Problems in EMS

[Niftymedic911]

"However because ambulance service can be billed, we finance both EMS and fire based operations. I hate being a tool for fire service who views us as the band aid squad but wouldn't have job without us."

Exactly. Fire based EMS oppression, they use to it fund the rest of their agency, because gee, hey 99.8% of all calls that go through the FD are maybe medical??? It's the red-headed ******* step child of the FD.

Municipal based third service agency that is paid for by taxes. Hell if FD can tax people for that then why not EMS???? If your town or government was serious about the well being and health of it's citizens, there should be a seperate professional 3rd service EMS agency for your service area. Or even better a seperate interfacility transfer divison, that takes the load off the 9-1-1 trucks but also secures the budget coming in.

 

[Ridryder911]

Ironically, this is the "hot topic" in my area, as I described my State Governor has made a proclamation .. "EMS is in Crisis". News stories are a common event.

The good of this problem is that we have started a coalition and started promoting ideas and brainstorming. I have to admit that IAFF has been helpful with insight and a surprising description that they are ashamed on how much EMS is usually paid.

Most of the public assume that their EMS services are Paramedic level. I believe that is one of my biggest pit peeves, is with that assumption they do not understand the need of funding. Then as described when the receive the bill, they assume that is the full charge and no additional funding would be needed for EMS.

What many citizens are not aware of is Fire Departments as well usually bills homeowners for fire services. Usually, they may not receive the bill themselves as it goes to the homeowners insurance claims, unlike medical bills. As well, it is hard to quantify how good we are, when a patient dies. In comparison, when a fire destroys a home we never question, "if better or different" fire attacks or tactics were different, would the outcome be different? Again, public perception is different.

My today's local newspaper had a photograph of two Firefighters with the Cat in the Hat reading to the children. Oh, what great heroes! Of course no EMS was there. No, they were responding to three times the number of calls than the FD, and alike most other EMT's are either too tired or working another EMS job to make ends meet.

The other problem is that EMT's are usually ignorant on legislation and the process of government. Compare EMT's to LEO, Firefighters and even other medical professionals to if they belong or participate in an association or group that promotes their profession. Almost every Firefighter I know of are members of some State Fire Association or IAFF. The LEO have the State Peace Officers Association or FOP. The medical associates i.e. Nurses have the ANA or ENA. The Physicians have the AMA or State Medical Associations. All of these are usually have strong activists along with lobbyist.

Now in comparison how many EMT's are members of anything associated with a professional association?

Like I said before, ask a Firefighter whom their representative is and they usually can tell you or have one of their rep's and they can call them on speed dial. Now ask the same question to an EMT and see what they will say?Yet, we do not understand why we do not get the same benefits and recognition ?

Our State EMS providers are having a meeting at our State Capitol Monday in regards this crisis. I will be meeting with members of the legislature and addressing committees in regards to the alarming numbers.

An idea that did develop was that all emergency services personnel that is providing care to the public representing EMS, Fire, Police should be considered as "public safety and service personnel. At first I was skeptical, but the benefits of insurance, protection of laws ( felony charges if assaulted, etc) would be beneficial to all. It would not matter what type of EMS they were. (paid, volunteer, third party, private, hospital based, etc).. just as long as they there representing an recognized agency.

Hopefully, this would also allow for more grants, etc. being recognized as a public safety agency.

I encourage all EMT's that really do care for EMS, start being active and participating in the "system" process. It is far much more than just taking care of the sick & injured.

R/r 911

 

[firecoins]

I did a paramedic rotation. The ICU nurse asked about the difference between an EMT-B and a Paramedic. Medical staff have no clue.

A high school friend of mine met up a couple of years ago. He just finished med school and was statring a Neurology residency. He had no idea there were EMT-Bs. He thought all EMTs were medics.

 

[JPINFV]

Well, to be fair, how often do non-emergency physicians actually interact with EMS? I wonder how many EMTs (B, P, other random letter combinations) know the difference between, say, cardiology and internal medicine.

 

[VentMedic]

I did a paramedic rotation. The ICU nurse asked about the difference between an EMT-B and a Paramedic. Medical staff have no clue.

So you know the difference between LVN, LPN, RN and the different job titles of ICU, OR, ED and Tele RNs? CNA and PCT?

Have you called someone with MLT (B.S. and M.S. degreed) a phlebotomist (150 hrs)? Yes, sometimes the MLT will come out of the lab to "phleb".

