What Would You Like to See Change in EMS?

[NYCEMS9115]

What I like to see change is; I can only speak for NYC, there must be brotherhood and sisterhood. There has and is still anamosity towards fellow EMS/PHC members. Why? We must get along, shared ideas, and co-exist. We don't have to break bread with one another but we must respect each other. Even on the forum; many do not respect each other. Its I'm better than you mentality. Do we need a disaster to honor each other? Let's get along. Let's respect thy fellow EMT...

This is one of the things I would like to see changed in NYC EMS and EMS as a whole...

Happy New Year, EMT City Members...

[Bieber]

In the U.S., I'd like to see an associate's degree as the bare minimum for paramedic certification in EVERY state (mine has this requirement, but I'd like to see everyone have it as well) with more Bachelor's degree options available along with other higher degrees similar to what nursing has, first and foremost. I'd also like to see a stronger unity between EMS providers with more power in our national associations and more professionalism across the board. We are professionals and we ought to act like it, however many services are decidedly UNprofessional in their conduct and practices. I'd also like to see an increase in wages and--and this is going to be one of those that a lot of people disagree with me on--the complete abolishment of volunteer services. I have yet to see a volunteer hospital or a volunteer ER or any nurse or doctor put in the amount of volunteer hours that we in EMS seem to be willing to put in, and I think it hurts the profession when we sell ourselves so short. We provide a service and we deserve to be paid for it.

[Alex Woo]

Beiber.. OmG!!! You believe what I believe..... Plz see my thread regarding EMT Restructuring and check the EMS Protocol Change thread too....

My idea is a bit aggressive but see how some see it & most insult me on the thread... Its awesome to see how EMS has really regress......

Sorry to be off topic.....

I would love to see EMS become a recognized profession by layppl... I want the Paramedic Profession to seperate itself from other EMT certs and become a degree only and advance degrees in discussion... Happy New Year!!!

[crotchitymedic1986]

This is not necessarily what I want, but it is what is needed to ensure the survival of our industry:

1. Medical Directors should be held liable for the mistakes of the company's employees. Once they have that fear in place, real training will occur.

2. We need to go to a mandatory tiered system. The current economy will not support double medic trucks, it is a tremendous waste of resources. There is no reason to have EMT-B's, they should be banned from ambulances.

3. I see no reason to mandate college degrees, it just makes more money for the colleges. To those who think it brings respect, would you respect a plumber with an associates degree more than you would one that has no degree but has 10 more years experience ? Our job is a blue collar job, park your ego, and deal with what we are. Be a good EMT/Pmdc skill-wise. An AKC registered dog's shit smells the same as a mutt from the pound. Paperwork does not make you better.

4. All ambulance models should be crash-tested and brought up to car standards, airbags in the box, better restraints, more crash worthy in a rollover.

5. Any shift longer than 12 hours should be banned. If a longer shift is still permitted, you should not be allowed to work the shift immediately following, at any provider.

6. No one under the age of 21 should be allowed to work in our industry. I am sorry, but if you have 1-2 years experience driving a car, are you really competent to drive an emergency vehicle ? Wonder why you dont see any 16 year old 18-wheeler drivers ?

7. You should have to pass a real "skills test" atleast once per year, where failure means you come off the truck until you prove your competency (every drug, every skill).

8. You should have to dress like a professional (no tshirts, no polos).

9. Each department should reflect it's community in minority make-up in employees and financial budget. We have been too "white-male" for too long, where the money goes to supplement the pensions of old white guys who make decisions that help the future old white guys. If your population is 70% hispanic, your workforce should be 70% hispanic, which means you have less white chiefs, and use that money to produce scholarships to medic school.

10. Your system should be profitable, or atleast break-even financially. The tax payors should not have to waste money on your chief's EMS Kingdom, full of too many non-productive work hours (hours not running calls), expensive trucks, too many personnel for call volume, not enough cheaper BLS trucks to handle the majority non-ALS calls. To do this, private interfacility transport services should be banned, all ambulance transport that occurs in a companie's "borders" should be handled by the licensed 911 provider. If you are not good enough to be a 911 provider, you should be in the wheelchair van business.

