How to improve EMS professionalism

[PRPGfirerescuetech]

Rid-

I can understand where youre coming from, but I still think it doesnt hold water. I mean esentially your argument is something like, if the town can thrown a veterans day parade, they can afford to pay their volunteer fire/ems. Not so, and I think you know that. We have a town about a hundred miles from where I live. It has a population of 110 people. They have little town picnics, etc and I think a bus might run through their every few days. Until a few years ago, they had no fire/ems response locally at all with the nearest responders being 30 miles away. So, the people of the town got together, got a firetruck (forgive me for not using FF terminology) and one ambulance. Then before using it, they send 4 of the towns men to FF school and there are 2 women in this little burg that have gone to medic level. Thats their emergency response system. But they cant afford to pay them. They need things like road salt and to pay someone to keep the weeds by the side of the road cut down because the state says they have to. I would honestly like someone to show me a study that says that across the board, volunteer EMS is no good...that it somehow sacrificies the quality of the care that it provides the inhabitants of its community. Or what about the towns closer to me but next to that little one...they have a Fire-Rescue service, all volunteer, called Win-Bur-Sew Fire Rescue, for the names of the towns they serve. Their fire fighters and EMS personnel make no money at what they do. they leave their jobs in the middle of the day and their homes in the middle of the night to put out house fires, tend to patients having acute MIs and deliver babies, among the million other things they do every day. Do you really have the conceit to say that they are no good or that the towns they live in are slacking off because they cant afford to pay these dedicted folks. Not everplace is NYC or Chicago or LA...alot of communities really do have to make do...do you honestly believe that having no EMS is better than volunteer. Pheh! I say.

NREMT-Basic,

As much as holding a discussion with you is as useful as trying to beat myself to death with a rubber spoon, im going to throw a few thoughts into the wind here.

First, a little Q/A session with your new friend PRPG.

Fact: The volunteer aspect of EMS is the one factor holding every problem from EMS from being solved

Fact: EMS education and advances cannot progress with volunteers in place as EMS providers.

Fact: I have the knowledge (please note lack of conceit) when I say volunteers in all systems are NO good to the communities they serve.

Now, im going to guess in your poorly educated mind, your wondering why I say such horrid things against our good friends, the jolly volunteers.

Lets explain the rationale for each statement chronologically, to avoid any confusion you might have, considering your exhaustion you must have from remembering to tie your shoes today.

1st:

The volunteer aspect of EMS is the one factor holding every problem from EMS from being solved

I took several polls regarding what people felt to be true problems with the EMS system, one of which was here at EMTcity. Realistically, I was quotes as "pay", "how we are viewed by others in the medical community", "education standards and poor education", "inability to establish a unique identity" and "a limiting scope of practice.”

Now, lets look at each problem one by one.

Education standards and poor education – Education standards haven’t been raised to all levels, because of the dying volunteer breeds. Simply stated, can we as a system raise education requirements to a group of people who struggle to clear enough time to 150 hour night course? To remove the volunteers from the system would still be such a PR nightmare, that no one wants to do it, as well as to remove the volunteers would cause a “systemwide critical shortage” at all levels which would be catastrophic.

-This of course is only true if you don’t change the current system to accommodate for the change to 100% career providers, but I digress….

Pay- With increased pay comes increased compensation. Medics make more than EMT’s, Nurses make more than medics, doctors make more than nurses, and EMT’s make more than your local Wal-Mart greeter….well, ok sometimes more than the local Wal-Mart greeter. Expand the education to a certain point, and bring home more coin, period. This is a principal that holds true in all aspects of the work force as well.

How others in the medical community view us- Simple really. Please tell me the last time you saw a MD with a nametag that said “Joe Blow, MD; volunteer doctor” When we expand ourselves as a profession of 100% career professionals, with a extensive level of true education, we will be viewed as a true facet of the medical community, instead of being lumped as the bastard children of the public safety community.

Limiting Scope of Practice- Simple math kids, pull out your calculators.

More education + More clinical time – less apathy from those who couldn’t hack it under the increased education = A bigger scope of practice!

A+ to the fat kid in the back who got that one right. Strong work!

2nd

EMS education and advances cannot progress with volunteers in place as EMS providers.

