Increasing Education from a perspective of system management

[AnthonyM83]

Ace,

Some say it's the communicator's job to get the information across to the receiver.

If so, the sender must callibrate for the audience.

On a message board with a dozen messages being posted every hour, with readers quickly choosing what post may be a good read, you're not going to get too many replies to such a long post, even if the information really is there.

[pyroknight]

Have you been to the ER lately and been told "You need an x-ray, but, unfortunately, we don't have a radiology technician available right now."? Have you noticed a shortage of laboratory technicians? How about physical therapists? Seen any pharmacies closed because they couldn't get any technicians to fill prescriptions? All of these professions set high standards years ago that kept any dick or jane from walking off the street and three months later being a "pseudo-professional." If we REALLY want to change how our profession is viewed by those outside our profession, we are going to HAVE to change the educational requirements. There will be a need for an entry level for as long as our citizens refuse to pony up the funds for full-time paid EMS. As long as there are volunteers, there will be an absolute need for a level of care that is attainable by people who cannot quit their jobs to go to school. In my mind, this would be a first responder certification that approaches what our current EMT level is today. These people would be trained volunteers, but would not truly be part of the profession of EMS. If you want to volunteer in a hospital, they don't make you a doctor. EMTs should have at least a two-year degree and paramedics should have a bachelors. If the entrance requirements go up, the compensation will go up. When the compensation goes up, people will seek entry into the field. How many diploma nurses do you know? Associates degrees have become the minimum in nursing with most employers preferring BSN. As a nurse, I can tell you first hand that nurses are no better than paramedics. The job a paramedic does is tougher. Why do we not get paid for what we do? Because even we don't take ourselves seriously enough to require a reasonable entry level education.

[BrianG1984]

I have been reading through this thread for a couple of days.Though I am only an EMT in training I feel I do have something to add to this post.I obviously made a decision to get into EMS recently, I was very happy that there was an opportunity to work after a short inexpensive time in training. I was able to go to EMT-B school for slightly under $1k. I will have completed my EMT-B training by this May. I feel this is a good thing for many potential EMS Providers because it allows the option of night school a couple of days a week for a short period of time until one is able to work in an ENTRY level position within the EMS system. This allows one to get a taste of life in EMS without investing years and years of their life and tens of thousands of dollars(as I did in my current career as an auto mechanic) I am extremely dedicated to being not only good, but the BEST EMS provider possible.This is my stance with everything I do, but especially EMS where I directly impact another human beings health and well-being. Personally it would be very hard for alot of people to attend a daytime school full-time five days a week. Most people need to work while in school and some have family responsibilities(I have a son coming in 2 weeks.)

I did an intense amount of research into the field of EMS and at an EMT-B level I will be taking a pay-cut from what I already make now in a job where I don't feel I am paid enough. However I don't plan to be an EMT-B for very long I would like to start Paramedic training ASAP, and God willing I will be able to work for a provider that provides tuition reimbursement for Medic school. In my opinion if entering EMS was extremely expensive and took years of schooling just to get a job in the field, the number of interested parties would fall dramatically. Unless someone decided to become an EMT very early in life( the time when many people aren't sure they want to do) would they have the time and support system(live at home, scholarships etc.) to complete the program. Most new providers would be very young.Also many people would not invest the time in money for fear they would not find a job, wouldn't be worth the money, may not like the field etc.

The current educational setup at many EMT and Paramedic schools in my state allow people to go to school and train for a small INITIAL investment and also at night, so they can work to pay bills and tuition. The only thing that would probably land EMS a large amount of mature hard working dedicated applicants would be to raise the pay scale.Unfortunately with as many folks failing to pay their bills as their is now, I doubt higher prices would help. Sadly, most people follow money it is their God and they will not work and invest alot of time in something that wont line their pockets, but then there are the self sacrificing individuals such as yourselves that not only work hard for little pay, but have a desire to do a better job, and improve the industry.

