22.52 an hour... Starting medics in FL get paid 22 an hour? Doubt it. This argument has been about entry level education... let's not change it to average just to suit your position. Don't go hiding behind the fact that this is a posting "copy/pasted" from the County either. If you are going to do the leg work, find out what it means first, and apply it to the issue at hand.

I guess what I find appalling is that those who argue against even getting the education for themselves is their failure to see where it could benefit their patients. Those in the other health care professions understood whatever excuses they could offer against education were useless as soon as patient care was made the issue.

No one is disputing the benefits of education, despite your assertion that we are... been reading Mein Kamph recently?

EMS needs a strong national association. The educators need to raise their standards and encourage more instuctors to take part in their national association.

Finally!!! You have made sense. This statement has been the crux of my argument the entire time... of which you have soundly ignored the entire time. If more energy was put toward this end and less toward trying to intimidate and shame people into education, we might affect some change some day.

[VentMedic]

Yes, so do we... but theirs is often paid for by their school district in the ubiquitous "work-shop" days. Just like EMS, they can choose how much education they want to receive after the minimum is achieved. Their minimum just happens to be higher than ours, AND, they have a strong union presence and established educational standards.

EMS also provides inhouse education especially if you work for county, city EMS or a FD. As well many private services also offer their own CEUs.

And, don't confuse a union with professional associations. They are NOT the same.

She would... if it were true. There are no 6 month Paramedic programs that I know of in my area. The Medic "trade" schools are 1 1/2 year courses, and a lot of programs are now being offered in technical colleges, awarding 2 year associate degrees for completion. I can not speak for Florida... but if you are putting Medic's through in 6 months... I would be concerned. BTW... you changed the criteria with your reply. We were comparing entry level to entry level, then you gave average salary for Teachers in FL. If beginning teachers with no experience get paid 42k to start... we live in the wrong state.

We also have medic mills that offer 1 1/2 year medic programs. They meet one night a week and stretch out the "hours" of training. Our most famous medic mill also offers an Associates degree which transfers to nowhere. I believe NH still requires only 1000 "hours of training" to be a Paramedic just like many of the other 48 states.

For the teacher's salary: NOTE the work AVERAGE.

Now you are fixing the numbers. 160 hours a pay period, I haven't been able to work 80 hours a week in a while.

Go back to that post and look at the word "maximum" and the classification.

It is not an appropriate comparison... your numbers are useless. Based on your entry level EMT base pay of 12.41, with a regular 40 hour work week that is $25,812.80.

[Kookaburra]

So here's what the steps seem like to me:

1. Get NREMT to be the National Standard.

2. Require entry level Paramedics to have an AAS.

3. Establish a nationwide professional association for Pre-Hospital Care Providers.

Though, due to how incredibly resistant I've seen Paramedics be to increased educational requirements, maybe just starting a new level of care provider and letting the EMT-* levels just wither away is the way to go.

[VentMedic]

I don't remember seeing a link to the new levels so here it is.

http://www.nhtsa.gov/staticfiles/DOT/NHTSA/ems/811077a.pdf

Here's a good site for some info:

http://www.ems.gov/

National Association of EMS Educators

http://www.naemse.org/

National Association of EMS State Officials

http://www.nasemsd.org/

http://www.nasemsd.org/EMSEducationImplementationPlanning/index.asp

National Association of EMS Physicians

http://www.naemsp.org/

The NAEMSP has a newsletter and a journal (Prehospital Emergency Care Journal) , both of which are great reading material.

http://www.naemsp.org/publications.html

[cosgrojo]

It is time for EMS to grow up to be a real health care profession and stop catering to the weakest links.

Nobody disagrees with you on this point... for the hundredth time. You agree , I agree, Herbie agreed, Kookabura agrees, we ALL agree. Now let's stop yelling for the purpose of yelling, and come up with a plan to fix it. For all of your bluster, you have not once tried to come up with a Global solution, just banging the drum for incremental, personal change. You are so into griping about your perception, you have failed to look at this issue in the manner that it was initially presented. What do you think of the changes, and how can we make it better? Instead you have spent the majority of your time arguing in circles, blatantly changing the argument to fit your narrow view, and providing nothing substantial toward furthering the discussion.

