Is EMT/PHEMS Seen As "Low Hanging Fruit"?

[ExpatMedic0]

Some valid arguments, and to get back on topic... I think EMS has some great people in it(not the majority, sorry folks), some are really bright and caring, and just overall outstanding people. I have met some medics who could easily become doctors or PA's, and unfortunately the best of them often do. If we want EMS to truly become something better than "low hanging fruit", the entire healthcare system in the United States has to change to open up doors for EMS like they have in place like Australia, the UK, ect...
I have a problem being overly optimistic for EMS, but I do believe American EMS has a fighting chance to catch up with the rest of the developed world if the healthcare system and reimbursement continues to take a different shape, and as IFT said, the older generation of upper management/working class good ol boys, needs to die off and be replaced by properly educated and trained individuals.

 

[Carlos Danger]

OBSERVATION: prehospital EMS (PHEMS) is flooded with low-paying jobs and low-paid or volunteer workers. (There are some exceptions but I think many are linked to firefighting unions).

Personally, I think the firefighting unions (and the volunteers and nurses) have a much smaller impact on wages than they are often blamed for. Wages in any industry are paid based on the value of the work performed and the supply vs. demand for qualified labor. Unions and politics can certainly affect that, but only locally. Wages in EMS are low everywhere in the US, even in areas without a strong Fire/EMS presence.

There is just not much money to go around in prehospital medical transport.

QUESTIONS:
1. Why do people still flock to this field for work?
a. Is it primarily because it is relatively cheap and fast to get in?

Yes. Whether a person wants to get into healthcare or public safety, EMS is the easiest way to get your foot in the door.

160 hour class and you are practically guaranteed a job (in many places, anyway).

 

[toxik153]

Why is everyone so negative damn man.

 

[ExpatMedic0]

I am not trying to be negative, I think EMS is great and that is why I am still involved with it. However, American EMS is in serious need of an overhaul and its disgraceful compared to the rest of the developed world. I would think anyone who truly loves EMS would be an advocate for its improvement.

 

[Carlos Danger]

I am not trying to be negative, I think EMS is great and that is why I am still involved with it. However, American EMS is in serious need of an overhaul and its disgraceful compared to the rest of the developed world. I would think anyone who truly loves EMS would be an advocate for its improvement.

I don't know about all that.

Yes there are a lot of problems in American EMS. We need higher education and quality standards and need to be quicker to incorporate clinical evidence into our practice. We need to stop pretending that a few-hour certification course makes us something we aren't. Some standardization of delivery models and licensure from state to state and region to region would be nice, as well.

However, I see no reason why our system needs to look like the ones in Europe or Canada. I don't think we need anesthesiologist-staffed ambulances, or paramedics to provide primary care. We don't need the added redundancy or cost, and as long as the vast majority of prehospital transports can already be safely done at a level (BLS) of training below what paramedics possess, we don't need to drastically increase the training of those that respond by adding critical care physicians or requiring a graduate education to practice as a paramedic.

Our basic model is a good template, I think. EMT's providing basic emergency care and paramedics providing a higher level of emergency care. Those with real critical care experience (ICU RN's or RRT's) added to the transport team for critical care transports. Primary care provided by physicians and midlevels.

Our system has lots and lots of room for improvement, to be sure, but I don't think it needs to look drastically different than it does now.

 

[toxik153]

I'm a major advocate for a new improved ems. I truly believe it's a great field and needs to be used appropriately and efficiently.

 

[rescue1]

Personally, I think the firefighting unions (and the volunteers and nurses) have a much smaller impact on wages than they are often blamed for. Wages in any industry are paid based on the value of the work performed and the supply vs. demand for qualified labor. Unions and politics can certainly affect that, but only locally. Wages in EMS are low everywhere in the US, even in areas without a strong Fire/EMS presence.

Since EMS is such a local thing, it makes sense that national pressure doesn't have a huge impact on local salaries, especially since most people are less willing to relocate for EMS jobs (as opposed to fire jobs).
But I think it would hold up to say that EMS that's affiliated with the IAFF, usually by behind a fire/EMS department is paid better then EMS that is non-union or single role. But to be fair, it's easy to justify a higher salary for a dual role position.

