What Would You Like to See Change in EMS?

[Ridryder 911]

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...

I understand your frustration; as one in EMS Management I understand the difficulties. I do know though in payment structure, HEMS is definitely paid in more proportion than of ground EMS. The reason being is the "specialized crew". Review the payment structure discussion with CMS and the justifications given.

Yes, EMS is not considered as a true health profession and thus reimbursement rates are poor. Unfortunately; as you and I know there are many reasons for this. True, they will audit and yes it is getting harder to obtain proper credit. Then again; have we as a profession (in whole) really presented anything different? It's hard to describe that you need increase due to shortage in the ability to staff when there is a surplus of EMT to Paramedics and in reality within 5 to 10 months completely have a whole new staff! The medical skill level complexity is only rated very low.

Insurance companies are seeking alternative ways to prevent premiums. If our education level and service would meet the demands of the health community; then we could make a change. Not all patients need to be transported to an ED. Insurance corporations (including Medicare) pay trillions on incidences that could be treated and not have to be transported. With the technology, increased acceptance of physician extenders, it is a shame EMS is not progressing and making a move to secure its future.

R/r 911

[NYCEMS9115]

Prmedc. Unfortunately, you experienced something that shouldn't be. It was the people involved not the degree. School only benefits a person. Its like saying a seasoned EMT or EMT-I can be a Paramedic based on experience. On paper the AS and BS in Paramedics is great. I have it in Paramedics. I've been Management since 2006. I was able to get a Management Position at a new company due to my degree and experience. That will seperate me from a Paramedic with just experience.

It may not make better Medics but it makes the Medic able to transfer credits to other Science Degrees like Nursing. We insult the Paramedic. Referring us to drug addicts, blue collar, plumbers, etc. We are that if the individual is like that. They're some like myself who respect the job or profession. Its people who've made what EMS is. All the negative comments one has is because of bad experience. On paper the degree Paramedic is better. We can argue all points. Look at the RN, NP, CRNA with ASN, BSN, MSN, PhdN Degrees. It took hundreds of years for Nursing to be what it is today. If we don't fix or improve EMS; we will remain stagnant and considered a hobby. If you want to be a doctor; you have to get your BS/Pre Med, pass the MCATS, then get accepted into Medical School, Greduate, get into Internship Program, then to Chief Attending, finally to Fellow. This is a process established to become a Doctor.

So Paramedics need to develop a process beyond a HS/GED. The Degree for the Paramedic only helps; it doesn't hurt. One without can hurt. If you want to be Director of EMS; most require a degree. If you want to be the Dean of an EMS Program; most if not all require a degree. If you want to be an Executive for Ambulance Company; many require a degree. Chief of EMS; most require a degree. Degrees don't make the profession; the person does but with the degree; that person's job is recognized as a profession.

EMT-B/I/P's are not consider a profession; its a job. Degrees will change that. You may be gray when that happens. So keep working, pushing, striving to be the best Provider possible. Lobby and write to your elected officials. I know we all want EMS to reach unlimited success. I know I do....

[NYCEMS9115]

Its a delicate matter and it will take years before something like Degree only Paramedic Programs. If there are changes; I hope its to the right direction. I know we all can agree on that...

[Prmedc]

It took hundreds of years for Nursing to be what it is today. If we don't fix or improve EMS; we will remain stagnant and considered a hobby. If you want to be a doctor; you have to get your BS/Pre Med, pass the MCATS, then get accepted into Medical School, Greduate, get into Internship Program, then to Chief Attending, finally to Fellow. This is a process established to become a Doctor.

As demonstrated by the crushing weight of student debt that doctors possess. I agree with you that having a college degree in addition to a paramedic's license can't hurt, and in most cases is helpful. However, is it really better (from a medical knowledge standpoint) to go from pass/fail minimum grades per test to requiring only a C average? Be that as it may, current paramedic degrees only tack freshman classes onto the DOT curriculum and clinicals. Ergo, a complete rewrite of the college EMS degrees (to a more science based curriculum) currently offered would be needed to do some good. It's ridiculous that the lab techs have four year degree programs and we don't - with the exception of "management" programs (again, an amalgamation of a two year degree with two years of business classes) .

We might not be considered an "official medical profession" but let's face it - until the widespread use of the automobile EMS wasn't practical except in small areas with large numbers of patients (battlefields). The doctor went to the patient, usually with a nurse or two. As long as what we do consists of ultimately delivering the patient to a higher level of care, then we won't be viewed on the same level as the professions that spend weeks with the patient as opposed to minutes. Regardless of the fact that our care tends towards dealing with more acute conditions, or how many degrees we have. We get paid (mostly) for what we do, transport. If we don't transport, the patient doesn't get a bill. In any profession, you have the people who get paid for what they do, and people who get paid for what they know. We tend towards the former, as demonstrated by our reimbursements. Doctors are the latter.

But hey, we're also somewhat separated from the problems of the "medical professions". We have property and sales tax bases to draw from that very few hospitals enjoy. Let's just not be in a hurry to dive deeper into the layers of bureaucracy that the medical professions are enveloped in.

[Ridryder 911]

I believe many will see an immediate change in the future. The new curriculum has not been tested yet, and as a test writer for the NREMT; I know that more emphasis on complex and higher academic questions is being developed. We will have to see educational paradigm shift, that is if institutions want their students to pass.

Alike all other health professions, the pass rate (or lack of it) will cause educational centers to have to change their teaching methods and criteria and even those teaching such courses. For example; statistics and public health courses are part of the new criteria. The number of Paramedic(s) or even EMS Educators that truly understand those topics are minimal but are very relevant to have a good understanding of medicine. We need to check our ego's at the door and widen our horizons and learn off other health care professionals and not take "hundreds of years" to change our profession.