Thats my short list, I am sure I will add more. Good TOPIC !

Edited January 2, 2011 by crotchitymedic1986

[Bieber]

Wow!

I gotta say, I pretty much vehemently disagree with everything you've said except for numbers 4, 5, 7 and 8. In fact, if I may I'll respectfully state my points of contention hopefully without sparking anything more than a friendly debate.

This is not necessarily what I want, but it is what is needed to ensure the survival of our industry:

1. Medical Directors should be held liable for the mistakes of the company's employees. Once they have that fear in place, real training will occur.

While that is good in theory, the reality I suspect would be a watering down of all skills to only those with the least risk. "Just load 'em and drive, 'cause if you do anything wrong it's MY butt on the line." Furthermore, aren't medical directors already at least in part liable for the actions of the employees they supervise?

2. We need to go to a mandatory tiered system. The current economy will not support double medic trucks, it is a tremendous waste of resources. There is no reason to have EMT-B's, they should be banned from ambulances.

Are you saying there should only be paramedics and EMT-I's?

3. I see no reason to mandate college degrees, it just makes more money for the colleges. To those who think it brings respect, would you respect a plumber with an associates degree more than you would one that has no degree but has 10 more years experience ? Our job is a blue collar job, park your ego, and deal with what we are. Be a good EMT/Pmdc skill-wise. An AKC registered dog's shit smells the same as a mutt from the pound. Paperwork does not make you better.

I disagree with you. It's not about paperwork, it's about education and knowledge--which WILL make you a better paramedic. Furthermore, even if paper alone does not make you better, it DOES improve the image of the profession (which, while admittedly is not and should not be our primary focus, it IS something we desperately need to improve) and add more credibility to us.

4. All ambulance models should be crash-tested and brought up to car standards, airbags in the box, better restraints, more crash worthy in a rollover.

YES! 110% yes!

5. Any shift longer than 12 hours should be banned. If a longer shift is still permitted, you should not be allowed to work the shift immediately following, at any provider.

I also agree with this in general. In the sense that nobody should be working more than 12 hours without a break, however I understand that many services are pretty slow and you're not likely to go without sleep at some 24 services.

6. No one under the age of 21 should be allowed to work in our industry. I am sorry, but if you have 1-2 years experience driving a car, are you really competent to drive an emergency vehicle ? Wonder why you dont see any 16 year old 18-wheeler drivers ?

Eh... I don't know about this one.

7. You should have to pass a real "skills test" atleast once per year, where failure means you come off the truck until you prove your competency (every drug, every skill).

Yes, but can we also include a written "knowledge test" as well?

8. You should have to dress like a professional (no tshirts, no polos).

Yes, though I don't necessarily agree that polos are unprofessional, however I personally prefer button ups.

9. Each department should reflect it's community in minority make-up in employees and financial budget. We have been too "white-male" for too long, where the money goes to supplement the pensions of old white guys who make decisions that help the future old white guys. If your population is 70% hispanic, your workforce should be 70% hispanic, which means you have less white chiefs, and use that money to produce scholarships to medic school.

How about we just hire those who are qualified, able and willing to do the job?

10. Your system should be profitable, or atleast break-even financially. The tax payors should not have to waste money on your chief's EMS Kingdom, full of too many non-productive work hours (hours not running calls), expensive trucks, too many personnel for call volume, not enough cheaper BLS trucks to handle the majority non-ALS calls. To do this, private interfacility transport services should be banned, all ambulance transport that occurs in a companie's "borders" should be handled by the licensed 911 provider. If you are not good enough to be a 911 provider, you should be in the wheelchair van business.

I agree with financial responsability, however I'm leery about a for-profit service. That's not really what I feel medicine is about, and I'm nervous about getting into any kind of system where we might be required to acquire payment prior to transport or as a requisite to transport. I'm not a salesman, and I really don't want to be one. And I'm not in favor of monopolizing EMS and kicking out private services all together either.