I also don't think having a well paid FD and a poorly paid EMS service, like LA County, is because of the firefighters are running off with all the cash, especially since the EMS companies get most of their profit through billing, not municipal funding.

I'm not sure what point I'm trying to make here, my brain is fried from organic chemistry.

 

[toxik153]

Does anybody here feel ems and fire rescue need to be separate? I think that it would be appropriate. You'd have people dedicated to single purposes and allows them to be highly proficient in that.

Yesterday I had a call where my patient had a hx of hip fracture and pain. We had to call for rescue due to his unstable vitals and also waiting for an ALS unit would've taken too long. They came in and just ripped this dude out of his bed while he was screaming and didn't place him back on the NRB I placed prior to. Basically they just treated the patient with no sense of care. Now I don't mean that all fire/ems guys are like that, but with the experiences I've had with them it's been all negative.

Most of the guys I work with are very ems knowledgeable and good at their work and really love it. I would really love to do have the system in that way, I personally want to be a medic, not a fire fighter.

 

[Carlos Danger]

I'm not sure what point I'm trying to make here, my brain is fried from organic chemistry.

I'm just saying that I disagree with folks who say that "EMS is low-paid because of the IAFF", or "EMS is low paid because of volunteers", or my favorite, "EMS is low paid because it doesn't require licensure or a degree".

EMS is low-paid primarily because of 2 reasons:

- There just isn't much money to be made in medical transport, especially 911. If a private EMS agency isn't making much money, then they can't pay much.
- Because EMS requires little training, there is usually a large supply of applicants relative to the available positions, which tips the labor supply:demand in the favor of employers.

Reliance on volunteers can reduce the number of available paid positions but probably doesn't have much affect on wages. Even if wages are affected in an area where there are a lot of volunteers, there are many areas where volunteers don't exist and wages are still low, so the existence of volunteers is an insufficient explanation for the industry-wide low wages in EMS.

The exception, of course, is municipal services. Whether fire-based or not, they tend to pay better because salaries are subsidized by taxpayers rather than just based on whatever billing and contracts the company can secure.

 

[CFal]

I don't know about all that.

Yes there are a lot of problems in American EMS. We need higher education and quality standards and need to be quicker to incorporate clinical evidence into our practice. We need to stop pretending that a few-hour certification course makes us something we aren't. Some standardization of delivery models and licensure from state to state and region to region would be nice, as well.

However, I see no reason why our system needs to look like the ones in Europe or Canada. I don't think we need anesthesiologist-staffed ambulances, or paramedics to provide primary care. We don't need the added redundancy or cost, and as long as the vast majority of prehospital transports can already be safely done at a level (BLS) of training below what paramedics possess, we don't need to drastically increase the training of those that respond by adding critical care physicians or requiring a graduate education to practice as a paramedic.

Our basic model is a good template, I think. EMT's providing basic emergency care and paramedics providing a higher level of emergency care. Those with real critical care experience (ICU RN's or RRT's) added to the transport team for critical care transports. Primary care provided by physicians and midlevels.

Our system has lots and lots of room for improvement, to be sure, but I don't think it needs to look drastically different than it does now.

There are also negatives to the Franco-German model, Docs on board start doing more than they need to on board and when a complication comes up because of it they are screwed because they don't have full ER resources.

 

[unleashedfury]

OBSERVATION: prehospital EMS (PHEMS) is flooded with low-paying jobs and low-paid or volunteer workers. (There are some exceptions but I think many are linked to firefighting unions).

QUESTIONS:
1. Why do people still flock to this field for work?
a. Is it primarily because it is relatively cheap and fast to get in?
b. Looking for excitement and glory?
c. Trying to put volunteer or military experience to work because it seems to be their best shot at a career?

people flock to this field for work for one of 3 reasons from my experience. there is the few that quite frankly love what they do, they enjoy being on the streets and providing patient care. Others are looking for a job that helps them as they advance their careers PA school, med school, or even BSN's. Then there is the ones who are looking for the glory of watching way to much TV and thinking that every call is going to be like the two ladies on Chicago Fire getting to go on shootings crazy accidents and unique medical calls. There is also the fact that the world of PHEMS which is easier to get started in 5 months of Basic school or One year of paramedic school.

