What Does it Take to Change EMS?

[mikeymedic1984]

The answer to your question is simple in theory, but impossible to pull off. We are the problem. As long as we will continue to work 2 jobs for barely above minimum wage, that is what the market will pay. We lost a great opportunity in the 90s when there was truly a shortage of Paramedics at least, and before fire departments starting pushing everyone to EMT mills. If we would all get together on a particular month, and say. "Sorry boss I am taking a sabatical for one month" and if all of us refused to work a part-time job for one month (on the same month nation-wide; dont quit, just take a month off), wages might go up, but if your state has the chance to put EMTBs in your place, then it may be a losing gamble.

You can't compare California to any other state, the wages are high because the cost of living was/is ridiculous. A 2 bedroom house used to cost $300k, and I believe gas is around $6/gallon. Taxes are higher, everything is higher.

Why can't you make 100k, because most services collect 40-45% of what they bill, 60-120 days after service was provided. If you are a 911 service you are probably only transporting 50-60% of your patients, so the revenue is far below the cost. If you are a private service in this economy it is very difficult, no banks are lending, fuel is high, and you never know what kind of revenue you will have from week to week.

But anywho, if you want to change, rally everyone together to take that month off from all part-time jobs.

Edited July 23, 2012 by mikeymedic1984

[CytochromeP450]

MikeyMedic is spot on. Simple supply and demand.

1) Decrease supply - Make it more difficult for people to get into the field and stay in the field. How do you do that? Increase education requirements.

2) Decrease supply - don't work extra shifts. We all do it because we need to make ends meet, but we are screwing ourselves in the long term.

3) Increase demand - somehow we need to affirm our place in society. Nursing has done a great job with this by having minimum staffing requirements with JCAHO. Fire departments have done a great job with this by NFPA standards (which there is not a single piece of literature to support, yet they still get it passed into standard and get insurance companies to back up the financial end). How do we do this? I'm not quite sure. In the past we have leaned on response times but in the end this result is just a smattering of undereducated EMTs and a paramedic on every piece of fire apparatus rather than system improvement.

So what it comes down to is pressuring government officials in favor of regulation that benefit us. I remember a post in a previous thread about the failure of unions for prehospital care because none will take a firm stance in fear of alienating fire-based and low-standard services and losing that revenue base. But why are we letting this stop us? How many people here have complained about the situation of EMS? Now how many of those people have taken it upon themselves to effect change? How many have contacted local, state and federal officials? How many have written letters to their elected officials? How many have been willing to contact news agencies and tell of our misery and woe (think of how scandelous a story it would be reporting that the people in the ambulance require less education than the barber cutting your hair)? I assure you the answer is not many. The problem is we like to complain to each other but we don't get up and do anything about it. We are unhappy...but not unhappy enough. We need the anger. We need the outrage. That is what will produce change.

What is the problem...We are the problem. We and our apathy.

Edited July 23, 2012 by CytochromeP450

[paramedicmike]

This is a multifaceted problem. However, as has been said many times before in many previous discussions, nothing will change until the education requirements change.

EMS-ers need to realize that for most of the professional world compensation is based on education. The more education one receives the better off they'll be. Until this mindset changes nothing else will change. Until EMS-ers figure out that they need to be degree prepared providers nothing else will change. Once basic educational requirements needed for professional entry are changed things will start to fall into place. It won't happen overnight. However, it will happen much faster than the pace at which it's happening now.

To the individual who said PA providers get $50K or more I call shenanigans. Not in Coatesville. Not in Chester County. Not on one job. And not without a boatload of overtime.

[azemt2007]

Look I hate to play devils advocate but the 1,000 hour paramedic operating to "protocols" is probably not worth much more than about $15 an hour

If you want more money then convince everybody that higher education is absolutely necessary and that the profession must take responsibility for its own development. New Zealand started doing it in 1972 and it's taken nearly forty years to get to we are now so it's not going to happen overnight

I'm finishing my Bachelor's of Science in Paramedicine in February 2013. Guess what that will get me? 0 pay increase, 0 respect increase from my employers, and only a handful of people know it's possible to get an undergraduate degree in that! I'm constantly staying up on new fronts in EMS and trying to stay ahead of the continuing education train. Unfortunately in the states, if you aren't part of a fire service that does EMS (here on the west coast), you won't receive the pay or the respect. I do know a very few areas of California that pay medics around $19/hour however there is typically an 800 person waiting list for 1 opening.

[Kiwiology]

It seems in US outside of the regulated professions such as law, medicine, accounting, engineering etc a Bachelors Degree is a "nice to have" i.e. something to work towards, I have numerous US friends who are working and are "going back" to finish their Degree. Here and in Australia you simply would fall flat on your face without one for the overwhelming majority of professional careers

Paramedic now requires the Degree and Intensive Care Paramedic requires a Post Bachelors Certificate.