.....scroll up.

3rd

I have the knowledge (please note lack of conceit) to I say volunteers in all systems are NO good to the communities they serve.

The existence of poorly performing volunteer services is the direct cause of why many state level politicians dont get involved in ensuring competent ALS coverage to ALL residents! The " we already have someone doing that" mentality within the state level, along with a intense apathy on the subject from the people who matter most....the politicians. Guess what, the current system is inappropriate, substandard, and going to fold if we dont act!

Regarding payment and reimbursement issues.

It should be noted that there are many areas of this fine country completely uncovered by EMS services. This is the most inappropriate and truely disheartening fact in my own opinion. EMS unfortunately is not yet considered a "essential service" in the eyes of the political world, thus not considered a need by politicians for their voting contingent. Now, until the state and federal level governments recognize a true need to ensure EMS coverage which meets the unofficial 8 minute 59 second standard, several areas will remain uncovered appropriately. This is of course working within the private service "mom and pop" ambulance squad mentality, and not looking at the larger scale EMS needs like regional, or even statewide EMS services, similar to a national EMS system in the UK or australia.

Lets remember that the true ideal is to force all states to provide EMS coverage to ALL residents to comply with the 8 / 59 standard.

Not that any of this matters, because until every blue lighting EMS T shirt clad volunteer is removed, none of this will ever happen.

If that is the case, all of us with a true grasp on the system can come to my house and crack a beer to watch the National EMS system self implode. What your not grasping is that including volunteers in the EMS system will eventually ensure there is no EMS at all.

Side note, a famous person said once, its better to shut up and know your limitations, that to open your mouth and prove where your limitations are.

I eagerly await a poorly informed reply.

XoXo

-PRPG

[emaxray]

...One can display professionalism no matter what level of education, age, or job function.

For me the ones I can identify are: attitude, knowledge, behavior, appearance, and being able to utilize all those in a manner to perform their position and job with all those traits in a positive manner.

#1

While working for a paid private service withh 911 contracts we were at the local hospital where we saw one of our employees there. Drunk, barefoot and covered in blood, she was present at a barfight and "assisted" her volunteer crew members who responded. She rode along in the back of the ambulance to the hospital. Helpful or harmful to professionalism?

#2

The volunteers around me sometimes respond to thier station for calls in pajamas, flip flops and other assortment of clothing similar. Helpful or harmful to professionalism?

#3

While working for the same paid private service as earlier, a call went out (during the day on a weekend) to a surrounding volly EMS agency (countywide dispatch) for an elderly female fallen, no one responded. Not 10 minutes late another call went out for the same department, this time for a Code 4 (which is MVA with injuries here, they use Ohio police 10-codes...I won't get into that) and you would have thought it was another 9-11 with all the people responding. Helpful or harmful to prfessionalism?

I use these examples not to start anything, but to give people an idea of why I think the way I do about volunteers. In my eyes, those systems are harmful, unsafe for all involved, and cost lives... period. It doesn't meet any form of a definition for professionalism. Not even close. Mind you this is in some surrounding areas (<10-15 miles) of a city of about 50-60 thousand with a full paid FD and full-time EMS.

We are all going to have different opinions based on differnt experiences in different places. The fact remains are people paying dearly for some of our ignorance.

Edit: I feel I need to add that this is not intended to be indicitive of all volunteers.

[JPINFV]

#1

While working for a paid private service withh 911 contracts we were at the local hospital where we saw one of our employees there. Drunk, barefoot and covered in blood, she was present at a barfight and "assisted" her volunteer crew members who responded. She rode along in the back of the ambulance to the hospital. Helpful or harmful to professionalism?

Define "assisted." Did he "assist" in the same way patients with acute psych problems and are on a hold are given a "choice" to come (i.e. they don't really have a choice, but being polite and respectful will get a good number to come with you peacefully)? If he didn't do anything when "assisting" and the crew got him peacefully to the hospital, than score 1 for the crew.

#2

The volunteers around me sometimes respond to thier station for calls in pajamas, flip flops and other assortment of clothing similar. Helpful or harmful to professionalism?

Are they responding to calls in their PJs?

[emt322632]

Speaking of drunk colleageus and other volly squad nightmare scenarios...