Have you referred to someone taking x-rays an "x-ray tech" instead of Radiology Technologist. One implies the OJT of yester year and the other is the degreed which is the standard today.

And, there are Radiation Therapists and Nuclear Medicine Technologist who are near the radiology department. These are very new professions but already have nationally established education and credentialing standards.

The same can go for Respiratory "Tech" and Respiratory Therapist. One implies a mimimally educated and possibly OJT from 20 - 30 years ago. Some may still be around but most states and hospitals have expected them to comply with the national standards of a 2 year degree minimum so the profession can progress professionally. The B.S. (4 yr degree) is also in the making for them as a standard in the near future.

EMS is almost 40 years old and has not established itself with education and credentialing standards. It can not longer use the "new" profession excuse. Those professions that are less then 20 years old mentioned above have moved on and are still moving forward.

An RN working with any of the above should but doesn't always know what the proper titles are either. Sometimes they are corrected and sometimes not. We know that not everyone got the memo on what someone is called in an ever changing world of medicine. There are other priorities at hand which involve patient care. Egos can be stroked at more appropriate times. We identify ourselves to the patients with our titles and a brief description of who we are and what we do. But, we don't drill them for a quiz later. There are just too many licensed HCWs to expect everyone to keep all the players, their proper titles, education requirements and job descriptions straight.

Of course, in our ED when we have paramedic students from the 6 month programs (medic mills) bragging about who they are and what they can do in just a few months of training, they can expect a few "surprised" looks from professionals who have a minimum of a Bachelors degree. It is truly amazing some skills can or should be done with only 6 months of training. A few skills do not always equal education or knowledge. Occasionally we are refreshed with a paramedic student from the college degree program. There is a big difference when they already have at least 1 year of college behind them. We actually have been trying to stop the medic mills from using our facility altogether. Quality and not quantity would be nicer. As it is now, they are not allowed to practice intubating in our ED or OR.

A high school friend of mine met up a couple of years ago. He just finished med school and was statring a Neurology residency. He had no idea there were EMT-Bs. He thought all EMTs were medics.

That is what TV presents and that is what some EMTs represent themselves as when talking to strangers. We had a lengthy discussion here about the term "medic" not too long ago. There is even confusion within EMS about the term "medic"
http://www.emtlife.com/showthread.php?t=2753&highlight=medic&page=15

 

[reaper]

Vent,

You must down around an FMTI school!!! Close them all down!

 

[triemal04]

Once again, it's same old, same old. Lot's of people b!tching about the problems (don't get me wrong, there are plenty) and bringing out their axes to grind. And once again, nobody proposes any real solutions to these problems (with about 1 exception) or is actually doing something to try and fix them (with about 1 exception).

I'm sorry people, but b!tching and whining is all that you are doing and it's completely unproductive. If you want to make changes then for f*ck's sake get off your a$$, go out and start trying! Sitting here and whining is pathetic and accomplishes nothing.

Start talking with those you work with, try and get everyone on the same page there. Go to the local colleges that teach new paramedics and meet with the instructors. Start calling your state rep, your mayor, city councilman, newspapers. Get in contact with the state department of health. Become actively involved in NAEMT, find out what you can do for them.

If you can recognize the problems that exist, good. But that's only the first step and it's the easiest. The hard one is doing something about it. Will it be easy? No. Will you have to make personal sacrifices? Yes. Will it be a long process that you may never get any personal rewards from? Yes. But if you actually care about this job enough to want it to improve none of that should matter.

 

[Niftymedic911]

Once again, it's same old, same old. Lot's of people b!tching about the problems (don't get me wrong, there are plenty) and bringing out their axes to grind. And once again, nobody proposes any real solutions to these problems (with about 1 exception) or is actually doing something to try and fix them (with about 1 exception).

I'm sorry people, but b!tching and whining is all that you are doing and it's completely unproductive. If you want to make changes then for f*ck's sake get off your a$$, go out and start trying! Sitting here and whining is pathetic and accomplishes nothing.

Start talking with those you work with, try and get everyone on the same page there. Go to the local colleges that teach new paramedics and meet with the instructors. Start calling your state rep, your mayor, city councilman, newspapers. Get in contact with the state department of health. Become actively involved in NAEMT, find out what you can do for them.

If you can recognize the problems that exist, good. But that's only the first step and it's the easiest. The hard one is doing something about it. Will it be easy? No. Will you have to make personal sacrifices? Yes. Will it be a long process that you may never get any personal rewards from? Yes. But if you actually care about this job enough to want it to improve none of that should matter.

