Dissapointment

[Eydawn]

You don't save a partner or correct their mistake *by virtue of being an EMT-Basic*. You save your partner by being an alert human being with some grasp of how medicine should be performed. The further your education has gone and the better grasp you have of medicine, the more likely you are to spot the subtle (but still potentially detrimental or lethal) mistakes that your partner may be making. Many people catch the big stuff. It's the little stuff that can kill you....

Incompetence exists at all levels of training, experience and education. Plenty of medics correct their basic partners and their fellow medic partners, just as much as basics correct other basics and medics.

And yes, as stunning as it may seem, there may be instances in which an EMT-Basic may have a little bit more information than an EMT-Paramedic about something. I don't think it is the rule by any means, but anything is possible and can happen --don't we all know that by now? Doesn't mean it is the rule concerning Basic/Paramedic teams.

Basics need to accept their limited scope of practice, and if they are frustrated with it, they need to pursue further education instead of insisting that their scope be widened. Further ability comes with further understanding and education. At least, that is the way it is supposed to work... right?

I am personally ok with being a basic right now. And I do have some good anat/phys to help me out with that, so I am slightly ahead of the curve. I wouldn't dare touch the medic's drug box except to help grab something and help verify the 5 R's of administration-- I know better. It's way easier to kill people than to "save" them.... and until I know more about what I'm doing, I'm ok with being a cot fetcher and splinter puller extraordinaire because that is what I have been trained to do.

Wendy

CO EMT-B

[Dustdevil]

At this point, "your" paramedic is spoiling you to the degree, that in your mind you feel you are already to the paramedic level, and feel no need for furthering yourself and your career to obtaining the paramedic credentials.

Oooh! Excellent point! One I don't recall ever being discussed here too. How guilty are we of fostering this attitude in EMTs by coddling them and blowing smoke up their arses to make them feel good about themselves? This sounds like a really bad hold-over from the current state of public education. "There are no losers. Everybody's a winner! No grades. No scores. I'm ok. You're ok." What a load of shyte.

This is all starting to make a lot more sense now, thanks to Risky's visionary observation! No wonder so many people come here and are totally shocked that anybody would not pat them on the back and congratulate their awesomeness for completing three weeks of night school. They've been raised to believe that everything they do is worthy of a party and a raise in their allowance. And we're enabling them by being nice to them.

No more Mr. Nice Guy! :twisted:

[Asysin2leads]

This is all starting to make a lot more sense now, thanks to Risky's visionary observation! No wonder so many people come here and are totally shocked that anybody would not pat them on the back and congratulate their awesomeness for completing three weeks of night school. They've been raised to believe that everything they do is worthy of a party and a raise in their allowance. And we're enabling them by being nice to them.

No more Mr. Nice Guy! :twisted:

If you've been fed blue pills all your life, the red one becomes very hard to swallow. Oooh, I gotta write that one down...

[tniuqs]

Just because I like the tangent this thread is taking.....I am going to play devil's advocate.

Please, anyone, provide specific examples so we may learn from it and be proven wrong

AK: I have saved your ass SO many times, but then that is my "volunteer job" as an unpaid helper to a Village Idiot. :twisted:

Yes, I too would love to hear the story of just how a EMT basic has "SAVED" a Paramedics ass, there is that "Saved" word again, omg PLEASE explain. I am getting a wee bit postal myself now as Asysin2leads and Ruffems sooo just when does the squinting stop? Granted there are minor errors in judgement made at every level, but really Jen if this is occurring on a regular basis then VERY serious questions in regards to the competence of that "individual" Paramedic need to be addressed and not a general commentary that EMTs routinely assist in treatment modalities in patient care, so please stop the smoke, its tickling me arse.

Bottom Line: an EMT is trained to be a linear thinker and that is not a bash in anyway shape or form, it has to be this way for "standards of care" with clear definitions as to scope of practice. In the Critical Thinker it is essential that a good solid grasp of physiology and pathophysilogy and current practices in medicine, hence ALCS.

For example the EMT mantra: NEVER give Entonox to a abdo pain, I came across this one just the other day, so then ....... "labour is abdo pain" I said to my EMT ? Don't jump on me just yet as "absolute" contraindications @ the EMT level ie (abdo pain) can be "relative" contraindications on the Paramedic level.... and this Entonox administration is NOT a new thread ...just an example. (If some one wishes to debate this I would be more than pleased to present 20 + studies, pro and con, granted I haven't used Entonox in 5 years...I have way bigger guns than that but dependant on the circumstance it just might be the right treatment to implement)

Oooh! Excellent point! One I don't recall ever being discussed here too. How guilty are we of fostering this attitude in EMTs by coddling them and blowing smoke up their arses to make them feel good about themselves? This sounds like a really bad hold-over from the current state of public education. "There are no losers. Everybody's a winner! No grades. No scores. I'm ok. You're ok." What a load of shyte. (edited for clever sarcasm

No more Mr. Nice Guy!