I got dispatched to a bar one evening for a drunk woman passed out ( no surprise eh?) to find one of the girls that volunteers with the squad at the patient's side attempting to take a pulse. She was almost as drunk as the patient, the cops had told her to step back, but she refused to listen, believing she was the ONLY person on scene this woman would talk to.

Granted, this type of individual exists in all systems, but you have to know when to be on duty, and when to leave your stethoscope at home...

Another volunteer nightmare, the one that made me disgusted with volunteering, occurred when a call went out for an 80 year old female, fell the day before, now experiencing knee pain. One of those calls where, yeah, it's B.S. and you know it, but it's still a call, still a patient in need...

15 minutes later....after paging 2x for the department and 1x for fire department mutual aid for a driver...I told dispatch to turn the call over to the closest available department, and miraculously got a driver...go figure? When someone is going to step into their sandbox, they can't stand it...

No volunteering for me thanks...

[EmergencyMedicalTigger]

EMS needs to be categorized as an essential service. There are many cities out there that can afford to pay for EMS, but they don't because there are volunteers. I know this because I used to volunteer for this type of department. I worry about my family and friends who still live in that city. I personally know the level of care and 'professionalism' they will receive if they ever have to call 911. These municipalities need to be forced into making EMS funding a priority in their budgets. "Oh no, you mean the city will only be able to have fireworks for July 4th and not Cinco de Mayo and the annual shrimp boil?" gasp! Many cities can easily cut things in their budgets to staff an ambulance.

EMS needs to demand higher standards for education. This will be a difficult change to make, but it needs to be done to improve the future of EMS. EMTs and Paramedics should be required to have college hours. Many people have studied Brady or Mosby and have memorized enough information to pass the certification tests. However, those books don't teach critical thinking skills.

It's important to realize that professionalism isn't attained by saying 'I've done this and this; I've reached this level, so now I'm professional.' An organization becomes professional when it sets goals, accomplishes those goals, and then says 'Now how can we be better?' There has to be constant quality improvement and training and most importantly people who care enough to make this happen. This is not going to happen while 6 week paramedic and subpar community college programs are considered acceptable

[medic001918]

It's amazing how this post has gone. But now it's time to chime in myself on the issue.

Asys, great post. That's a great snapshot of what can be accomplished. I'm sure he didn't intend it to be a business plan for those who are questioning the feasibility of it; rather it's there simply to illustrate a point of what can be done when you plan things out and when you break things down to a per person basis.

As far as the little town of 100 people not being able to afford it. I'm guess that they manage to pay the other officials in their town? They were able to raise the money to purchase a fire engine and an ambulance. With the prices that many new vehicles are getting now, they should be able to look into a means of raising the money to pay a staff? Or better yet, since most small towns are surrounded by other small towns that combined might not have an overly high call volume; why not combine them in a regional or county system? Let a handfull of towns absorb the cost of equipment and staffing? That just might work. It might not be quite as fast as of a response (depending on the call location and location of resources), but then again it could be just as quick even with a greater distance to cover due to there people there dedicated to respond isntead of having to leave work, get to the ambulance and then arrive on the scene? I'd be curious to see how the response times would average out in that scenario.

As far as volunteer's go, and those described not appearing professional or acting professionaly; unfortunately there are those people in every field. And in EMS, they happen in paid services and vollie services. The issue with volunteers impacting EMS as a profession and not a hobby is that it's hard for someone doing this as a career to demand better wages or benefits when you have many others in the field willing to take your job for free. That goes to the basic supply and demand concept. If people weren't volunteering, the towns would be forced to obtain the means of paying for EMS. This would allow us to negotiate a fair wages and benefits package. In Connecticut, the majority of EMS is provided by volunteers (although more services are starting to pay people). In fact, my full time spot is as a paid contract paramedic (through a commercial service) to a volunteer service (which is considering going paid in the future). This gives me some more insight into the paid vs. vollie issue. I have seen some of the issues as far as staffing go. Some volunteers don't see the harm in booking off of a shift at the last minute leaving the town to rely on their backup coverage from the commercial service. This causes response problems, as well as a loss of revenue for the service which they depend on to cover operating costs. If the vollie service isn't transporting, they aren't getting any financial recovery on the job. So now someone books off a shift at the last minute and leaves an opening in the schedule that can't be filled. Can you discipline that person? Are you going to suspend them? You could, but what do they lose? They have no financial loss or reason to stay dedicated to the service. In theory, with paid personnel you can expect a reasonable level of staffing (since many people can't afford to lose money by not showing up to work). The other problem with volunteer services is that since people aren't doing this full time, they don't want to put in a great deal of time to be able to participate. This limits the training requirements that you can enforce. If you were to be a paid service, with adequate compensation you could expect to see higher salaries like those that are found elsewhere in healthcare. A higher level of education yields higher salaries which in theory would yield more interest and more providers looking for something other than a hobby. It's a vicious circle with a tremendous startup cost for a service to take on. However, once taking on the higher cost they could expect to see an increase in the efficiency of their day to day operation.

