In Your Opinion, What Is Holding USA EMS Back?

[Blue Goose]

The paradigm of EMS is the single biggest contributor to our decline. Merriam-Webster defines paradigm as “example, pattern; especially: an outstandingly clear or typical example or archetype.” We are seen as not being a separate profession by much of the public and many of the EMTs out there. A few of the reasons I could think of:

Education. It’s been discussed enough here not to warrant any further mention.

The fire departments: where I grew up, ambulance service was provided by the local fire department if you called 911 or by a private company if you called them. Given that most people’s interaction with EMS was through 911, it is believed by many that all “real paramedics” are firefighters primarily, and medical care is just part of the job, while those employed by the private services are simply “ambulance drivers.” Although I was disappointed that many don’t believe EMS is a separate profession, I can understand why. To create an EMS department that handled fire suppression on the side would only transfer the problem to the firefighters, and as good of an idea as this sounds, separate departments is the most effective.

Volunteers: like the firefighters, as long as people continue doing EMS in addition to a real job, we will not be recognized as a profession.

Our name: EMS; Emergency Medical Services, has defined what many in our field think that we should provide: medical care in times of emergency. It’s funny, the last time I read that, transportation was not written anywhere in there, yet is somehow an expectation of EMS. Somehow or another the terms EMS and ambulance transportation have become synonymous and one who provides EMS is also expected to provide ambulance service and vice-versa. We need a name that accurately reflects our purpose.

Lights and sirens: having them and using them on an ambulance only reinforces the image of us as public safety, rather than health care professionals. I’ve never seen an air ambulance with a light bar, and only regarded them higher for it. I firmly believe that removing them from ambulances would be one of the best ways to help us become a true health care profession.

[Dustdevil]

:shock:

Damn, Goose! Where you been?

Plus 10 for another serious, Holy-Mother-of-Jesus-quality post!

Can we count on you coming back in another three months with more words of wisdom, or can you stick around for awhile this time?

[spenac]

When I started this thread being forced to act as a Taxi was one of the biggest things holding us back. Since many sunrises and sunsets have passed I think as Dust basically says the whole thing is busted. Shut it all down. We have way to many idiots in the field.

[unknown]

=D>

I agree with Dust, I am very impressed with what Blue Goose had to say. Its all too true. To many warm bodies filling vacant slots.

Oh if you only could have heard the fiasco I heard today......

[zippyRN]

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.

except many nurses don't work in controlled environments nor in hospitals ...

the Emergency Department is not a controlled environment

home health, Primary care, Occupational health ( and response roles attached to OH), military, event medicine doesn't occur in the hospital

<snip>

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.

as can be seen world wide with community first response models and the use of the voluntary sector in specific supprting roles to a paid professional service...

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?

through local and national taxation in most cases on a world wide developed world view...

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.

event licencing needs an equivalent tothe Uk para 712 of the purple guide which tells event organisers that their event must not adversely impact o nthe routine emergency services and hospital Emergency department cover offered to the local population

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.

which is how many services world wide achieve their degree level entry qualification for Paramedics ... there is space for a vocationally trained assistant grade ... but this assistant still needs more training and education than the 110 hour glorified first aid course that is the US federal minimum for EMTs...

<snip>

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.

ever heard of 'FIRST DO NO HARM' a cavalier attitude to wards oxygen therapy in patients with COPD can result in someone requiring a cirticla care admission rather than a ward admission or prolonging their ward admission to deal with the sequalae of their deranged blood gases all becasue some glorified first aider with a nice big patch belived 'oxygen doesn't do any harm '

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.

this is what holds US EMS back ... where elsewhere in the world EMS is part of a continuum of Emergency care and there are few clear lines in the sand of 'ambulance man jobs' 'nurse jobs' and 'doctor jobs'

[VentMedic]

Many would wither without their light bars and sirens. But, the confident and competent would survive.

[WANTYNU]

There are a lot of great arguments here defining the separate problems within and surrounding EMS, not to be repetitive but the Hippocratic practice puts the “DOCTOR” at the top of the food chain, until that is dissolved, nothing in the hospital or prehospital setting will change.

Several old jokes come to mind that exemplifies this point, Why don’t doctors worry? A: they can bury their mistakes (Ours are QC’d to death….) .

What do you call someone who just graduated last in their class at medical school? A: Doctor…

But back to the question that started this thread, what is wrong with EMS?

WE ARE ALL VICTIMS OF IDENTITY THEFT, and don’t know who we are, there are Cop / EMS, Firefighter / EMS, Volunteer EMS, along with a host of striations within our own profession that we can’t even clearly define.

WE ARE FRACTURED, we as a group, are not a group.

