In Your Opinion, What Is Holding USA EMS Back?

[Chief1C]

Must be a pain in the ass having to move all that equipment all the time. But at least it's shiny.

Huh?

[GFD136]

I think a big part of the problem is crews becoming involved with each other, and being seen in public, in uniform displaying PDA. Another problem is, at least around here, out of shape, non shaving, smoking in the bus providers that are keeping us from getting that title.

[WANTYNU]

I would like to offer my opinion... given my nearly 30 years of EMS experience that includes volunteer, paid, EMT, Paramedic, Instructor, hospital based, helicopter, chiefs etc etc. I have developed a bit of an opinion like most other type "A's in the business....

... EMS personnel must understand where they stand in their own shop before they try to compare themselves or get parity with nurses etc. EMTs with 120 hours of education must stop asking for equal pay to a nurse, police officer, or FT Fire Fighter. Paramedics must follow that lead as well.

EMS as an industry should develop its own pay scales and industry standards. One simply cannot compare 120 hours of class to 4000 hours of class ...

Lessen the negativity (as mentioned above) and increased self regulation with clearly defined missions, educational requirements, and standardized certifications or licensing.

We must stop EMTs from thinking they are paramedics or nurses and we must stop paramedics from thinking they are nurses or physicians. We are who we are and we must accept it. ... And yes... we may have to suffer the pain of knowing that the minimum may be a BA/BS for a paramedic who wants to "practice". We must accept that there will be areas that are served by volunteers. Though I do agree that we should not EVER lessen our standards just because they dont get paid.... after all it was their choice.

I apologize to anyone I may have offended... that is definately not my intent. This topic will be a hot one for many many years.

Nursing in most states is a 2 year program; and there are many 2 year Associate degree paramedic programs with more following.

My program was 1800 hrs, (the equivalent time of two years in college) with that said I also have a four year degree, and truth be told, the Medic was harder, as it was more intensive then when I carried 21 credits in advanced science (Bio, chem., etc), as that was over in 5 months, and I had time to drink beer, while my medic program was 10 months, of 4 days a week of class (not to mention clinical rotations) and I worked as an EMT full time.

But I stray:

I agree this field is in the same disorganized position nursing was 30 years ago, I disagree “we should know our place” and we will never be positioned to demand the same salary as other patient care services.

Hippocratic medicine has long put doctors at the top, this is changing, nursing has come a long way, but is still taught under a completely different system then Doctors, palliative care verses definitive treatment. Unless by obtaining an advance degree (more hours but still working under a doctor’s license) a nurse cannot even give an aspirin in the hospital without a Dr’s OK, there are no “standing protocols” for nurses.

A PA’s training is more like what a Dr goes through, yet it is still 2 years in length. I have long thought this (nursing / medic) was a bad comparison in the first place.

Better is the respiratory therapist, (many examples on this thread, no need to repeat them).

I’ll give you there is a point with the basic EMS curriculum, but I don’t think you find a EMT-B comparing themselves to doctors on this thread (which would be missing the point as well), as most of the posts have been suggesting raising the education standards anyway.

30 years in EMS is an admirable sacrifice, however with all due respect your view is skewed. About 20 years ago, hospitals (because they were failing on a business level), began to hire business people to run them, these folks had a different view point, and the statement “because we’ve always done it that way”, no longer held water. Hospitals have since changed and so have the metrics we measure them by.

I put forth the same is needed in the prehospital field, and change is brewing, but as of yet, it is not organized.

As it is today, Paramedicine has changed from the Johnny and Roy days of calling for a blood pressure, and popping the green vile for the blue patient, to the requirement and practice of real clinical diagnostic skills. The ability to make a judgment on one’s own and effect a treatment for an unassisted diagnosis is required and expected.

Every day we come one step closer to becoming true practitioners, the amount of education required for the advanced Paramedic specialties is enormous, that our pay has not caught up with the responsibility is just a factor of recognition, and a growing symptom for the need for change in how we're viewed as a branch of medicine.

In medical school, they teach prospective doctors what nurses do, they don’t even mention paramedics.

It’s far and away time we were given mention.

Be Safe,

WANTYNU

PS. Still a GREAT first post! Please stay with us. -w

[USCISMEDIC]

I am so pleased that some of you have read my post and replied...!