Sir,

You obviously missed the post. The post called to identify problems with EMS. We're not b****ing on here, we're simply identifying the problems within our area for commonalities. So, do us all a favor before you fly off the handle, read the post.

 

[VentMedic]

Vent,

You must down around an FMTI school!!! Close them all down!

Yeah that one and a few others as well as FCI which hasn't changed "endotracheal incubation" on their website. For the past several months they have gotten emails and phone calls from myself and others but still they have not gotten their web person to correct the spelling.
http://www.floridacareerinstitute.edu/emergency_medical.htm

"Do all this in just a few short months!"

For those in Florida and elsewhere, "approved" does not always mean "accredited.

triemal04,
Have you ever noticed that at a state and/or national conference with several thousand EMTs and Paramedics attending, only 20 - 30 show up for the legislative updates? That is a great time to meet the local reps and lobbyists. Many perceive that part of the seminar as boring or a waste of time or it is just a bunch of suits talking crap. So, when these representatives see only 20 out of 5000 - 8000 show up, what are they supposed to think about the enthusiasm for the profession?

And, as some of the Representatives and Senators have stated in the past, "Come back when you can define who you are". They are correct. When you have 50 states with 48 different titles, certifications and levels of training, all presenting their data at the same time jockeying for position, who knows what we are. Many would like to funnel more money to EMS, but who, what and where does it go?

Other professions have a representative speaking with national unity, a national credentialing process with a national education standard and each is recognized by state licensing boards.

In EMS there is not a strong organization that speaks for EMTs and Paramedics as medical professionals regardless of where they work. The NAEMT is the closest to that and the Flight organiations that have their own agenda but do lobby for advanced scopes. No union will ever argue for scope of practice. Nursing realized that long ago and have nursing associations (not unions) to go to bat for them when it concerns their scope of practice.

Do you want to know how many show up for EMS regional meeting? Only those that are required from the state and a couple of administrators.

Too many are so concerned about "skills". "If they change my title to that I can't do this or that". There is even a lack of understanding about what education can do for those "skills". We have more internal battles amongst ourselves than external battles with politicians.

 

[triemal04]

Niftymedic- I've read every post here and stand by what I say. I don't care if you call it b!tching or just recognizing the problems; that part is long done. Everyone needs to get off their collective lazy a$$ and go do something about it. (wasn't referencing any particular post either)

Ventmedic- Thanks for helping to prove my point, I do appreciate that. (no sarcasm intended) That is exactly what I'm talking about; a golden opportunity to get something done, or at the minimum try and get the ball rolling, to expose the problems that exist to someone with more power than us and do people take advantage of that? Nope. But you can be sure that plenty will b!tch about it at that same convention.

I know we've gone round and round about unions before, and it's not a arguement I want to have again (not right now anyway B)) but we both agree that EMS needs an organization that is only about us and fights for us. Apparently a lot of other people here seem to want that. So why is nothing being done?

Because talk is cheap. Now it's time to start standing up for ourselves, or just say screw it, and let EMS die in the US.

 

[ffemt8978]

Play nice, people

 

[Niftymedic911]

Then why am I being attacked, but yet your attacking people saying all they do is whine whine whine whine and "nothing" gets done.

If your talking about unions.... mayeb you guys should stem and befriend your local IAFF union. We're fully represented by the Local 1826 IAFF. Just like Visa, "Unions, can't leave home without it."

 

[Airway Junkie]

I don't think there is much we can do about the general public. Its not something they think about until they need it.

Medical staff also have no idea. As a BLS provider we don't carry pulse oxs and glucometers but nurses and doctors ask me for that info all the time because they get it from ALS providers.

Wow, what region are you in that you dont carry that?

 

[JPINFV]

Wow, what region are you in that you dont carry that?

California, for one, doesn't allow pulse oximetry or glucometers use at the EMT-B level.

Meh, to be honest, there isn't much use either. EMT-B treatment is not going to necessarily change. If the patient has a LOC that is altered from baseline then they should be transporting to an emergency room and/or calling for paramedics. Not screwing around on scene trying to obtain a number that doesn't change their treatment.

On the other hand, if a system allows providers with 110 hours of training and a few hours of "CEs" to administer medications other than oxygen and oral glucose on their own accord, then I need to make plans to not pass through that area. Yes, if you (generic "you") don't understand why a person needs glucose besides the ambiguous "cell fuel" description thrown out in class, then you shouldn't get to play with the D50 or, god forbid, glucagon. I say "god forbid" because I highly doubt that providers who lack a basic understanding on cellular respiration understand things like gluconeogensis and glycogenolysis. These are things that aren't covered when A/P is limited to 2 hours.