I’ve said this before: “WE HAVE GOT TO STOP EATING OUR YOUNG” , the inrank fighting has got to stop.

Until we can speak as ONE voice nationwide, will not be listened to, the standards from County to County much less from State to State are a joke.

On a side, a few years ago, an EMT in NYC was arrested for carrying a shield into a federal courthouse (accused of impersonating a police officer), after many months of petitioning the state DOH (which clearly states not to use the state issued EMT certification card as ID, and TO USE a patch or SHIELD on a uniform as ID of function and rank), the STATE DOCTOR in charge refused to issue a letter that it was a State accepted practice to carry a shield (as many of us do), and in essence left this EMT to sway in the wind. Forget the state they don’t have your back.

State control keeps us fractured.

It was stated earlier that we must involve ourselves in the government process, not on a local level, but on a national level, lawmakers must be lobbied to change policy.

Municipalities must PAY for our services, to steal a phrase “Why buy the cow, when you get the milk for free?” as long as there are those that will do this work for free, we will never be able to raise the standards under which we practice. There is no such thing as the professional amateur. The public needs to be educated that there is a difference.

Here is a radical thought: everyone joins one organization, this organization BUYS the national registry (Hey everything’s for sale, and it is the budding universal standard), since this organization then speaks for all EMS nationwide, policy makers are lobbied and policy is changed making the national registry the standard across all states, now raise the bar, require a college degree to become a medic, require ALL EMS systems to have PAID PROFESSIONAL medics for their service.

Govern the standards nationwide so the PUBLIC would be outraged if they found out they were getting less then this “STANDARD OF CARE”.

Run ads educating the public as to just what emergency medicine is, and why prehospital care is the first and most important step in the medical chain that saves lives (Hey could we get a J&J commercial here?).

Tell the Fire department to work on its own problems, (if fires are decreasing, retrain for something else but leave the medical calls to the professionals…)

And last we need to be inclusive, not exclusive, if someone is not working to the “standard” train them, remediate them, if they can’t carry the load, they’ll quit on their own.

But until we work as one, we will be picked off one by one and treated like dirt, and paid low wages forever.

As always IMHO.

Be Safe,

WANTYNU

Lights and sirens: having them and using them on an ambulance only reinforces the image of us as public safety, rather than health care professionals. I’ve never seen an air ambulance with a light bar, and only regarded them higher for it. I firmly believe that removing them from ambulances would be one of the best ways to help us become a true health care profession.

PS: this might work in the big country, where the highways are wide, and traffic sparse, but in an urban environment, when the only viable treatment is an operating room, and the taxis stop in front of you to drop their fairs, and the oncoming lane is the only free drive, you’d be crazy not to have them… -w

[WANTYNU]

WE ARE ALL VICTIMS OF IDENTITY THEFT, and don’t know who we are, there are Cop / EMS, Firefighter / EMS, Volunteer EMS, along with a host of striations within our own profession that we can’t even clearly define.

I meant to add this into the above post, it was late, I had just finished a double, please forgive me here:

From a previous post, to clarify the above statement:

PERCEPTION IS EVERYTHING.

UNITED WE STAND, DIVIDED WE’RE AMBULANCE DRIVERS…

How many people do you know that are firefighter / EMS and refer to themselves only as firefighters? That’s because the public UNDERSTANDS what a fire fighter is, EMT / Paramedic / EMT – CC / EMT – I / CFR it’s a moving target.

Be Safe,

WANTYNU

[firedoc5]

This is an outstanding topic. But a bit overwhelming to completely address.

I'm not positive but I had once heard that in the mid-late '60's when the idea of actually having an EMS system, it was first proposed to those governing nursing to have it as an extension of their profession. It was shot down due to the concerns of working outside the hospital or clinical setting. I've been told that EMS was conceived in Chicago, L.A., Seattle, or Baltimore. So I have no idea where it originated. So since the nursing profession declined it was proposed to the Fire and Police services, and to city governments to come up with a solution.

I could be totally wrong but that was the history I was told.

Personally, I think it was a great concept there was but no precedent on how to carry it out. So along the way it was trial and error. They looked around the country and saw what did and did not work and tried to incorporated the best results and tried to standardize it. But some states and cities went with what worked best with their systems. What worked great for one system didn't necessarily work for another. So that is one reason why a national standard, like nursing, was not developed and accepted by all systems. Perhaps that is one reason the profession has not advanced more quickly and efficiently. Clear as mud?

But like I said, I could be wrong. :roll: Please don't hit me. :boxing:

[scott33]

How many people do you know that are firefighter / EMS and refer to themselves only as firefighters? That’s because the public UNDERSTANDS what a fire fighter is, EMT / Paramedic / EMT – CC / EMT – I / CFR it’s a moving target.

This is a very good point