I must admit that wrote the entry quickly and while being tired... and therefor it may be a little off from what I really meant to say. However, was is clear from all the posts is that the EMS industry has many many dedicated, intelligent and enthusiastic people in it. We all agree to disagree and we agree its messed but... we continue to try.

I will admit that overall for those paid in the industry the pay is poor... from a pure ambulance/EMS perspective. For those of use that sometimes practice our beloved trade within other areas such as law-enforcement, the pay is better. I have been fortunate to have risen through the ranks had the opportunity to see and experience many types of EMS systems.

When I mentioned that we "need to know our place", the comment was made in meant to be in the context of knowing that we are not in the other categories and we cannot parallel them or use them as examples. We are EMS in many forms... and often, many levels of education. PAs as well as nurses have disparate training programs that include 2 year programs (for nurses), 4 and 5 year programs for PAs and RNPs. But what they do have as an advantage is the minimum requirement for post high school formal education. Some states do not honor 4 year PA program grads... so we are alike but not.

Those states that have licensed paramedics have increased over years but still remain fairly unified in the educational requirements (college). Again, not all but many.

Yes, we coming back to education. And... I will be the first to admit that there are many many great EMTs and Paramedics that do not have a college education. I grew up in EMS with a degree...

I continue to regret that I did not get my ass up and into college earlier. Yes, my paramedic program did come with a boat-load of college credit but it was not all that we should have.

I wont go on and one... but I appreciate the opportunity to throw thoughts out to others that have the same goal in mind - EMS Success.

Mike

[VentMedic]

Nursing in most states is a 2 year program; and there are many 2 year Associate degree paramedic programs with more following.

For nursing, the equivalent of a 2 year degree is required. For the paramedic, it is not. Except for a couple of states where the 2 year paramedic degree is required, there is usually the certificate option for the paramedic in the colleges. This also allows the colleges to be competitive in attracting students in areas that have many medic mills.

My program was 1800 hrs, (the equivalent time of two years in college) with that said I also have a four year degree, and truth be told, the Medic was harder, as it was more intensive then when I carried 21 credits in advanced science (Bio, chem., etc), as that was over in 5 months, and I had time to drink beer, while my medic program was 10 months, of 4 days a week of class (not to mention clinical rotations) and I worked as an EMT full time.

There are those that do find college general education and sciences easier than patient care classes. Patient care can be difficult to learn especially if you did not know what what to expect. When you sign up for a math class, math is what you expect. Patient care can be more difficult to grasp when dealing with the complexity of the human body outside of a textbook and when human behavior is involved.

I agree this field is in the same disorganized position nursing was 30 years ago, I disagree “we should know our place” and we will never be positioned to demand the same salary as other patient care services.

Until the education field is leveled, it will be very difficult to petition and position for the same salary. Other healthcare professionals recognized this quickly and spent less time trying to identify with other professionals and more time developing their own identity through education.

Hippocratic medicine has long put doctors at the top, this is changing, nursing has come a long way, but is still taught under a completely different system then Doctors, palliative care verses definitive treatment. Unless by obtaining an advance degree (more hours but still working under a doctor’s license) a nurse cannot even give an aspirin in the hospital without a Dr’s OK, there are no “standing protocols” for nurses.

Have you ever seen the standing orders for RNs inside an ICU, CVICU or even med-surg floor? They can be very impressive. That's not even mentioning the nurses that are on specialty teams both inside and outside of the hospital. Even for in hospital codes or rapid response calls, a physician is not always there. RRTs and RNs get things started with "standing orders or protocols". Almost every licensed healthcare professional inside the hospital has standing orders or protocols written by their medical director to follow whether it is RT, PT or RN. Yes, RNs work under protocols and standing orders written by the Medical Director for their unit.

Paramedics are also not independent contractors and still work under a medical director.

In medical school, they teach prospective doctors what nurses do, they don’t even mention paramedics.

The skills that paramedics possess are not that unique. The out of hospital scene makes the paramedic unique.

Nurses are there for the patient for the long haul. There will be many RN/MD exchange of information during one 12 hr shift and for several days for many patients. Due to the broad range of information and planning of care, it is necessary for MDs to know a little about their patients' primary inhospital caregivers.