Dust: I too have made this error to by allowing a junior team member on whatever level to somehow believe that they are an equal partnership, an attempt to empowering that individual to feel a part of the team, "empowering" them has bite me in the ass on more than one occasion. NOW My word is the end all and be all on all call's, any disagreement and NO more MR NICE GUY. ps I stomp on bugs too. The entire concept of team building is really "nice" a warm, soft and a fuzzy logic so to speek, BUT the pecking order ( it works for chickens ) just has to be established from the start as there always HAS to be a TEAM LEADER. Ever hear in the military....ok all you privates lets talk about this and see what we can agree on to take this hill !

Bottom line as the buck stops at my ASS, it is not my helpers practice permit that is at risk its MINE!

Somehow standing in a courtroom somewhere 'I just can't hear myself saying (Your Honour my "helper" told me to do it that way).

For those that actually believe that they are saving a Paramedics ass on a routine basis .......... PLEASE get a grip on reality.

If you would have read what I put...I basically ride as an extra pair of hands on the already staffed PAID ALS service. I don't take their shifts, I don't work the ambulance alone, or give extra hands for coverage if they are short. ......... sniped for brevity.

AMESEMT

Back on the real topic: After reading this it becomes very clear, you are not volunteering at all ! Your just not being financially reimbursed to advance yourself in the ALS experience and the more exposure you have to the good, the bad, and the ugly the better you will become, kudos, many folks out there would call this an unpaid clinical or practicum.

That said: the individuals that offer there ideas and experiences to advance the profession on EMTCITY, We are all volunteers .......... So why do I feel impending doom?

In Closing:

I firmly believe that EMS is an essential service world wide and to those that Volunteer to staff a service "even in snowshoe" you have real power in the "threat of withdrawl of services" this is a grass roots movement and it is successfully changing in many communities to reimburse those that have the dedication to protect the public's interest.

cheers

[Dustdevil]

I firmly believe that EMS is an essential service world wide and to those that Volunteer to staff a service "even in snowshoe" you have real power in the "threat of withdrawl of services" this is a grass roots movement and it is successfully changing in many communities to reimburse those that have the dedication to protect the public's interest.

This alludes to a point that most of these vollies don't want to admit. That is, they are not doing it for the community. They are doing it for themselves. They are not doing it because they want their neighbours to have quality EMS available. They are doing it because they want to be the one providing EMS, even if somebody else could do it better. This whole thing about "giving back" to the community is such a load. I've watched many volunteer fire and EMS services shut down and go paid. Not once have I ever seen any of those volunteers take their volunteer spirit down the road to the public library to put away books, to the parks department to mow grass, to the city hall to answer phones, to the sanitation department to pick up trash, to the school district to drive buses, or to the city garage to wash cars and change oil. Wait... what happened to that volunteer spirit? What happened to all that concern for giving back to the community? If you were so concerned about your neighbours having EMS, then why did you fight the city plan to go paid at every council meeting for three months? And if it is all about YOUR community, why are you now driving ten miles to the next fire district to volunteer?

The first time I see a volunteer EMT volunteer to go be a janitor at the courthouse for free, so the janitor's salary can be used to hire a full-time professional Paramedic, I'll bow down and praise his volunteer spirit and true devotion to "giving back" to his community to assure they have essential services. That would be a man worthy of my deepest respect and admiration. That would be a man who could honestly say, "I am giving back to my community because I want them to have quality EMS care" without being a lying narcissist. But, other than that one elusive altruist, each and every one of them is either incredibly naive, incredibly stupid, or incredibly selfish. That's why I would never hire a single one of them.

[Ridryder 911]

AMEN! .. whoops!.. :oops:

R/r 911

[FredG]

This alludes to a point that most of these vollies don't want to admit. That is, they are not doing it for the community. They are doing it for themselves. They are not doing it because they want their neighbours to have quality EMS available. They are doing it because they want to be the one providing EMS, even if somebody else could do it better. This whole thing about "giving back" to the community is such a load.

The first time I see a volunteer EMT volunteer to go be a janitor at the courthouse for free, so the janitor's salary can be used to hire a full-time professional Paramedic, I'll bow down and praise his volunteer spirit and true devotion to "giving back" to his community to assure they have essential services. That would be a man worthy of my deepest respect and admiration. That would be a man who could honestly say, "I am giving back to my community because I want them to have quality EMS care" without being a lying narcissist. But, other than that one elusive altruist, each and every one of them is either incredibly naive, incredibly stupid, or incredibly selfish. That's why I would never hire a single one of them.