Despite that your reputation meter keeps going up... I think my mind must be going wonky... You've made more spelling mistakes in your last two posts than I have in all of my posts combined, yet you are the highly educated "alphabet soup" provider, and I the undereducated fool. If you want the standards raised, start with the spell check.... besides I've never liked the number 14 anyway.

[HERBIE1]

Nobody disagrees with you on this point... for the hundredth time. You agree , I agree, Herbie agreed, Kookabura agrees, we ALL agree. Now let's stop yelling for the purpose of yelling, and come up with a plan to fix it. For all of your bluster, you have not once tried to come up with a Global solution, just banging the drum for incremental, personal change. You are so into griping about your perception, you have failed to look at this issue in the manner that it was initially presented. What do you think of the changes, and how can we make it better? Instead you have spent the majority of your time arguing in circles, blatantly changing the argument to fit your narrow view, and providing nothing substantial toward furthering the discussion.

Despite that your reputation meter keeps going up... I think my mind must be going wonky... You've made more spelling mistakes in your last two posts than I have in all of my posts combined, yet you are the highly educated "alphabet soup" provider, and I the undereducated fool. If you want the standards raised, start with the spell check.... besides I've never liked the number 14 anyway.

Like II said, vent was building strawmen. You can't argue with a strawman.

As for solutions, a minority group cannot by definition directly implement change. We can be the most professional and educated providers possible, but certain things will not change.

Among them...

First and foremost, the biggest obstacle to overcome is the organizational culture of the fire service, which is becoming more and more dominant in EMS. This is the underlying reason why it is so difficult for EMS to establish their own separate identity- independent of the fire service.

EMS gets is not a self determining entity- we receive our marching orders from a medical director, and we can be quite educated and still require medical control. We will never be allowed to operate independently, unless our standards are elevated to the point of a physician. Even nurse practitioners, who are far more educated than EMS providers, do not operate without some physician oversight.

IAFF is the premier and most powerful public safety organization, and receive the most publicity, the most funding, and have the most political clout to effect change and implement policies with their PAC's and lobbyists. EMS cannot compete with that and I see nothing that suggests that will change any time soon.

Like it or not, fire departments are still absorbing EMS into their fold- with various degrees of success and quality of care.

Fire departments have an established and necessary infrastructure- manpower, locations, apparatus, a dedicated revenue stream via taxes, but thanks to EMS also generate revenue via billing. That increases their political power and makes them even more valuable to a municipality. From a management standpoint, fire based EMS is more cost effective than EMS. You have one person able to do 2 jobs(note I am not discussing quality of that care here), which is attractive to a city's bottom line, and these days, that is job one.

ALthough many areas have seen FD takeovers, there are still many independent EMS agencies, which makes it difficult to have a united front. Yes, the altruistic answer is that everything is about doing what's in the patient's best interest. Reality is quite different than that. Does that mean we change how we do our jobs- nope. It does mean we need to try new tactics. In too many instances these days, an EMS provider who becomes cross trained tends to emphasize their fire duties over EMS- despite the fact that EMS is the bulk of their work. Too many people also use EMS as a vehicle to get to the fire service- for better pay, better benefits, less call volume, or simply to fulfill their "true desire": to be a FF.

As much as I hate to say it, I feel the only way to effect change is to work within the framework of the fire service system. The problem is, how many members of that system are willing to push the EMS agenda? I think the culture is slowly changing, and gradually fire leaders are realizing their profession is changing, and that they need to adapt to that new paradigm- one that is dominated by medical care. That will benefit the patient, but I am afraid that in many cases, single role EMS providers will become a casualty of the process, and will be reduced to more of a transport-only entity after initial treatment by a fire EMS provider.

If the fire service truly embraces EMS-not just lip service at the national level- then quality of care will improve, but EMS will be fundamentally changed.