2. Does this support any future for advancement of PHEMS towards truly professional level and the perks (pay, benefits, help with working conditions)?Advancements in EMS will occur when some of the dinosaurs finally leave the field. There are many that are pushing for advancement but there are the ones that are the "good ol boys" that remember riding the Cadillac and treating your patients was limited. if at all

3. This situation was intentional at first to quickly and cheaply flood America with better-trained PHEMS workers. Is that still needed in some areas, or can everyone afford to pay and staff PHEMS at professional instead of quasi- and actual volunteer status?

its dependent on the demographics, a demographic area with a greater population density will have more patient contacts and most likely more reimbursements. Also richer areas, will most likely get more reimbursements vs. poorer areas. Can most places afford to pay their staff better I am sure they can, But prehospital reimbursements need to improve, Secondly since the training requirements are very little, the Market becomes flooded with basic providers that the employer can tell you this is what we pay. you don't like it we have 100 other applicants that will take it.

 

[CFal]

its dependent on the demographics, a demographic area with a greater population density will have more patient contacts and most likely more reimbursements. Also richer areas, will most likely get more reimbursements vs. poorer areas. Can most places afford to pay their staff better I am sure they can, But prehospital reimbursements need to improve, Secondly since the training requirements are very little, the Market becomes flooded with basic providers that the employer can tell you this is what we pay. you don't like it we have 100 other applicants that will take it.

Fire jobs pay well and there are 2000 applicants for 10 jobs.

 

[ExpatMedic0]

Firefighting is not a medical education, it has absolutely nothing to do with EMS other than justifying the fire departments existence through staffing and call volume. The fire service is vocational training that is done with a GED and some elbow grease, and that is fine. Brawn over Brains works just fine for that service.

Practicing medicine and firefighting have nothing to do with one another, so just erase that from anyone's mind right now. This is why Paramedics makes more than firefighters and nurses in all other developed countries, which happen to also require a minimum of a bachelors to practice as a medic. American EMT's and Paramedics should be receiving the proper education that the industry needs.

This is someone practicing with out any immediate supervision present, pseudo autonomously, as quasi-clinicians. They deliver a plethora of potentially deadly medications, and make countless independent judgment calls on a daily basis. Doing this while loosely following some guidelines, which can also often not be followed if there reasonable clinical evidence to support why. They are suppose to be an extension of a physician... I think the minimum standards are due for an increase from 1 year of vocational training to a minimum 4 years bachelor degree.

 

[wanderingmedic]

Firefighting is not a medical education, it has absolutely nothing to do with EMS other than justifying the fire departments existence through staffing and call volume. The fire service is vocational training that is done with a GED and some elbow grease, and that is fine. Brawn over Brains works just fine for that service.

Practicing medicine and firefighting have nothing to do with another, so just erase that from anyone mind right now. This why Paramedics makes more than firefighters and nurses in all other developed countries, which happen to also require a minimum of a bachelors to practice as a medic. American EMT's and Paramedics should be receiving the proper education that the industry needs.

This is someone practicing with out any immediate supervision present, pseudo autonomously, as quasi-clinicians. They deliver a plethora of potentially deadly medications, and make countless independent judgment calls on a daily basis. Doing this while loosely following some guidelines which can also often not be followed if there reasonable clinical evidence to support why. They are suppose to be an extension of a physician... I think the minimum standards are due for an increase from 1 year of vocational training to a minimum 4 years bachelor degree.

Well said. VERY well said. Thank you.

 

[Carlos Danger]

This is someone practicing with out any immediate supervision present, pseudo autonomously, as quasi-clinicians, delivering a plethora of potentially deadly medications, and making countless independent judgment calls on a daily basis. Doing this while loosely following some guidelines which can also often not be followed if there reasonable clinical evidence to support why. I think the minimum standards are due for an increase from 1 year of vocational training to a minimum 4 years bachelor degree.