Just my Two Cents

[pyroknight]

BrianG - as a well-trained auto mechanic, you make more than an EMT. Why do you think that is? If ASCE (I hope I got the acronym right) certification were not the gold standard in auto repair and if it did not take so much time to achieve, we would have 17 year-olds under the hoods of cars in every auto dealer in the country. Even the AUTO REPAIR business requires more education than EMS!!! You can practically sign up for one of Sally Fields study-at-home programs and get an EMS credential. What is that worth? Until the profession requires an investment, we will continue to be treated as unskilled labor. The fire service in many parts of the country is suffering from the same challenge. Firefighters now respond to EMS calls, perform extrication, mitigate hazardous materials incidents, and generally deal with any emergency that arises. The community thinks all the fire service does is nap and occasionally put out a fire or two. If you compiled firefighter I/II, EMT, technical rescue, vehicle extrication, and hazardous materials into one training program, threw in an english, a math, a physical science or two, a psychology, and a sociology, I almost GUARANTEE you would have enough course work for a bachelors. It's way more than enough for an associates degree. If the fire service ever figures out just how much they are getting the shaft, look out! Because firefighters accumulate all their education in two to four hour blocks, very few realize just how educated they are. If firefighters actually compiled all that training into a degree program and demanded to be paid for being SKILLED workers, the entry level salaries for firefighters would double.

[Nate]

Can we get some use of paragraphs please...killing my eyes.

[AnthonyM83]

I agree that if we did away with EMTBs, we'd have a problem getting new people in, including smart people.

Perhaps if the main focus was increasing paramedic education and then reducing the cases were EMTBs can work alone without someone with the advanced schooling degrees, that might help. You can't just take them away, though. They're the backbone of the service and many won't have the resources/desire/long-term commitment to job to upgrade.

Another important issue: after reading Ace's plan (which seems like a good one for most part)

Where is the funding for all this going to come from?

Is AMR going to pay to put their employees through more training?

Is every city/county going to put out more money?

Private companies are incredibly stingy as it is (from what I've heard) and public EMS services seem to always be lacking in personnel and proper equipment. How would this change get pulled off without a command and assistance from state or federal government?

[Dustdevil]

So why not support the attempt at education, as you claim to be a proponent of it?

I do support attempts to improve education. I was merely pointing out why you frequently do not get the responses you expect to your posts. Take it or leave it.

But I do not support blatant copyright violations.

[Nate]

They have been trying for a few years to require paramedics on every ambulance, however rural fire cheifs have been fighting this because it would most likely require them to pay for paramedics, which they generally either can't afford.

[Dustdevil]

I agree that if we did away with EMTBs, we'd have a problem getting new people in, including smart people.

That doesn't make any sense. You are suggesting that smart people only want to rise to the minimum required level. Doesn't sound very smart to me.

Perhaps if the main focus was increasing paramedic education and then reducing the cases were EMTBs can work alone without someone with the advanced schooling degrees, that might help.

You may have a point there. I can see waivers for ambulance drivers. Any idiot (read: volunteer firemonkey) can do that. But require that each and every ambo still be staffed by a paramedic. That way, you are cutting your trained personnel requirement in half, but still ensuring that patients will be attended by a medical professional. I could go for that.

You can't just take them away, though. They're the backbone of the service...

Only because we allow it. If it is no longer permitted, they will simply (and yes, I mean very simply) rise to the new standards. They will have no choice.

...and many won't have the resources/desire/long-term commitment to job to upgrade.

That is because the current requirements and career potential doesn't attract those with long-term commitment. The key is to attract the right people from the start. I am not concerned in the least about losing the rest of them. Good riddance.

Another important issue: after reading Ace's plan (which seems like a good one for most part)

Where is the funding for all this going to come from?