Shane

NREMT-P

[Chief1C]

They were able to raise the money to purchase a fire engine and an ambulance

now read the whole thing b/c I'm not on anyones side

Not a good example.. Not many towns with a hundred people or less cannot outright buy a fire apparatus or ambulance.. We have 900, and couldn't do that.. Low population, tax base isn't strong enough to support something of that size and Fequency of use.

Then again, if a perfect answer could be given for this, it would have been done thirty years ago. eh?

Edited: The topic is derailed... Just like EMS.

[Ridryder 911]

Why do each town.. have to have an EMS unit ? What is the problem with qualified and well trained first responder units. Amazing larger services utilizes them until ALS responds, and as well most can stabilize for at least 15 to 20 minutes, until ALS respond.

Second, why cant there be established EMS regions and districts ? Pulling communities together and placing units in acceptable areas. Again, I still say it is pride, not really the concern they have towards of patient care. The attitude of "we have to have our own"...

Well, it will change.. sorry fight all you want to, but economics and as well increasing run volume due to the increasing age of the population will make it impossible to maintain volunteer status. So, would it not be wiser to work on a workable system than to "fog' the picture with egos and pride. IMHO it would be must better to have a implemented system than within 5 years no system and be in panic.

In my state, there is a panic due to rural areas now going from poor private private to volunteer, to no EMS. Yes, I mean no one will be there to respond. Mutual aid from neighboring communities (30 -50 miles) is responded. It would had been much better if all those smaller communities "banded" together and work as one, than as separate identity. Volunteer first response units, until the regional area responded.

Change is hard to accept, deciding upon which change would be the best in the long run..

r/r 911

[brock8024]

Why do each town.. have to have an EMS unit ? What is the problem with qualified and well trained first responder units. Amazing larger services utilizes them until ALS responds, and as well most can stabilize for at least 15 to 20 minutes, until ALS respond.

Second, why cant there be established EMS regions and districts ? Pulling communities together and placing units in acceptable areas. Again, I still say it is pride, not really the concern they have towards of patient care. The attitude of "we have to have our own"...

Well, it will change.. sorry fight all you want to, but economics and as well increasing run volume due to the increasing age of the population will make it impossible to maintain volunteer status. So, would it not be wiser to work on a workable system than to "fog' the picture with egos and pride. IMHO it would be must better to have a implemented system than within 5 years no system and be in panic.

In my state, there is a panic due to rural areas now going from poor private private to volunteer, to no EMS. Yes, I mean no one will be there to respond. Mutual aid from neighboring communities (30 -50 miles) is responded. It would had been much better if all those smaller communities "banded" together and work as one, than as separate identity. Volunteer first response units, until the regional area responded.

Change is hard to accept, deciding upon which change would be the best in the long run..

r/r 911

I agree with this 100%. Why can we not put our egos to the side and take care of our patients like we went to school to do. I also live in oklahoma and it is starting to get scary for ems here. I think last year we had over 10 services close due to funding. The only problem I have with regional ems is the medical directors. I mean we have some that are awesome and that are more knowledgeable in ems and want to help ems forwards but have others that know nothing and would set us back and not let us think for ourselves.

[Chief1C]

Second, why cant there be established EMS regions and districts ? Pulling communities together and placing units in acceptable areas.

That's what I was trying to say..