[Dustdevil]

When I mentioned that we "need to know our place", the comment was made in meant to be in the context of knowing that we are not in the other categories and we cannot parallel them or use them as examples. We are EMS in many forms... and often, many levels of education.

Welcome Mike. I understood what you originally meant, and I couldn't agree more with you. It's an excellent point. What you are talking about is establishing an identity. After over three decades of working without a plan, we still can't even agree on what our entry level education should be. Considering that, it is positively ludicrous that so many wankers sit around and have a toss over establishing an "Advanced Paramedic Practitioner" level to rival PAs and NPs. Give me a break! Without a foundation, we will never build to that height. But I submit -- and I think that you do too -- that that should never be a goal of EMS. Every job we take that is not EMS, dilutes our purpose and our strength. It dilutes our public image, because it muddies the waters. The more jobs we try and take, the less sure society is of what we do.

I fully agree with you. We do need to know our place. Our place is on the ambulance. It is not in the hospital. It is not in public health clinics. It is not in nursing homes. Until we put down the crack pipe and commit ourselves to concentrating one hundred percent on our prime mission -- EMS -- we are going nowhere. And if we insist on alienating the other health professions by trying to encroach upon their territories, we will never have their support, which we desperately need. THAT is what "knowing our place" means.

[WANTYNU]

Considering that, it is positively ludicrous that so many wankers sit around and have a toss over establishing an "Advanced Paramedic Practitioner" level to rival PAs and NPs. Give me a break! Without a foundation, we will never build to that height. … Every job we take that is not EMS, dilutes our purpose and our strength. It dilutes our public image, because it muddies the waters. The more jobs we try and take, the less sure society is of what we do.

I fully agree with you. We do need to know our place. Our place is on the ambulance. … Until we put down the crack pipe and commit ourselves to concentrating one hundred percent on our prime mission -- EMS -- we are going nowhere. And if we insist on alienating the other health professions by trying to encroach upon their territories, we will never have their support, which we desperately need. THAT is what "knowing our place" means.

We should know our place… ??!?

I usually like your posts, but you missed the side of the barn with this one.

So by your language since I sometimes transport people on a vent, I should have a RT with me, drips, a Doc, or RN, plus there is no need for EMS on tactical teams, USAR or SAR teams, DAT teams, Airports, Transit, or any where there isn’t a transport.

Where is our place? Just on a Bus, then bring back the MVO.

Of all people, you’re a self stated professed history buff, you tell me in the past when the statement “Know you place” is a good thing?

The folks that should “put down the crack pipe” are not the ones talking about establishing a new “level” of practice (requiring a degreed education), it’s the ones who are essentially saying sit-down, shut-up and like what you’re served.

I thought of a lot of ways to respond to this post, and have rewritten it a number of times, to take as much of the rancor out of it as possible, as I said I respect your opinion, but feel very strongly you missed the mark on this one.

On a side note, you have been the author of some the most insightful, thoughtful and intelligent (if not prolific) posts on this sight. But as of late you have taken on a decidedly acidic and negative tone.

You once said you respected my opinion, so please don’t take offence, but nearly 8000 post in 30 months? That works out to nearly 10 a day, every day with no breaks, ever.

I’ve been to Texas a number of times; it’s a beautiful state, put things in perspective get outside and get some sun.

Be Safe,

WANTYNU

[Dustdevil]

We should know our place… ??!?

I usually like your posts, but you missed the side of the barn with this one.

So by your language since I sometimes transport people on a vent, I should have a RT with me, drips, a Doc, or RN, plus there is no need for EMS on tactical teams, USAR or SAR teams, DAT teams, Airports, Transit, or any where there isn’t a transport.

No, I'm afraid you completely misunderstood me, just as Mike was misunderstood. My point was to clarify that misunderstanding, but apparently I failed.

Our place is EMS. EMS is not nursing or Respiratory Therapy any more than it is firefighting. I'm not saying it takes a nurse or RT to perform those functions on the ambulance. Far from it. I am saying that it is OUR domain on the ambulance, but not in the hospital. I am saying that we have no business asserting that commonly heard idiocy of, "well, I'm a paramedic, so I should be allowed to work as an ER nurse because I know more than them!" And similarly, we have no business trying to establish a clinical practitioner level for paramedicine when two other professions already serve that function much better than we could ever hope to.