Is Ace's post the only one you have read in this thread? Again, it is very simple. You pick your priorities and you fund them. When a city/county is mandated to provide something, they will find a way to provide it. They will stop spending money on the pointless bull$hit they currently waste their money on and redirect it. They will raise revenue through taxation or billable services. Or they can just die.

Is AMR going to pay to put their employees through more training?

Why should they? They didn't pay to put them through school in the first place. They aren't responsible for the professional education of their employees.

Is every city/county going to put out more money?

Nope. Only those who currently do not provide adequate service to their citizens.

Private companies are incredibly stingy as it is (from what I've heard) and public EMS services seem to always be lacking in personnel and proper equipment. How would this change get pulled off without a command and assistance from state or federal government?

It wouldn't. Governmental involvement will ultimately be important in ensuring that EMS progresses as a profession.

[Ace844]

I agree that if we did away with EMT-B’s, we'd have a problem getting new people in, including smart people. Perhaps if the main focus was increasing paramedic education and then reducing the cases were EMT-B’s could work alone without someone with the advanced schooling degrees that might help. You can't just take them away, though. They're the backbone of the service and many won't have the resources/desire/long-term commitment to job to upgrade.

First off, I am not advocating taking away of EMT-B, they have their place, and they fill a need in the EMS system. As long as we have different levels of providers, non-standard and un equal education standards we will have this problem. At some point someone is going to have to “stand up†and say, look, these are the minimum standards, and if you don’t like it..too bad..you’re outta luck. Your patient’s and families, etc.. deserve X amount of top notch pre-hospital care and the providers should have Y amount of education to address this. Remember, a lot of the success of this is “HOWâ€, the message is delivered as opposed to “What,†that message actually is.

Another important issue: after reading Ace's plan (which seems like a good one for most part) Where is the funding for all this going to come from?

Well, here’s what I think should happen to a service who is seriously considering doing this. In business there is a long held principle that you need to sometimes outlay capital in the short term to increase efficiency and profitability. So here is what I’d recommend. Since most EMS companies/systems aren’t profitable or grossly so, one needs to identify the problem areas that are affecting that and re-address/fix them. I think that if an organization were to say hire or bring into it an accountant, a lawyer, and a professional, capable, experienced management/employment consultant and make the scale of their salaries dependent on success, they would have the motivation to “fix†the issue. That being said, the overall management and organization would need to support these measures as well as understand them. Once the finances/management are straightened out there, there should be an increase in available funds. Take these funds and apply them to further the goals you have set forth to improve the organization, and training to improve it. Depending on how much of a capital shortfall, you have, would then dictate what actions the organization would need to decide on how best to address this. The key here is not to throw large amounts of money at the problem without justification and accountability for the expenditures.

Is AMR going to pay to put their employees through more training?

I wasn’t speaking specifically about AMR or any other company, so the answer would be dependent on how important improvement in care, service, efficiency, and management, is to them. I worked under the assumption that since an organization was considering this issue, that they were serious and being proactive to bring about this change…

Is every city/county going to put out more money?

See my responses above

Now some say you need to “start with the providers outside of the organization.†I disagree. I think that if you have a solid philosophy, good teamwork, and management, as well as a solid well defined plan over a period of time as well as various ways to allow the implementation of this plan. It will create an environment for success and provide you a solid platform to grow from. I’m in no way advocating an over night change, but a gradual, progressive, measured change. In the mean time as I said you would need to institute a minimum hiring/qualification requirement, but this should happen after you have your own organizational foundation in place as aforementioned. In that transitional period in between, you would need to decide, what is an acceptable compromise and minimums prospective employees need to meet as mentioned in my last post.

As fort the local/regional/National issue. If an organization were to seriously take these measures, and provide clear benchmarks, for their measure of success, or even accept that as time goes on and the overall plan is implemented, then the success of the change would speak for itself. It would influence and get noticed locally for its success, compel competitors to “keep upâ€, and if done properly, garner the attention and imitate the “wish†for change via example at the other levels…

Hope this helps,

Ace844