I'm not happy about the direction of this, but I'm merely facing reality. This is about dollars and sense, and yes, patient care, but the almighty dollar is what drives this whole process- for a community, for the fire department, for EMS, and ultimately the town that employs them.

[JPINFV]

EMS gets is not a self determining entity- we receive our marching orders from a medical director, and we can be quite educated and still require medical control. We will never be allowed to operate independently, unless our standards are elevated to the point of a physician. Even nurse practitioners, who are far more educated than EMS providers, do not operate without some physician oversight.

Do you think PAs and NPs work completely independent or are subject to a "supervising" or "collaborating" physician? To say that EMS doesn't and won't ever practice completely independent in the US misses the point that there are only an extremely limited number of health care professionals outside of MD and DOs that practice independently.

[46Young]

I've asked several times on this forum and others as to how this positive change will come about. I only get vague answers claiming that education will force change, education plus organization will force change, but no concrete plan of action. I've suggested that EMS learn from the IAFF's success and employ a similar strategy. Or form unions to better their deal at their particular agency.

Just think, the union will demand higher wages, better retirement, working conditions, medical, so on and so forth. Management will scoff, of course. The union can come back with a suggestion that management meet them in the middle if they all up their education to a degree level in an agreed upon time frame, as a condition of continued employment. A higher quality provider deserving of this generous deal. Having successfully bargained for a better deal, other EMS professionals will seek employment there. They'll also need degrees to apply. Other agencies will lose their best employees to this one. Other employers will be forced to increase their salary, benefits, education requirements, etc. etc. to match. Just one possible scenario.

At the present, I don't see many in EMS going the degree route solely for a career in EMS. Not without a federal mandate or a livable wage and decent retirement to attract the more highly educated. EMS missed the boat on increasing education. Many use the field for a quick way to make some cash without spending years in school. Since most that enter the field are doing so to earn a living without having to go to school for several years or so in the first place, then it's quite a stretch to believe that individuals in the future that enter EMS for the same reasons would voluntarily go the degree route without an immediate lucrative payoff for their efforts. RN's, RT's and others went the education route first, citing pt benefit, then increased insurance reimbursement, then salary/benefit increase, but the EMS workforce is of a different mentality.

Edited October 18, 2009 by 46Young

[NRPinNEPA]

Here's what I propose for the new levels...

Paramedic - Certified (PM-C)

Paramedic - Advanced Practice (PM-A)

Critical Care Paramedic (CC-P)

Eliminate "technician" from the job title, make PM-C equivalent to EMT-Basic in terms of skills, maybe give them a few extra tools, and make it a one year certification program. PM-A would be equivalent to the current EMT-Paramedic and would be a two year associate in applied science. CC-P would be a four-year bachelor's.

This is my perfect world. As long as we have "technician" in our name, we will continue to be treated like technicians and continue to earn a technician salary. Look what happened when RTs became Respiratory Therapy and upped their educational standards. Besides, everybody calls us paramedics already anyway.

[46Young]

Here's what I propose for the new levels...

Paramedic - Certified (PM-C)

Paramedic - Advanced Practice (PM-A)

Critical Care Paramedic (CC-P)

Eliminate "technician" from the job title, make PM-C equivalent to EMT-Basic in terms of skills, maybe give them a few extra tools, and make it a one year certification program. PM-A would be equivalent to the current EMT-Paramedic and would be a two year associate in applied science. CC-P would be a four-year bachelor's.

This is my perfect world. As long as we have "technician" in our name, we will continue to be treated like technicians and continue to earn a technician salary. Look what happened when RTs became Respiratory Therapy and upped their educational standards. Besides, everybody calls us paramedics already anyway.

That's not a bad idea, just that you'd need to convince employers to get onboard with that. Tell them that they could stop using RN's to do CC txp's, and instead bill for the CC medic at a higher rate. Perhaps CCEMT-P's could muscle in on the RN home visit sector. Another income stream for the agency.