How to improve EMS professionalism

[emt322632]

Everyone has to have the biggest, shiniest truck...The newest, most sophisticated equipment...

It's oneupmanship at it's finest. Volunteer services around here anyway seem to think that by buying the shiny new toys, they're doing everyone a favor...

But honestly...it's no good if the time it takes to get out the door to the call exceeds 12 minutes on average...Or worse if there is no one is there to staff the rig...

[shira_emt]

I was going to reply to a post on here, but thought better of it. I was angry at the time and my reply was pretty harsh. So I deleted it. I am a volunteer myself. And yes I have showed up on runs in my PJ's. My OSU fleece PJ bottoms as a matter of fact. But I don't think the woman who ran her car into a tree really cared what I was wearing. She was just thankful that we showed up to help her. Honeslty if you are having an active MI do you really care what the EMT and medics are wearing? I know I wouldn't. I know the topic title is EMS and professionalism. Do I think I looked professional in my PJ's? No of course I didn't. Was I thinking about how professional I look when I was trying to take care of my pt? No I wasn't. I got my job done, dropped her off at the ER and went home.

I have read most of these posts (there's a lot) and I have listened to my b/f (emaxray) talk about volunteer vs paid. Is no one thankful for volunteers? I know I was when I was in my MVA. Had it not been for the volunteer FD and EMS I dunno what would have happened. I volunteer because I want to make a difference in people's life. If my department goes paid, great. I know it's not going to, but that isn't going to stop me from helping people. I'm not going to argue with anyone anymore about this, it's pointless. I'm not going to try and change anyone's mind. I do it because I want to. There are some that refuse to volunteer because they aren't getting paid, Okay suit yourself. However, I will rarely agree with someone who is totally against volunteer systems, I've seen them save too many lives that otherwise would have died waiting. But I've heard pt's dying because it took the volunteer system too long to get there, or they didn't get maned. I see both sides, really I do.

Back on the topic of professionalism, at one point in time my department had jump suits. They were lovely, lol. navy blue with reflective stripes everywhere including down your backside. I guess that way when you were bent over on a MVA scene the cars coming could see your butt sticking up in the air. But a couple of years ago they did away with them. I happened to like those things because, if you wanted to go in your PJ's no one ever knew because they were covered up. Plus if you got yuckies on your it was on your jump suit not your personal clothes. Plus they were more professional looking, instead of my OSU PJ's. There is my 2 cents, take it or leave it, really doesn't matter to me

Shira EMT-I

[emt322632]

Shira Emt...

Most people do appreciate volunteers, however most people in the public do not know anything else other than what they are given by their public leaders. I do not agree that volunteers are the answer, nor should they be. They are just that, volunteers. In order for EMS to be taken seriously as a profession, having people around willing to do this for next to nothing, severely limits the ability of those of us who wish to do this for a living to argue for our jobs.

True, people do not care who comes to their house to help them, they only expect an ambulance to be out the door the minute they hang up with 911. With volunteer companies, there is no guarantee that an ambulance will be out the door every second of everyday, staffed with the best crew that can be found.

An example of this...One day a volunteer squad in my area got paged for a male having chest pain. 4 pages later, they were still not out the door, 2 pages for the next closest volly squad ended up with nothing, and the same thing with the next. They ended up paging a squad that was 20 miles away to come to the guy's aid, who by then was unconscious, apneic and pulseless. He died, leaving a wife and newborn daughter behind.

The reason the volunteers didn't respond, was because everyone was attending a training at the EMS center about 40 miles away.

That is just unacceptable in my opinion, call it poor planning, call it stupidity...it's unacceptable. With a paid organization, you are guaranteed a response, within a certain amount of time, with a full ALS crew...no additional pages for ALS, no ALS from a department 20 miles away, heck no ambulances from 20 miles away...

I have no doubt that you volunteer because you love to do it...but that doesn't mean that those of us that are paid do not love our jobs either...we aren't forced to be there just as you aren't...

As the system stands, it is built for volunteers...less education time so we can churn out techs so we can fill trucks...less time spent on the why more spent on the how...

Sorry for the rant...

[ERDoc]

Since this seems to be going down the volley vs. paid route again, I just fingured I'd add my 2 cents. There was a case recently in my area where a guy went into cardiac arrest. The volley FD was able to get 3 members to the scene in less than 6 minutes. The FD does not have an ambulance because they are in a paid system. They waited on the scene for over 20 minutes doing CPR and shocking with an AED. The paid ALS crew finally showed up and took the pt to the hospital where he was pronounced in the ER. No way to say what the outcome would have been, but if they volleys had their own ambulance they could have had the pt off the scene and at the hospital much earlier.

[medic001918]

And yes I have showed up on runs in my PJ's. My OSU fleece PJ bottoms as a matter of fact. But I don't think the woman who ran her car into a tree really cared what I was wearing. She was just thankful that we showed up to help her. Honeslty if you are having an active MI do you really care what the EMT and medics are wearing?

I'm curious about what your department has for a policy regarding uniforms? Is it commonly accepted to violate a policy? While your patient might not care about what you're wearing, the rest of the healthcare community is basing opinions of EMS as a whole based in part upon what they see. And if they see people coming to the hospital in PJ's, then they certainly aren't going to take us seriously. Also, out of curiosity if you're responding in PJ's how are you identified from a bystander on scene by other personnel (possibly from other agencies)? Something to think about with regard to appearances.

Had it not been for the volunteer FD and EMS I dunno what would have happened.