The Degree is just the first step, once everybody accepts that at least a two year Degree is required then things will begin to change from there, until then, nothing meaningful will change, including pay.

Edited July 24, 2012 by Kiwiology

[azemt2007]

I want to thank all of you for adding your perspective and insight on this topic. I appreciate that all the discussion was positive and I can tell you are passionate about what you do as I am. I have taken it upon myself to reach out to a friend of mine who is a network television anchor news reporter and we will be discussing this topic in great detail. I will be bringing a culmination of all of your insights with me to share so this will be the first step in the right direction....I hope. I am all for education but at the same token I think it has to be tempered with need. Does it make sense to require a bachelors degree for the EMT-Basic that has a scope of practice that is very limited as in Los Angeles County? Before we can make substantial changes in education requirements, we need to get every state, every county/burough/parish on the same page.

Just an aside, did you know that in LA County, paramedics are not even taught how to read a 12-lead ECG in the county course? Did you know that the protocols don't allow the paramedic to interpret the 12-lead even if they are trained? We are told to just read what the machine determines...which we know 90% of the time is either totally incorrect or at least partially incorrect. Paramedics in LA County (and because I'm new to this system and appauled at the care given and the expectations of this system is why I keep referring to it), operate below the National Registry and DOT standard for rendering care because the county determined that the 10% of paramedics that were not able to meet national standards but had been allowed to work here, would require increased costs to bring their skills and knowledge to the national level, it was cheaper to just lower the scope of practice.

So even in the areas where education is supposedly prized and mandated, those officials are working against us even though they don't realize it.

[nypamedic43]

I'm with Mike on the shenanigans...Bradford county EMS agencies don't pay that much AND the one I worked at you had to pay for your own boots and uniforms. I'm in chemung county NY now and get paid $13.90 an hour but our uniforms are furnished and there is reimbursement for boots. The company also matches our 401k 100% up to 6%. Yeah I don't know where libby is...but I know that the EMS agencies in PA don't pay that well.

az....I'm not sure I could work there. I'm an east coast girl that's for sure and I can feel your frustration.

[zippyRN]

Hello. I don't have an answer for your question at this time. I just need to say that I have been a certified nurse assistant and I feel the same way we are treated just because we don't have a higher education or a degree of nursing. I really dont want to be a nurse because I see to much competition among the nurses and the B.S that goes on in nursing homes. so I decided to go to school for EMT-B and continue school for EMT-P. Here in PA paramedics salary get paid 50,000 to 70,000 per-year and EMT-B 35,000 to 40,000 per year depends on location. Been a C.N.A for 22yrs and dont even make what emt's make per year. CNA's only make 25,000 per year and with all the experience of 22yrs, it is sad what we get paid per year and no appreciation or no respect from no one. Even some nurses treat us like we are something that they carry on the botton of their shoe( crap ).

with accountability come responsibilty and rewards, this is why HCA /PCTs /CNAss and protocol munkey EMTs are paid relatively little compared to RNs or Cops ...

if you look at the places in the world where Paramedics are professionals with degrees they get paid what a professional with a degree is worth ...

PTS staff or 'advanced first aiders' doing event cover in the UK getas much if not more training than EMTs in the USA ...

Edited July 27, 2012 by zippyRN

[Kiwiology]

A Johnno first aider, PTS Officer or Community First Responder gets about the same training as a US EMT here

[celticcare]

No I have to disagree there Ben, an average EMT-B in the states receives more training than a PTS officer or a first responder here. Even if it is the "cookbook" course that you call it, how can you say a four day course here is more training than the EMT-B course in the USA.

Yes accountability comes reward, I get paid very well as an RN, but then I also get penal allowances and that makes my pay all the better. EMS here in NZ is now standard for three year degree in Health Sciences majoring in Paramedicine to get into the field. The in house training system is now coming up to that standard, has it taken 40 years, NO it has not been an easy process, but now its coming along at a national standard of skills and scopes of practice.

EMS will only get respect, when we as an industry actually push for it. Let the communities see how much up shit creek they would be if EMS wasn't there, just put it out there to the communities, rally, do your own PR, go out and actually say to the community - We do this service and get paid this much, how much can you place on a human life *try that approach tug on the ol heart strings etc*

Get some self respect out there, there are some EMT's and Para's out there that I cringe seeing as they make the truck tilt when they hop in. Now we have standards for fitness and uniform etc, and most of the wombles are in the first responder ranks rather than frontline it makes it better, but it takes time.

We are lucky here in NZ, EMS wages are really good, education standards are actually really good and yes there are bad points, but on a whole, we have it a lot better than the USA I am afraid.

Scotty