[zippyRN]

This is not necessarily what I want, but it is what is needed to ensure the survival of our industry:

1. Medical Directors should be held liable for the mistakes of the company's employees. Once they have that fear in place, real training will occur.

they and the employing ageny are vicariously liable anyway, what you actually need is increased accountability of the providers in the field to a professional regulator i.e. 'proper' Health Professional Status

2. We need to go to a mandatory tiered system. The current economy will not support double medic trucks, it is a tremendous waste of resources. There is no reason to have EMT-B's, they should be banned from ambulances.

the whole ALS/BLS split thing is peculiarly USAn way of thinking especially as you point out that EMT-Bs have so little preparation for practice

3. I see no reason to mandate college degrees, it just makes more money for the colleges. To those who think it brings respect, would you respect a plumber with an associates degree more than you would one that has no degree but has 10 more years experience ? Our job is a blue collar job, park your ego, and deal with what we are. Be a good EMT/Pmdc skill-wise. An AKC registered dog's shit smells the same as a mutt from the pound. Paperwork does not make you better.

odd then that elsewhere in the World , paramedics ARE Health Professionals and earn the same or more than the 'Bedside' Registered Nurse ( for Same example the UK where both jobs start at AfC band 5 , for same or more the Dutch -Scandinavian model where the 'Paramedic' is an Nurse practitioner

4. All ambulance models should be crash-tested and brought up to car standards, airbags in the box, better restraints, more crash worthy in a rollover.

something which has been in existence in Europe as a 'voluntary' but effective compulsory CEN Standard for 10 or more years ( though not with airbags in the salloon as far as i am aware) , along with better manual handling practice as well

5. Any shift longer than 12 hours should be banned. If a longer shift is still permitted, you should not be allowed to work the shift immediately following, at any provider.

yep agree with that - again effective health and Safety / employment law should make that a complete no-brainer

6. No one under the age of 21 should be allowed to work in our industry. I am sorry, but if you have 1-2 years experience driving a car, are you really competent to drive an emergency vehicle ? Wonder why you dont see any 16 year old 18-wheeler drivers ?

symptom of driver training ( or lack thereof ?) and the way in which some localities have their driving licence structured , if you make ambulances vocational licences either specifically or by weight / mass and then require proper driver training , not just a 16 hour classroom course ...

7. You should have to pass a real "skills test" atleast once per year, where failure means you come off the truck until you prove your competency (every drug, every skill).

effective skills audit through field based assessment by properly prepared Team educators and lectuer practitioners ?

8. You should have to dress like a professional (no tshirts, no polos).

why ? especially given that polo shirts are an increasing staple in Emergency services uniforms around the globe ... now if you said 'stop looking like plastic policemen ' with shiny badges and arms full of boy scout badges ....

9. Each department should reflect it's community in minority make-up in employees and financial budget. We have been too "white-male" for too long, where the money goes to supplement the pensions of old white guys who make decisions that help the future old white guys. If your population is 70% hispanic, your workforce should be 70% hispanic, which means you have less white chiefs, and use that money to produce scholarships to medic school.

2 main issues one easily solvable one much harder without a backlash

1. resolve or minimise cultural bias in recruiting and retaining ,

2. changing viewpoints among populations both inside and outside the profession, as has bee nseen with certain south asian ethnicities and Nursing i nthe UK - if the members and leaders of the ethnic group consider the role to be 'below' members of the group as it is dirty or demeaning - then they can't expect to see the profession matching proportions in the wider community ...

10. Your system should be profitable, or atleast break-even financially. The tax payors should not have to waste money on your chief's EMS Kingdom, full of too many non-productive work hours (hours not running calls), expensive trucks, too many personnel for call volume, not enough cheaper BLS trucks to handle the majority non-ALS calls. To do this, private interfacility transport services should be banned, all ambulance transport that occurs in a companie's "borders" should be handled by the licensed 911 provider. If you are not good enough to be a 911 provider, you should be in the wheelchair van business.

part of the problem is the fragmentation and too smallness of the services - this is apparent in many US fire services and EMS services where the service is stand alone around a relatively small centre of population rather than serving populations of millions and areas approaching State sized ...