I used to think the same thing. But the more I learn myself and the more we find out that many traditional ALS interventions tend to have little impact on outcomes, the more the evidence points to "transport" rather than "treatment", the more cost becomes an issue in healthcare, the harder time I have justifying drastic increases in educational requirements.

I think paramedics definitely need to learn more physiology and pharmacology than they are currently required to. I also think a basic course in clinical research would be helpful. But I think that could all fit easily into a 2-year degree program. Paramedicine will always (and should, IMO) be protocol driven and overseen; there is no way to create an autonomous practitioner in just a couple years (probably not even 4 years) of education.

 

[terrible one]

I'm just saying that I disagree with folks who say that "EMS is low-paid because of the IAFF", or "EMS is low paid because of volunteers", or my favorite, "EMS is low paid because it doesn't require licensure or a degree".

EMS is low-paid primarily because of 2 reasons:

- There just isn't much money to be made in medical transport, especially 911. If a private EMS agency isn't making much money, then they can't pay much.
- Because EMS requires little training, there is usually a large supply of applicants relative to the available positions, which tips the labor supply:demand in the favor of employers.

Reliance on volunteers can reduce the number of available paid positions but probably doesn't have much affect on wages. Even if wages are affected in an area where there are a lot of volunteers, there are many areas where volunteers don't exist and wages are still low, so the existence of volunteers is an insufficient explanation for the industry-wide low wages in EMS.

I disagree. Fire unions have a huge impact on EMS salaries.

1) if a city/county/municipality has a large fire union presence that fire departments budget will be large. If they do not transport that leaves the city/county with little money for EMS. Welcome private company! Then an RFP goes out and guess what? The lowest bidder wins. Which obviously equals, low pay, low benefits, etc. for the employees of said company.

2) what job has a larger supply to smaller demand than a fire department? 1000, 2000, 10000 applicants for a hand full of jobs. How much training does it take to get on with a large FD? A GED, a drivers license and a pulse. (Maybe an EMT card) Yet, they are compensated just fine. Why? Unions.

 

[Carlos Danger]

I disagree. Fire unions have a huge impact on EMS salaries.

1) if a city/county/municipality has a large fire union presence that fire departments budget will be large. If they do not transport that leaves the city/county with little money for EMS. Welcome private company! Then an RFP goes out and guess what? The lowest bidder wins. Which obviously equals, low pay, low benefits, etc. for the employees of said company.

2) what job has a larger supply to smaller demand than a fire department? 1000, 2000, 10000 applicants for a hand full of jobs. How much training does it take to get on with a large FD? A GED, a drivers license and a pulse. (Maybe an EMT card) Yet, they are compensated just fine. Why? Unions.

What you are failing to take into account is the fact that the majority of EMS services are in areas that are do not have a paid FD for miles.

I was referring to the industry as a whole, not every local situation.

 

[CFal]

In RI there are multiple Towns that use volly FFs and paid full time EMS, interestingly enough the EMS is represented by IAFF.

 

[terrible one]

What you are failing to take into account is the fact that the majority of EMS services are in areas that are do not have a paid FD for miles.

I was referring to the industry as a whole, not every local situation.

True. I can only speak for the several CA services I've worked in. I realize it is different in the rest of the country, but CA EMS serves over 35million people so you can bet they have a large presence and influence.

 

[Medic Tim]

where I live there are only a handful of ft fire departments (city) the rest are all volley. EMS for the entire province uses ft and pt medics. There is no oncall or volley. The old EMT level we had was in between the US EMT and AEMT. pay was about what it is now in most of the US.. A touch above minimum wage....jump ahead a few years. We became self regulated. The education requirements went from 250-500 hours to a 1 year ,m-f, 9-5 program. People were required to upgrade or they were phased out. within 3 years our salaries had more than doubled. When the government took over so there was only 1 ambulance service our scope, salary and education also increased again. The medics we have are medics because they want to be medics. It is not a stepping stone to something else or a hobby. Another added bonus to this was the professionalism also largely increased.......Our system does have its share of problems but the sit here and listen to people say that increasing education wont increase salary is ridicules to me. I have seen it with my own eyes (I know n=1)

/rant