By saying we should know our place, I was only attempting to clarify what Mike said, using his terminology. Perhaps I would have been clearer if I had changed the terminology and said we need to know our purpose, not our place. And the purpose of EMS is EMS. Until we fulfil that purpose to the best of our abilities, we aren't doing ourselves any favours by trying to branch into other territories. We're only shooting ourselves in the foot and alienating ourselves from the support we desperately need from the other health professions.

I hope that is clearer, because I really don't think that we disagree.

[WANTYNU]

No, I'm afraid you completely misunderstood me, just as Mike was misunderstood. My point was to clarify that misunderstanding, but apparently I failed.

Our place is EMS. EMS is not nursing or Respiratory Therapy any more than it is firefighting. … I am saying that it is OUR domain on the ambulance, but not in the hospital. I am saying that we have no business asserting that commonly heard idiocy of, "well, I'm a paramedic, so I should be allowed to work as an ER nurse because I know more than them!" And similarly, we have no business trying to establish a clinical practitioner level for paramedicine when two other professions already serve that function much better than we could ever hope to.

By saying we should know our place, I was only attempting to clarify what Mike said, using his terminology. Perhaps I would have been clearer if I had changed the terminology and said we need to know our purpose, not our place. And the purpose of EMS is EMS. …

I hope that is clearer, because I really don't think that we disagree.

Ya know, you never fail to surprise me, just when I think you couldn’t be more wrong, I see you couldn’t be more right.

I think you and I are getting hung up on this “Practitioner” wording, as you noted, I also look at the ambulance (may I say Pre hospital setting) as our domain, we need to own it, it is ours and ours alone.

When I say Practitioner I am only trying to raise the descriptive language to that of other fields, as I feel strongly we are a specialty in and of itself.

If my statements were viewed to imply that we start providing non emergency care, let me clarify that home palliative treatment should be left to the visiting nurse services. As for the folks that want to work in the ED, let them take tech or nursing classes, or go to medical school… for me the less time I’m in the ED the better! (did you know there are SICK people in there?)!

Thank you for your post.

Be Safe,

WANTYNU

[WANTYNU]

Wow, OK, well then first you should know I read and like your posts, I always find them educated and well informed, however I’m not sure what you’re saying here, it seems except for a couple of statements, we basically agree, and where we don’t, you’re entitled to you opinion as I am mine.

For nursing, the equivalent of a 2 year degree is required. For the paramedic, it is not. Except for a couple of states where the 2 year paramedic degree is required, there is usually the certificate option for the paramedic in the colleges. This also allows the colleges to be competitive in attracting students in areas that have many medic mills.

I think we’re in agreement here, as I’m not talking about what is not, but what is, as in you can compare one two year associates degree with another, in both quality and substance.

This is about the only statement you’ve made that I find potentially insulting, so I blame myself for reading it wrong, I’m not sure what you saying here, are you saying College is easy?

Do you have a degree?

Are you making the assumption that all studies are equal?

The average semester is composed of 4 or 5 subjects carrying between 12 and 16 credits, 21 credits was 7 subjects not all didactic. Still a student spends 20 -30 hours a week in the classroom.

My medic program was 20 hours didactic, 16 to 32 clinical per week not counting extra time spent in the ED and OR practicing skills. Add to that a full time 40 hour job, and that’s a minimum of an 80 hour week, every week, for 10 months.

In truth the easiest part was the patient care.

Again, I think we agree here.

Yes I have, and these are customized per patient, by the treating doctor, they are not based on a RN or RT diagnosis , as I stated earlier, only the doctor can make a diagnosis in a hospital. However Paramedics are required to do so, outside the hospital (this is a crucial difference).

I don’t argue this point, as we are limited to our treatment by our standing orders, as it should be, as we are not doctors, however, the variance in what we can do county to county much less State to State is an issue that needs resolution.

So I don’t see a disagreement here.

Again, I think we agree here. I’m only saying the insight we bring into the hospital with the patient is often overlooked, as the connection is not made that we first see the patient as they are, in a neat well cared for environment or filthy and unkempt or noncompliant with a treatment regime, was the trauma thrown, of safely buckled in with no glass breakage nor deployed airbags?

We can complete the picture, if asked, that does affect patient care.