I'll take a stab at this one. My guess is that if it weren't for the volunteers your town would have some contract established with another service (commercial or otherwise), or possibly have come up with the funding for their own paid staffing of the ambulance. This would mean that you still would have had an ambulance show up to your car accident and you still would have been treated. Most likely, this would have been a crew ready to roll out the door at any time. The final guess to this one is that the end outcome would not have changed at all.

However, I will rarely agree with someone who is totally against volunteer systems, I've seen them save too many lives that otherwise would have died waiting. But I've heard pt's dying because it took the volunteer system too long to get there, or they didn't get maned.

So why would you rarely agree with someone who is totally against volunteer systems? There is no conclusive evidence that these people would have otherwise died? I'm reasonably sure that there would be some form of emergency medical service in place? My guess if you wanted to compare response times of paid vs. volunteer services; you would find that the paid services hold to a more consistent standard. When you're paying someone to be there, you are guaranteed staffing. You won't be holding an ambulance waiting and hoping for another crew member to respond.

Since this seems to be going down the volley vs. paid route again, I just fingured I'd add my 2 cents. There was a case recently in my area where a guy went into cardiac arrest. The volley FD was able to get 3 members to the scene in less than 6 minutes. The FD does not have an ambulance because they are in a paid system. They waited on the scene for over 20 minutes doing CPR and shocking with an AED. The paid ALS crew finally showed up and took the pt to the hospital where he was pronounced in the ER. No way to say what the outcome would have been, but if they volleys had their own ambulance they could have had the pt off the scene and at the hospital much earlier.

I'm curious as to what the delay was from the paid ALS crew? Is it a commercial service? a county service? If the town maintained their own transport service, they would have tighter control of response times and delivery of resources to the scene. It's much easier to come down on people to ensure tight standards when they're getting paid. I know of many volunteer services that are afraid to come down on members for fear of them no longer being involved. People are less likely to take a gamble with their livelyhood.

Shane

NREMT-P

[emaxray]

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.

Are they responding to calls in their PJs?

1) Assisted as in was in the back of the ambulance fucntioning as a basic setting up IV's, doing bandaging to the cuts (apparently from glass) etc.

2) Yes, responding to calls in PJ's from home to station and then getting in the ambulance and responding to the house, building, whatever in pajamas.

I have more examples like this than I can count. As I said earlier in a discussion about this topic with a friend offline, I don't have to have volunteered to know and I have heard no one tell me how a volunteer service does anything to help the image of professionalism we are talking about. They almost always resort to the "if there were no volunteers..." or the "It's all they have..." reasonings to why they exist.

[shira_emt]

No my department doesn't have a dress code so to speak. I'm IDed as an EMT and a member because we are issued jackets that have our department's number on it and the star of life. About the only think we can't wear is dresses (which I have seen) and really really short shorts or skirts.

I'm done having this conversation. I've been having it for over 3 years now. The ones that are against the volunteer service are going to stay that way and the ones that are for it are going to dig thier heels in. In my opinion there is no right or wrong answer. I'm moving on to another topic now, ya'll have a nice day and stay safe out there.

[Laura Anne]

A few questions for someone to please answer for me....

1. Uniforms: Is it a law that, when on duty in the role of a provider, have some sort of level of certification/ licensure visible?

2. Uniforms: Does OSHA/ workman's comp provide some sort of regulations as to what need to be worn on a scene for protection, IE: fireman wear fire gear.... EMS providers wear steel tipped boots or blood resistant shirts/pants?

3. Duty: When off duty, if you act in the role of a provider, shouldn't you be SOBER? Just a few things that scream some sort of law suit via negligence? :shock:

[NREMT-Basic]

A few questions for someone to please answer for me....

1. Uniforms: Is it a law that, when on duty in the role of a provider, have some sort of level of certification/ licensure visible?

2. Uniforms: Does OSHA/ workman's comp provide some sort of regulations as to what need to be worn on a scene for protection, IE: fireman wear fire gear.... EMS providers wear steel tipped boots or blood resistant shirts/pants?

3. Duty: When off duty, if you act in the role of a provider, shouldn't you be SOBER? Just a few things that scream some sort of law suit via negligence? :shock:

Answers (as far as I know):

1. I dont believe a law governs uniforms. In IL..if you are responding on duty, you do, however have to have something visible...the volly service I am with issues photo ID's that clip onto our shirt collars. We also have an official copy of each providers DOPH/EMS license up in a prominant place in the station (right as you come in the pubic entrance) with our photos next to it. Our tags have our name, level and our call sign on them (all EMS in this county is Charlie or "C" and then a number.)

2. From working in labor law in a previous life, I dont believe OSHA really has anything regarding what a uniform must be worn. Mostly these are in the "equipment" section of our protocols. We dont require steel toe boots because their is a dispute among providers as to whether or not they are helpful or would cause further damage. i wear steel toed flight safety boots.

3. Yeah, i would think being sober would be a good thing. Though around here, if you respond off duty, you fall under the good samaritan law so you are much less likely to be sued. We arent like policemen who are required by state statutes to respond to a situation no matter whether on duty or not.

[ERDoc]

I'm curious as to what the delay was from the paid ALS crew? Is it a commercial service? a county service? If the town maintained their own transport service, they would have tighter control of response times and delivery of resources to the scene. It's much easier to come down on people to ensure tight standards when they're getting paid. I know of many volunteer services that are afraid to come down on members for fear of them no longer being involved. People are less likely to take a gamble with their livelyhood.

Shane

NREMT-P

I do not know what the delay was. It was a commercial service that has a contract with the county. I do not know what the specifics of the contract are, so I don't know if there are any response time provisions. Obviously, being a commercial service they also do the hospital d/cs and interfacility transports so it is possible they were caught on one of these, but like I said, I cannot say for sure.