In Your Opinion, What Is Holding USA EMS Back?

[spenac]

OTHER THAN EDUCATION, In Your Opinion, What Is Holding USA EMS Back? What is keeping us from being viewed as professionals? What is the main reason if you have more than one?

Is it fire involvement? Is it our lack of identifiable uniform? What do you think is holding us back? Please don't bash anyone for their opinion, I really want to see what besides limited education is behind us being unable to advance as a profession.

In my opinion I think what holds us back is that we have to transport all callers. We have lowered ourselves to nothing more than taxi drivers. Do you see Doctors doing heart surgery just because the patient say's hey I woke up this morning and well I think I want a triple by-pass? I am all for having people dialing 911 if not sure if it is an emergency, but after we evaluate we should be able to treat and release or deny transport if it can wait for them to buy over the counter med, put ice on it, wipe their nose, or they can safely go private vehicle to the ER or their doctor. Until we can say no to people we are nothing more than low paid taxi drivers and will never be looked at as healthcare professionals.

[scott33]

Lack of Autonomy:

Make EMS staff practitioners, instead of providers. Get rid of the physician extender mentality, and medical control, and have the EMS employees fully autonomous and accountable for their own actions.

Professional status:

Have all EMS staff licensed and registered under one governing body. Minimize levels of licence to EMT, Paramedic, and Critical Care Paramedic.

Association with the FD:

Never nice to be looked at as someone’s bitch, and I have yet to hear a convincing argument as to what good it does EMS. The two entities should be totally separate.

Education:

Have to mention it…Entry level at Bachelors of Science before you can practice professionally. Emphasis on heavy A&P, math and pharmacology.

Volunteers:

Should be used as an adjunct to a professional service only, or to provide the paramedic student with some road experience. Perhaps each volly crew should have at least one licenced professional practitioner as an integral component. Too many poor practices going under the radar

Driving:

21 to be considered, CDL required, more instruction, and tougher road test. One strike and you are out rule for "red mist" or "road rage"

Pay:

In line with other autonomous health care professionals

Media:

Conscious effort to change the part-time hero / whacker / patch-hunter image as portrayed by the media.

I know...it will never happen :roll:

[EMS Solutions]

Great topic. One that can go in circles forever, unless action is taken beyong us talking about it here and in other forums.

So far I agree with most of the comments. But..

No vollys

No EMT, EMT-I, EMT-CC etc. - One license, One Level - Paramedic

Unity is also key to getting where we want to be.

One governing body is a great idea. Who wants to start that body? Who will start it and stay with it?

PM me if you are serious about making a change.

[SSG G-man]

What if prehospital providers were a branch of nursing. There are CCNs, Trauma nurses, etc. What if we were all trained to that level? That would take EMS out of the FD. Maybe keep paramedics as drivers as EMT-Bs are now. Just a thought. Smack away...

Sarge

[Richard B the EMT]

The only reason the EMS is in the FDNY, is because now presidential candidate Rudy G wanted it that way. Theoretically, if firefighters wouldn't lose jobs by being needed for CFR-D runs, as fire call volume was going down, they'd vote for him for mayor of NYC, and they did!

Then, after he got elected, he had to force through local laws to allow the EMS to be removed from the management of the NYC Health and Hospitals Corporation, and placed under the management of the Fire Department of New York city, by the New York city Council, and then get the state to do likewise. Both were accomplished, and the transfer of power came on Saint Patrick's Day, March 17, 1996.

Do you know how I know Rudy got the FF vote? I was at the campaign headquarters for a different office wannabe, and saw firefighters in bunker gear dancing at Rudy's celebratory party, on the TV, as he got elected mayor over the incumbent.

That, in your humble servant's opinion, is why EMS in New York City, is under the FDNY!

[WelshMedic]

What if prehospital providers were a branch of nursing. There are CCNs, Trauma nurses, etc. What if we were all trained to that level? That would take EMS out of the FD. Maybe keep paramedics as drivers as EMT-Bs are now. Just a thought. Smack away... 











Sarge

What, like Holland you mean?