EMS is at a crisis point. Unfortunately, what we are currently doing obviously is NOT working. Only an idiot would expect a change in results if you continue the same pattern. We will either have to broaden our horizon or be replaced by others that will do it for us. The whole "healthcare system" is undergoing radical changes. The current system will be changed. Either we can be a part of it and prosper or be reduced, replaced or eliminated. Don't believe me? Look at other medical professional exploring prehospital care as an avenue to expand and secure their profession(s). More physicians are making more house calls than before in decades including physician extenders (PA's, NP's) or even prehospital RN's. Don't bury your head in the sand and not be aware of the surrondings and NEVER assume anything...

In other words be part of the change or suffer the consequences.

R/r 911

Edited January 6, 2011 by Ridryder 911

[rat115]

I'd like to see the basics covered.

Let's start by getting everyone on the same page in the US. Let's get a national standard of training and care like other countries have. By standardizing practice levels and training levels, there is an increase in understanding within the profession of what each level can do. It also decreases the ability of people to fake certification.

I agree with better training. Basics need better training before they're released to work in the field. We are professionals and quality training gives us a better chance to be seen as professionals. That also means that we must ACT like professionals and treat each other with respect. That means that nasty comments on a website or face to face shouldn't be considered ok by anyone.

I think if we can start by getting those IN the EMS field to understand that we ARE professionals and must act like professionals. When we change our attitudes and get the training that allows us to work as a team with those in the hospitals and clinics, they will see us as health care providers and professionals like them. From there, things can only improve.

[RedOnTheHead]

I definitely agree with many of y'all here: better ambulances, higher standards of education, and taking responsibility for the practice of medicine on the truck rather than holding the distant med controller by the throat for a screw up. My county's med controller is so strict, there's so much the medics in my county can't do that they learned to do in class, so many drugs they're not permitted to administer that can save lives, but med control won't allow it because his butt would be put to the fire if anything happened.

As for education, I earned a B.S. prior to entering EMS and it gave me a tremendous edge against my counterparts, both while obtaining my EMT-B and in the field. I fully intend on going back to school before getting my Medic, mainly because I do not feel that you can learn everything you should in a cram packed 1-year long course designed to deprive you of sleep and pump out medics as fast as possible. There isn't a degree program for medic in my area (which I think both sucks and is dumb), but I will go in for nursing and take the paramedic course along side it so I can slow the pace and actually LEARN. I've talked with others who have done the same and they believe it really is a great way to do it. Besides, Ridryder911 makes a good point about how this will affect pay as well as insurance compensation.

I also agree with getting rid of the volunteer services. I have NEVER come across one, in any state I've been to, that actually had a quality volunteer service. I wouldn't want what they do to reflect poorly on my profession given the trust put into EMT's and medics by they community.

Speaking of which, how about some better community education? Aside from the frequent flyers who will call you no matter what, the community needs to understand that a 911 service ambulance is not for when you have a cold or a headache (I mean, unless it's a debilitating migraine that keeps you from driving). I don't think it's ok to remove a unit from service to tote somebody to the ER for the sniffles. God forbid their next door neighbor has a heart attack and has to wait 15 minutes for a truck because you had to go to the ER for a snot-nose. Those who use the 911 system for that purpose should be held accountable. Also, it would contribute to the community's health to understand that having a GP who knows their medical history and can better assist them with ailments because of that knowledge is better than the medical quickie they'll get from the local ER doc who doesn't want to deal with their excessive mucus.

Moving on, I don't agree with removing EMT-B's. We all know there are a lot of calls that a medic doesn't need to ride. If you live in a more rural and poorer state and county like I do, paying for 2 medics - even on a tiered system - when 2 aren't needed is silly and a waste of money and resources we can't afford. Your state and county/parrish should take into account the needs of your individual area and staff accordingly. Besides, we're not retarded because we're Basics. If properly trained, we are useful, even in an ALS situation.

As for an age limit...I'd say that could be a valid point.I think you can be a great first responder or EMT-B at a young age, but it's rare that I've seen (at least at my service) really young people with the maturity to be a medic at the ripe old age of 19. But, perhaps my experience is too limited. I'm open minded about it.

I also think we need serious tort reform, but I think that's agreed upon in every medical profession. In my state, we're scared to death of screening out certain calls that, in all honestly, are not emergency calls because we're terrified of the litigious concerns. I understand wanting to transport what might look like just a headache and turn into a TIA, but colds? drunks? stubbed toes? Eh...something needs to be rethought a bit there.

Anyway, that's my 2 cents...

[NYCEMS9115]

Ridryder 911 awesome post; you're 100% right.... Its happening... Thank you...

rat115 you're so right; standardization; that's the first step. NREMT for all; sounds good. Respect; that too. Many on this forum are not respectful for one...

RedOnTheHead we won't rid ourselves of volunteers; as long as areas continue to pad their pockets and not services; we won't see that. Look at trying to get rid of volunteer FD; at this time impossible. Improving the EMT-B is a start. Restructuring a system's teir is another start. Having Degree only Paramedic; starting with an Associates is another start; its there but needs to be like Nursing, available. Increase the Paramedic's scope; allowing us to be like a fast track; many more patients will not be transported to the hospital; is another start. This will save $ for the Healthcare System; where reimbursements will be better. However, its all a tough sell and something where in the US will not likely happen because of the green all love; thus greed. Your thread was great; thank yoy...

Prmedc your right. We are not is the same umbrella. Education only helps; for many it makes who they are. Its something that will never be taken away. Its a process but who will take on this process. Definateluy not DOT, NHTSA, or NREMT. Its up to all of us to lobby & protest for education change for EMS. Thank you...