[Ridryder 911]

I would like to see EMS to begin to become a profession. This would include removing those that don't know the difference between skills and knowledge (i.e. plumbers vs. clinical practitioners- blue collar vs. professional services). Usually only those with limited clinical experience or those that have worked in limited areas could have obtained such a narrow opinion. Funny, it is usually those that work in FD type service would ever consider or would want to be associated as a blue collar. (No, not all FD are created the same). Hence, the reason I obtained an education. (You know the old saying, a Doc can dig a ditch but a ditch digger can't practice medicine?)

Remove the old stigma of "Emergency" from our profession. We should be Mobile or Out of Hospital Medical Services, and not limit our scope. Citizens and insurance payers are tired of paying high dollar $ taxi rides with a 500 hour trained ambulance attendant proclaiming that they are a medical professional. Remove the ability of every person with a pulse, having the ability to enter the Paramedic program and decrease the amount exiting by half then we will see a demand. Only those with a true professional education (not training), and proper clinical exposure be released. Place a one year residency with an accredited EMS, so those released will have proper in-sight of what medical care should be like... (Hmmm... just like other medical professions... oh, yeah that's what we are supposed to be!).

Yes, CMS and other Insurance providers would gladly pay EMS millions of dollars a day in reimbursement rates if..... we were properly educated and do more than just provide first aid and a taxi ride. We can justify salaries to triple, if we could save ED admits and transports, but to do that providers would have much further education and clinical exposure than what is currently taught now. Want to be treated, respected, paid and thought as a professional?.... then become one.

I will agree with the statement of making physicians more responsible but; I would also add increasing the liability of the Paramedic to be solely responsible if they did not perform proper treatment and remove the physician liability all together, alike some countries already have in place. There is no excuse for ignorance in knowledge of medicine other than those that do not want apply themselves maybe just simply lazy and truthfully there is no place in healthcare for them... get another job or go back to your primary job!

Edited January 5, 2011 by Ridryder 911

[NYCEMS9115]

Ridryder 911, I agree with almost everything you've said. I've been saying that for over a decade.

That being said; I don't believe insurances will pay more: regardless of who's on the ambulance. They pay for the ride not the care. No itemized payments. The US HHS hasn't increase the Medicare and Medicaid rates in years. They've enacted policies to make it harder for ambulance services to get and retain money. On audits they'll take the money paid to the service if mileage, times, & signatures with printed names are not on the paperwork. That's why Managers like myself reprimand all who do not comply. They just passed a policy where the mileage must have the decimal tenth on the mileage too. If not; they'll round it down and take back partial reimbursements.

I'm just saying...

[island emt]

Beiber.. OmG!!! You believe what I believe..... Plz see my thread regarding EMT Restructuring and check the EMS Protocol Change thread too....

Sorry to be off topic.....

I would love to see EMS become a recognized profession by layppl....

alex: as long as PPL keep presenting thmslves as textspk morons there will NEVER be that recognition. plz learn how to type full words.

[Prmedc]

Just to comment on the "two year degree" buzzphrase:

I moved to a state that required a two year degree (generally through community colleges) to become a paramedic, specifically because I believed that the additional education would make me a more "well rounded" provider of medical care. I found a medic population full of drug users, fired law enforcement, and just plain incompetents. All of whom possessed a two year degree and multiple student loans. Needless to say, I got the hell out of there and went to a well recommended technical school. No two year degree, although I did receive college credits if I decide to pursue a degree.

My point is that slapping some English, math, and freshman psychology classes together with a paramedic class doesn't "make it better". Give me a four year B.S with reasonable tuition and college level A&P, chemistry, biology, etc and then EMS as a profession will see some benefits to possessing college degrees. Unfortunately if you want that level of education you might as well get into nursing and work towards CRNA or something similar that has decent wages.

Oh, and writing the EMS texts to 8th-10th grade levels doesn't help our case much.

Prmedc

Edited January 5, 2011 by Prmedc