[spenac]

Lack of Autonomy:

Make EMS staff practitioners, instead of providers. Get rid of the physician extender mentality, and medical control, and have the EMS employees fully autonomous and accountable for their own actions.

Right on. If we do not have the ability to think, to make decisions, and just transport everyone our image will always be viewed as a taxi driver and no more. That is the sad fact, we can change everything else ever discussed here and elsewhere to improve our image but then still transport every stubbed toe and the public will still view us as taxi drivers rather than healthcare professionals. Sad fact that everyone seems to blind to see.

IN MY OPINION TRANSPORTING EVERYONE THAT CALLS HURTS OUR IMAGE MORE THAN VOLUNTEERS DO!!!!!!!!!!!!!!!!!!!!!!!!!

[tator55]

Lack of a true national standard. Sure we have Nationally Registry, but if that was a true national standard, we would have no need for state cards. Protocols vary by state, which i think is holding us back. Make protocols, education and Basic/I/Medic abilities standard nationwide.

[scott33]

What, like Holland you mean?

Not a bad system from what I have read.

Who am I to say that "RN" after your name would not be a good thing for all those wishing to work in EMS? Food for thought...

Here is a link to the Dutch system (for those interested) with a wee video at the bottom

http://www.ambulancezorgnederland.nl/publiek/english.htm

[aussiephil]

To save my fingers & mouse clicks i wil start by saying that EMS should NOT be a division of Fire or Nursing. It is a seperate stand alone profession.

I do not want to denegrate nurses, they do a fantastic job, but on the whole work best in a controlled hospital environment.

Same goes for our Fire friends. Firefighting is a specialty & is treated as such, as are Police.

EMS is a unique specialty that crosses many different fields & we deserve the repect that is afforded to other professions.

There will always be a place for volunteers in ems. I say this because we always have to be mindful of costs & practicalities. Smaller areas need to have some Vollies to provide BLS until paid professional EMS is available. I say this because as scott stated 'Pay should be in line with other health professionals' Where does the money come from to pay for these professionals in smaller communities?

I am also a firm believer that while ems crosses both the health field & emergency services fields, it should not be run on a 'for profit' basis. Same for all healthcare. Health & Primary Emergency services should be a function of Government, with paid providors used as an adjunct for things such as sporting events with licensing controlled by the government to enforce regulations. This should be a state, not federal function & would allow for the use of statewide protocols etc.

I cannot however agree to an entry level of a Bachelor of Science, from experience, the best pre-hospital care providors I have come across would never get this qualification, they are hands on, I do however believe that education should be continuing & current thinking on the best forms are a combination of didactic learning initially with self paced learning in set modules with exams to follow& a graduation of learning over a set period of time.

Education needs to be kept current with modern proven learning techniques engaged to ensure the highest possible level of practical knowledge maintained.

EMS is education in progress. You need the basics, but from there you need to have common sense & the ability to put that knowledge into practice.

A combination of the above will lead you to Autonomy, increased professionalism & community respect. Uniforms, badges & the like are a necesarry wank, but keep it simple & practicle.

The most important thing we do is show we care, over 90% of people dont need any form of intervention, just a taxi ride to hospital, but they deserve as much of our attention as the major trauma, the major cardiac event.

We need to also remember what we are not. We are not Doctors, we are not in a sterile hospital environment. We provide professional prehospital care to the sick, injured & needy of our communities. We make a Provisional diagnosis based on the information we have provided to us. We make decisions based on that information. I have seen too many people in here get hung up on things like over oxygenating a COPD patient. We hey, they need it, give it to them, on high flow, then let the DOCTORS & HOSPITAL worry about it later. Or one i saw in chat was trying to convince me that I should be considering electrolytes when infusing fluids. Well sorry, if the pt is severly hypotensive or dehydrated, i am more concerned with renal function than an electrolyte imbalance that i cant test for & can be corrected in hospital.

Lets leave the Doctor stuff for the Doctors & concentrate on the things that are proven to provide positive outcomes for people, early administration of ASA to AMI pt's with nitro & O2, defibrillation for cardiac arrest patients, pain managment etc. that too will help with professionalism.