 

[skyemt]

California, for one, doesn't allow pulse oximetry or glucometers use at the EMT-B level.

Meh, to be honest, there isn't much use either. EMT-B treatment is not going to necessarily change. If the patient has a LOC that is altered from baseline then they should be transporting to an emergency room and/or calling for paramedics. Not screwing around on scene trying to obtain a number that doesn't change their treatment.

On the other hand, if a system allows providers with 110 hours of training and a few hours of "CEs" to administer medications other than oxygen and oral glucose on their own accord, then I need to make plans to not pass through that area. Yes, if you (generic "you") don't understand why a person needs glucose besides the ambiguous "cell fuel" description thrown out in class, then you shouldn't get to play with the D50 or, god forbid, glucagon. I say "god forbid" because I highly doubt that providers who lack a basic understanding on cellular respiration understand things like gluconeogensis and glycogenolysis. These are things that aren't covered when A/P is limited to 2 hours.

after many disagreements, i am in complete agreement here...

airwayjunkie, i'd love to hear how having those two items will change your treatment as a basic...

 

[daedalus]

Save it guys, this is not a thread about why EMTs should not carry glucometers or oximeters. This is a thread about the problems in EMS. We have discussed the use of these tools many times before. Maybe if EMTs wish to be allowed to use these devices everywhere and have absolutely no controversy over it, we should lobby for better education. I can virtually swear to you all that if EMT was a year program and Paramedic was two years, the whackers, volunteer departments, and idiots will all but disappear. Im not saying any smack on vollies other than, usually, professionals do not offer their services for free, and if EMT took a year, and not a two week camp, many would reconsider getting into EMS. And consider the rise in professionalism...

I recently met a co-worker who went through a two week camp. When a nurse gave him report and told him the Pt was given some ought units of insulin, my coworker said to the nurse: "you mean how milligrams of insulin, right?"

Hmm.....

 

[skyemt]

Save it guys, this is not a thread about why EMTs should not carry glucometers or oximeters. This is a thread about the problems in EMS. We have discussed the use of these tools many times before. Maybe if EMTs wish to be allowed to use these devices everywhere and have absolutely no controversy over it, we should lobby for better education. I can virtually swear to you all that if EMT was a year program and Paramedic was two years, the whackers, volunteer departments, and idiots will all but disappear. Im not saying any smack on vollies other than, usually, professionals do not offer their services for free, and if EMT took a year, and not a two week camp, many would reconsider getting into EMS. And consider the rise in professionalism...

I recently met a co-worker who went through a two week camp. When a nurse gave him report and told him the Pt was given some ought units of insulin, my coworker said to the nurse: "you mean how milligrams of insulin, right?"

guess what... many vollies are paramedic level, and did not attend "two week camps"... and guess what... they are top notch and do work for free...

if your post is another soap box to "bash vollies", please, it's tired and it's all been said before about a billion times. let's not go there...

 

[daedalus]

This isnt a soap box. I am not bashing volunteer EMTs or Paramedics. If EMS wants to be seen as professional, than schooling needs to show it. The paramedic program I am starting in the fall is two years long and when finished I will have a degree in paramedic studies (AA) along with the paramedic certificate. The program will cost me seven thousand dollars and countless hours of studying and probably most of my friends. I have already taken the time to finish the semester long paramedic prep class along with a few college units in pre-recs. After all of this, I do not plan on offering my services for free. So to my knowledge, nowhere in the greater LA area has "volunteer" paramedics. I plan on becoming a PA later on in life, and beyond doctors without borders and clinics serving the uninsured, I have yet to see PAs or MDs running around running "vollie" hospitals.

I respect your views, Skyemt, and I respect volunteers. What I do not respect is the amount of education needed to enter EMS. And it is my personal views that after all the money and time I will spend in Medic school, I want a paycheck.

 

[daedalus]

ill need to pay off my car and student loans

 

[Zanerd]

I have heard some Medics/EMT's discuss volunteering.

Some think its great and others believe it drags the profession down. Why pay someone a decent wage (or wage at all?) when there are people out there doing it for free?

Im not saying volunteering is good/bad or doesnt serve a purpose, its simply a point I found interesting and thought others might too