I beg to differ with you. Most of the volunteers that I know are involved in multiple community services. Personally, I serve on the board fo Directors of our Local Development Corp. I know other EMS/FD volunteers that volunteer to serve meals to the elderly, volunteer their time to repair community buildings, volunteer to help run the local community festivals, volunteer to staff local historical societies, etc. I would say that between 30% and 50% of the volunteer EMS providers I know are involved in other volunteer community based activities. Many people that have the "volunteer" spirit will volunteer where they think they will do the most good and can put their skills or talents to best use.

On the topic of switching to a paid service, some of the comments that have been made here has gotten me thinking about the possibilities in my region and potential outcomes. Now that i have given it some more serious thought, one question keeps coming to mind... Why should I, or any other EMS provider, in a volunteer service spend time trying to convert to a paid service when the going salary is just above minimum wage?

Yes, I know your argument about the volunteers causing the salaries to be lower, but I don't buy that it is the biggest problem facing EMS. Look at the NEMSA/AMR thread about Portland's attempt to get salary on par with other regions. If the EMS unions cannot support EMS provider attempts to get some parity on salary and other EMS providers do not support the effort (as exemplified by some of the comments in that thread), what will converting rural volunteer services to paid do for salaries? As far as I can tell, there are no volunteer EMS services in the Portland area, in fact, the AMR contract seems to cover EMS for several counties! So, the "volunteer effect" should be minimal there. And, the 3 cities mentioned are similar in size, so the cost of living should not be great enough to justify a 5k or 15k difference in base salary.

Getting back to my local area, the salaries in EMS in the two closest cities start at $8 per hour, regardless of experience (and they are union!). I do not consider that a living wage and cannot, in good conscience, put anybody in the position of having to accept such a low salary that it would essentially be poverty level and that I, personally, would not accept. Keep in mind that the current poverty level according to HHS for a family of 3 is $17,170 (http://aspe.hhs.gov/poverty/07poverty.shtml), so working a 40 hour workweek at $8/hr (about $16, 885/yr) is under that threshold.

I also realize that local government officials will press for salary parity with the nearby cities.

If paid EMS is destined to become a job that can be turned into a career that everybody could live on, then salary increases must be seen. If you want to help convert volunteer services to paid, the paid providers must prove they are willing to step up to the plate and ask for more money. Knowing politicians, rural departments will most likely be mandated to base their salaries on comparisons with the nearest cities with paid services, then go a bit lower that that.

I know it is a Catch-22, but look at it from a volunteer service point of view. Why should we go through the process of fighting politicians, educating the public, then go through the pain of creating/restructuring the department and getting a new CON (which in NYS can be a 2+ year process), when in the end, we will most likely be forced to lowball the salary and likely get lesser qualified candidates? If there was a snowball's chance in hell of getting base salaries for EMT-Bs close to the 30K per year mark, then I can see the effort being worth it.

Several of you have made your point over and over again about not liking volunteer services. You (especially Dust) have made me think long and hard about this and even think about what I may be able to do from my little rural area. Please stop throwing the volly thing into so many threads, these anti-volly and anti-BLS posts distract a lot from the other posts and threads that discuss other issues. Overall, it gives this site a negative feel, which is a shame because there are so many good topics that have been discussed.

[tniuqs]

Several of you have made your point over and over again about not liking volunteer services. You (especially Dust) have made me think long and hard about this and even think about what I may be able to do from my little rural area. Please stop throwing the volly thing into so many threads, these anti-volly and anti-BLS posts distract a lot from the other posts and threads that discuss other issues. Overall, it gives this site a negative feel, which is a shame because there are so many good topics that have been discussed.

An interesting post and very informed alternative view, but your talking pocket change Not a Concept:

THE bottom line remains that the "ESSENTIALITY" of ALS Ambulance Operations is NEVER debated. So why is just the volunteerism from you folks down south debated at nauseam, I think your barking up the wrong tree entirely ! Yes, it is a factor in slowing the development of EMS granted but it is not surmountable, perhaps the first baby step, put it into the bigger playing field.

So just for terms of reference/ comparison, just try paying the local Sheriff below poverty line and see what happens to your communities.

Seriously: if I were a Volunteer and was offered any/some form of reimbursement for my time (on whatever level) I would be very pleased to augment any other income that I may have, its a start, but again that these Volley services are Essential to the welfare of the community and continues to go financially unnoticed ? Why do some states differ so radically? ps unfortunatly It happens here too.

Even those that rely on Volunteers here receive "honorariums or tax breaks" granted a pittance but all in all a reward of some kind. Is it Socialism vs. Capitalism ? If that were the case then in theory you would be well paid for these essential services in the US. Now please don't get all crazy loonie on me and associate Socialism with Communism.... ONE is an economic state and One is a ideology, you Yanks get all heated under the collar with that type of stuff.... I can debate for hours and days the political science on this topic.... and I am not trying to hijack a thread here, I am not comparing counties either this is intended as a conceptual change in thinking only, EMS spans ALL borders.

I do commend those that would further and support their communities in all of the other ways you mention, in Canada we are wholly dependant for Vollies in so many areas, just yesterday $250,000 was raised in one day for advancing literacy, over 2000 folks in one community alone volunteered to read to kids. Seriously, I think that in part defines our Country not saying you Yanks don't, but no where near the same level, these are serious cultural differences just across the undefended border.

BUT there is very, very few Volunteer Ambulance Operations HERE so just why is that then?

Yes true and unfortunately even in my "Country" in the majority of cases EMS Operations are the Bastard Son of Health Care, i.e. underfunded, and NOT identified as an ESSENTIAL SERVICE.

EMS IN THE PAST just transport to the Hospital, i.e. ( I just love this phrase....rushed to Hospital ) or between facilities, but things can and do change, how about: The Paramedics rushed to the scene and stabilized the patient enroute....an entire attidude change is what is required.

Now with the capabilities of actual treatment for the ALS provider i.e. stabilization of the cardiac patient, pacing, thrombolytics "they have put thrombolytics on Car in the UK in many places !" Treatment for 5 types of shock, the Asthmatic, shall I go on....nope. Point being that moving on down the road ALS Paramedics are making positive impact in decreasing mortality/ morbidity, so your saying that the status quo is acceptable ? If good reliable studies and research can PROVE this then ..... the door becomes unlocked persay, fight the right fight, I say.

Why, say in large communities is ALS mandated and the Rural areas frequently forgotten, because I surmise that the volunteer service are in their happy place believing they are doing the right thing ? Simply BALDERDASH as these are the areas that can benefit the most when transport to Hospital is the longest... Good Gawd MAN we have it ass backwards!

Dare to challenge the politicians, and that they could be held accountable for not taking steps to provide the best "standard" care available, put the thought in their heads that a "wrongful death suit" or the politicians were not "duly diligent" in proving standard ALS care to their communities, change the way they think, fear is a great motivator, Then again we do have a the trump card.....its called preserving LIFE!

A communications Professor I had really changed my way of thinking when he introduced this concept to me:

IF YOU CONTINUE TO THINK THE WAY YOU HAVE THOUGHT.

YOU WILL CONTINUE TO GET WHAT YOU HAVE ALWAYS GOT.

IS IT ENOUGH ?

yes a bit cliché's,

one can day dream or take action

cheers

[FredG]

So just for terms of reference/ comparison, just try paying the local Sheriff below poverty line and see what happens to your communities.

I agree. The difference is that law enforcement has a strong lobby and a solid salary history. EMS does not.

EMS IN THE PAST just transport to the Hospital, i.e. ( I just love this phrase....rushed to Hospital ) or between facilities, but things can and do change, how about: The Paramedics rushed to the scene and stabilized the patient enroute....an entire attidude change is what is required.

Again, I agree. The general public only knows what they see on TV. You very rarely see advanced skills being done by EMS providers on TV or in the movies.

Why, say in large communities is ALS mandated and the Rural areas frequently forgotten, because I surmise that the volunteer service are in their happy place believing they are doing the right thing ? Simply BALDERDASH as these are the areas that can benefit the most when transport to Hospital is the longest... Good Gawd MAN we have it ass backwards!

In my region we have paid ALS fly cars with volunteer services providing BLS ambulances. I would say 90+% of our ALS criteria calls get ALS either on site or intercept and they are dispatched simultaneously with the BLS rig if the call info meets criteria. We also have access to ALS helicopter services, if necessary. So, the quality of care and response times are generally good and there is very little legal risk due to not providing necessary services.

I consider ALS intercept capability a minimum requirement for rural areas.

[tniuqs]

An ALS tiered response then ?

Triaged by whom....a dispatcher with a crystal ball?

This is NOT a cost effective "in most areas" it is redundant, so explain to me why not put the Paramedic on the Truck ?

Running another truck and a second party providing service when other's are not reimbursed for their time looks clear to me that its a rip off, no brainer.

I believe with this information you provide, I do think your being dupped into believing this is a good thing for the longevity of essential care for your community.

cheers... yet confused

I agree. The difference is that law enforcement has a strong lobby and a solid salary history. EMS does not.

Best get after it I say!